Evidence gaps in the world anti-doping agency's prohibited list: A critical analysis of scientific and policy limitations

Background: The World Anti-Doping Agency (WADA) prohibits substances and methods based on three criteria: performance enhancement, health risks, and violations of the "spirit of sport." However, peer-reviewed critiques highlight inconsistencies in the empirical validation of these criteria. Objective: To evaluate gaps in the scientific evidence and policy implementation of WADA’s Prohibited List using official WADA data and peer-reviewed literature. Methods: A systematic review of WADA technical documents (2015–2023), Anti-Doping Testing Figures, and peer-reviewed studies (PubMed/Scopus) identified methodological, empirical, and ethical gaps. Results: Key gaps include insufficient evidence for performance enhancement (only 19% of prohibited substances supported by athlete RCTs), regional disparities in testing (Africa: 0.2 tests/athlete vs. Europe: 2.1 tests/athlete), and ambiguities in transgender athlete policies. Conclusion: WADA’s framework requires urgent reforms, including evidence-based substance evaluations, equitable testing resource allocation and transparent policy development.