By Rachel Savage
LONDON - Caster Semenya, the South African double Olympic 800 metres champion, lost her appeal against World Athletics rules that women with high natural testosterone levels must take drugs to reduce them to compete in middle-distance races.
Switzerland's top court on Tuesday upheld a 2019 ruling by sport's highest court, the Court of Arbitration, that the global governing body's rules were necessary for fair female competition.
Why did Semenya go to court?
Semenya both wowed and raised eyebrows when she became 800 metres world champion at the age of 18 in 2009, having recorded dramatic improvements in her personal bests.
The South African athlete has a medical condition known as hyperandrogenism, which is characterised by higher than usual levels of testosterone, a hormone that increases muscle mass and strength and the body's ability to use oxygen.
Athletics' governing body has repeatedly changed its rules over her eligibility to run, in a case that has tested how sports authorities treat athletes whose bodies fall outside standard ranges.
Semenya now refuses to answer questions about her sex.
What are World Athletics’ rules?
World Athletics introduced rules in 2018 for middle distance athletes with differences in sex development (DSDs) who are legally female and have testes, XY chromosomes - typically found in men - and male levels of testosterone.
DSD athletes were told to lower their testosterone levels to those of "a healthy woman with ovaries" by taking the contraceptive pill, having a monthly injection or undergoing surgery to remove their testes.
World Athletics denied that it was targeting Semenya, who immediately challenged the rules at the Court of Arbitration.
When she lost her case in 2019, she accused the governing body of discrimination and using her as a "human guinea pig", stating that contraceptive pills made her feel "constantly sick" and that their long-term side effects were unknown.
What happened when Semenya took the contraceptive pill?
Semenya took medication after the first ruling in 2011 by World Athletics - then the International Association of Athletics Federations (IAAF) - that all female athletes with hyperandrogenism had to lower their testosterone levels.
Her performances slowed, although her 2012 Olympic silver medal was upgraded to a gold after Russian athlete Mariya Savinova was stripped of the win for doping.
The restrictions were lifted in 2015 after a legal challenge by Indian 100 metre sprinter Dutee Chand.
Semenya returned to domination in the 800 metre category, winning at the 2016 Olympics and 2017 World Championships.
How has the battle affected Semenya’s life?
When Semenya blasted to the world title as a teenager in 2009, she was almost immediately embroiled in questions about her sex, and the IAAF made her take a sex verification test.
More than a decade on, the battle still dominates her life.
She accused the IAAF of taking it upon itself to decide who was "woman enough" after it sought to have her declared a "biological male" before the Court of Arbitration, which rejected her appeal against the testosterone rules in 2019.
South Africa's ruling party, the African National Congress, has called the rules "blatantly racist".
The IAAF - now World Athletics - has said that "biology has to trump gender identity to ensure fairness" in sport.
"World Athletics has always maintained that its regulations are lawful and legitimate," it said in a statement on Tuesday after the Swiss court backed its rules.
"They represent a fair, necessary and proportionate means of ensuring the rights of all female athletes to participate on fair and equal terms."
What next for Semenya?
Semenya, now 29, said she was disappointed by Tuesday's ruling, but that she would continue to refuse to take testosterone-suppressing drugs.
"Excluding female athletes or endangering our health solely because of our natural abilities puts World Athletics on the wrong side of history," she said in a statement.
"I will continue to fight for the human rights of female athletes, both on the track and off the track, until we can all run free the way we were born."
Her lawyer Greg Nott said she may challenge the judgment in Swiss and European courts.
In March, Semenya said she was confident of qualifying for the 2020 Olympics in the 200 metres, where she can avoid the DSD regulations. The Tokyo games were subsequently postponed due to the new coronavirus pandemic.
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