Olympic runner Caster Semenya will be allowed to compete, after rules that banned her from races due to high testosterone were suspended

Caster Semenya hasn’t lost an 800-meter running race since 2015. The three-time South African world champion has won two Olympic gold medals.

But until today, Semenya was unsure whether she’d ever be able to compete at the international level again.

Semenya’s body naturally produces testosterone at levels higher than the average woman’s body, and the International Association of Athletics Federations (IAAF) decided she had to take medication to reduce her testosterone in order to continue running internationally.

Semenya refused to meet the new demands, meaning she wouldn’t be allowed to compete in IAAF-approved events, which are the only qualifiers for the Olympic track and field competitions.

Semenya and her lawyers appealed the decision, but the Court of Arbitration for Sport (CAS) sided with the IAAF. However, Semenya also appealed to the Swiss Federal Supreme Court, which has now ordered the IAAF to suspend their new regulations while the appeal is pending in their system. This means Semenya will – for now – be able to compete without lowering her testosterone levels.

Read More: The highest court in athletics told her she was no longer allowed to compete because her body produced too much testosterone. Caster Semenya responded: ‘No man, or any other human, can stop me from running.’

The IAAF’s new rules were based on the idea that top female athletes are more likely to have higher-than-average testosterone levels. Angelica Lindén Hirschberg, who chairs the group of medical experts advising the IAAF on this issue, gave a talk at the annual meeting of the European Society of Endocrinology last month in support of sporting organizations’ efforts to account for these hormone differences.

“Elite female athletes want to compete fairly against other women, not those who have a more male physiology,” Hirschberg said in a press release.”In the interests of fairness in sport for all, a policy that responds with sensitivity to those who may have a condition causing high testosterone is needed.”

But Katrina Karkazis, a bioethicist at Yale University, told Business Insider that this position is cause for concern, since the IAAF’s rules raise big questions about gender identities.

“It relies on folksy ideas about who’s really a woman and what traits make you a woman,” Karkazis said.

‘Differences of sexual development’

Semenya is considered to have “differences of sexual development” (DSD), a blanket term for conditions in which a person’s reproductive organs or genitals don’t develop as expected.

Sometimes, individuals with DSD are called intersex, meaning they were born with “a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male,” according to the Intersex Society of North America. Females with DSD can sometimes have one X and one Y chromosome, or under-developed ovaries or clitorises.

In some cases, DSD can lead to higher levels of testosterone. This is the case for Semenya.

Semenya competes at the international level for South Africa.

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Semenya competes at the international level for South Africa.
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Alexander Hassenstein/Getty

The IAAF rules that were just suspended dictated that certain DSD women competing in races between 400 meters and one mile in distance must not exceed a designated threshold for testosterone: 5 nanomoles per liter of blood. That’s half the previous limit.

“If we cannot maintain separate male and female categories, then women will no longer have a path to success in elite athletics, and the IAAF is committed to the principle of equal opportunity for female athletes,” Nicole Jeffery, head of communications for the IAAF, said in a statement to Business Insider. “We have put the limit on testosterone rather than any other characteristic because this is the defining characteristic of the two categories … It is about the larger principle of maintaining the separation between the male and female categories, which allows women to shine in athletics.”

If female athletes’ testosterone levels were found to be above the IAAF’s new limit, the rules dictated that they use injections or oral contraceptives to artificially lower their testosterone for six months before rejoining international competition.

The Guardian reported that the two CAS arbitrators who voted in favor of this policy indicated that, because a higher testosterone level “confers significant advantages in size, strength, and power,” the regulation was “necessary, reasonable and proportionate” to ensure fair competition.

“The female category in sport is a protected category. For it to serve its purposes, which include providing females opportunities equal to males, it must have eligibility standards,” Hirschberg and four other experts said in a statement.

What Hirschberg’s research says

According to Hirschberg and her colleagues, testosterone levels in healthy men are between 7.7 to 29.4 nanomoles per liter of blood, and 0 to 1.7 nanomoles per liter for women.

Previous studies in men indicated a relationship between their testosterone levels and enhanced performance, but that relationship had thus far remained tenuous among women. However, Hirschberg’s recent research showed that “women with very high testosterone levels develop muscle mass and physical endurance more similar to that of men.”

Based on that data, the scientists recommended the testosterone maximum that the IAAF used in its new rule.

“We have focused specifically on defining the levels that really confer additional advantages on strength and speed in women, and setting an appropriate limit for competitive fairness,” Hirschberg said in a press release. That limit, she added, “takes into account whether the levels are high enough to push women’s physiology to be more similar to men’s.”

Athletes with

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Athletes with “differences of sexual development” can’t compete in hurdles between 400m and a mile without lowering their testosterone levels.
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Lintao Zhang/Getty Images

But the abstract from Hirschberg’s talk at the conference raised some red flags for Karkazis.

“The fact that [the IAAF] have turned to their in-house scientist to provide the evidence for their regulations really struck me,” she said. “Normally what you’d do is have science note something that could be a problem and consider regulating it. But here evidence is coming in with the idea to support a regulation. The cart’s coming before the horse.”

Is the IAAF regulating what it means to be a woman?

Karkazis also pointed to an IAAF question-and-answer sheet in which the organization refers to the oral contraceptives that lower testosterone levels as “a gender-affirming standard of care.” Gender-affirming care typically refers to surgeries or treatments that help individuals change their bodies to conform to their gender identities.

Vikki Krane, a professor of human development at Bowling Green State University, told Business Insider that she thinks this language suggests “the IAAF are claiming this is a medical issue that DSD women want to address.”

But many female athletes with DSD, Semenya included, don’t want to undergo hormonal therapy.

“These athletes have been socially and legally recognized as women their whole lives,” Karkazis said. “So in what sense are these interventions ‘gender-affirming?'”

Instead, Karkazis and Krane said, the ruling raises questions about whether DSD women with XY chromosomes are really women.

“It all comes down to the IAAF policing who gets to call themselves a female, all under the guise of fairness in sport,” Krane said. “The ruling opens the door to greater policing of female bodies.”

After the Swiss court put the new IAAF rules on hold, Semenya said she is “thankful to the Swiss judges for this decision,” CNN reported.

“I hope that following my appeal I will once again be able to run free,” Semenya added.