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The Caster Semenya debacle is not over. This week, the Court of Arbitration for Sport (CAS), ruled in favour of the world governing body, World Athletics (WA), formerly the International Association of Athletics Federations (IAAF). She is again required to take medication to limit the amount of testosterone (T-levels) that her body naturally produces. This applies to when competing in events in distances starting at 800-metres in length.

She may, however, compete in sprints at 400m and below. This means that at the Tokyo 2020 Olympic Games (2021) she will not be able to defend her 2016 Rio Olympic 800m championship. She also won in London in 2012.

The limiting of testosterone in women

The idea is to limit the T-levels to less than 5 nmol/L, more than double the normal female range of below 2 nmol/L. Most females have testosterone levels ranging from 1.12 to 1.79 nmol/L while the normal adult male range is 7.7 — 29.4 nmol/L – she is caught in no man’s land.

WA had attempted to put forward regulations in 2011, but that rule was cancelled when the Swiss-based CAS decided in 2015 that there was a lack of evidence linking high testosterone to real competitive advantages in women. Anecdotally, we know the performance benefit exists, that’s why women who test high in testosterone levels, who do not live with the condition hyperandrogenism, are sanctioned for cheating.

In 2017, the WA (IAAF) came back with research and published it in the British Journal of Sports Medicine (BJSM). The research apparently found that elite women runners with the highest testosterone levels performed as much as three per cent better than those with the lowest levels in several events.

Again WA was thwarted, this time by Roger Pielke Jr., director of the Center for Sports Governance at CU Boulder as well as Ross Tucker a physiologist with the University of Cape Town and Erik Boye, professor emeritus of molecular biology at the University of Oslo.

“We found problematic data throughout the study and consequently, the conclusions can’t be seen as reliable,” Pielke said.

South Africa will fight for Semenya

The South African Minister of Sport, Arts and Culture, Nathi Mthethwa, announced this week that he will fight the injustice of the ruling.

“Both the South African government and the global sporting community always held a firm view that these regulations are a gross violation of fundamental human rights of hyper-female athletes,” he said, as reported by Political Analysis South Africa. Interestingly, the term “hyper-female” was coined by conservative radio host Rush Limbaugh. Perhaps he could have chosen a more apropos term to describe Semenya.

Although it would be ridiculous so suggest that Semenya is at fault for her condition, and it is not something that she should be shamed for, hyperandrogenism likely gave her an overwhelmingly unfair advantage over the athletes that she competes against. Currently, there is not enough research on the subject to prove how much she benefits, but she demonstrated that there is a benefit herself.

While Semenya’s sex verification test results that the IAAF ordered up in 2009 were not
officially released, some information was leaked. Semenya has internal testes, no ovaries or womb, and endogenously produces at least three times the testosterone in comparison to the average woman, 99 times out of 100.

Competitors shared frustration with her so-called advantage. Elisa Cusma Piccione of Italy said, “For me, she is not a woman… it is useless to compete with this, and it is not fair.” Britain’s Lynsey Sharp said after being easily defeated in Rio, of racing Semenya that “it is out of our control and how much we rely on people at the top sorting it out.”

She also suggested in an interview with Athletics Illustrated that her feelings about Semenya’s unchecked testosterone levels were echoed by other 800m runners that finished off the podium.

A case of sore losers? Perhaps, perhaps not. Canada’s all-time fastest 800m runner Melissa Bishop has wisely kept quiet but did take the high road and to say that she simply did not run fast enough to win. Regardless, South Africa sees a human rights issue. From a legal perspective, perhaps they are correct. From a fair play and medical perspective, who knows!

Semenya’s performances proved increased testosterone provides a benefit

After the initial CAS ruling, Semenya stormed back in 2009. In just one year, she dropped her bests from 2:04.23 to 1:55.45 as a teenager. this is an unheard-of performance improvement, which prompted the IAAF to put her through a sex verification test.

It revealed Semenya’s unfair advantage. She was subsequently ordered to take testosterone-limiting medication.

During the time that she was receiving the testosterone-controlling protocol, her performances plummeted. From 2009 to 2016 she ran annual seasonal bests at well under 2:00. Except during 2014, when she could manage just 2:02.66; a big drop in performance.

Once again, it was proven that high T-levels significantly influence performance, but it varies per person and during various conditions. In fact, apparently, after winning and experiencing the joys of victory, testosterone levels are higher, than when that same person loses. So much, for post-race doping test accuracy.

There is no easy answer

From May of 2019, WA published the following:

Empowering girls and women through athletics is a core value of the IAAF and the sport and sits at the heart of what all of us in athletics believe the sport can offer to participants and to the world. Because of the effect of testosterone on the body from puberty onwards, men are bigger, stronger and faster on average than women. That is why the female classification is ‘protected’, and why individuals who identify as female but have a certain difference of sex development (DSD) (which means that they have the same advantages over women as men do over women) can pose a challenge to that protected category. This is why we introduced the eligibility regulation and why it must be defended: to ensure fair competition for all women.

The CAS has upheld that principle saying:  ‘The Panel found that the DSD Regulations are discriminatory but that, on the basis of the evidence submitted by the parties, such discrimination is a necessary, reasonable and proportionate means of achieving the legitimate objective of ensuring fair competition in female athletics in certain events and protecting the “protected class” of female athletes in those events’.  CAS released a six-page Executive Summary of the decision, which we recommend you read in full:” 


Are there any other options available to World Athletics?

If we stretch our imaginations, there are two potential options for WA and CAS, and for that matter the World Anti-Doping Agency: allow women to take testosterone-boosting drugs, perhaps under a Therapeutic Use Exemption (TUE), or create a third category called something more marketable than, but meaning Hyperandrogenic.

The former would represent the thin edge of the wedge, potentially opening the floodgates for wide usage among female athletes and perhaps would become impossible to control. not to mention the sheer legal goliath of past suspensions. The latter would create a category too small for the sporting world to take seriously and perhaps it would be construed as a circus sideshow act.

There is no winner in this debate and there is no simple answer. The sport can mollify those who see a human rights issue, like the South African government, or pander to those who see protecting the women’s category like World Athletics or the athletes themselves as important. Either way, the debate will rage on. At age 29, Semenya probably has two and perhaps three Olympic cycles remaining in her athletics career. This issue is not going away anytime soon.