By David Epstein
November 19, 2009

So this week's much anticipated news about South African women's world 800-meter champ Caster Semenya turns out to be that there is no news on the most controversial issue: whether Semenya will be allowed to continue competing as a female.

An agreement between the IAAF, the governing body for track and field, South Africa's government, and Semenya's lawyers will allow Semenya to keep the gold medal and the prize money she won at the world championships in Berlin in August. But the real question is what happens from here?

Given Semenya's prodigious rise to the top of the world -- she was a virtual unknown on the world scene until she dropped more than seven seconds from her 800-meter time between 2008 and '09 -- it seems likely that, if Semenya is allowed to continue competing without restriction, South Africa could soon have a world-record holder.

The IAAF has also now said that the tests conducted on Semenya to determine her sex will remain confidential. However, it will be obvious if Semenya disappears from competition that the tests gave the IAAF basis to classify Semenya as a male for the purposes of competition.

A September article in Australia's Daily Telegraph reported that tests on Semenya found that, while she has external female genitalia, she has no womb or ovaries and has internal male testes, and three times the testosterone of a "normal" female. So what does that mean?

First off, if that report is accurate, then Semenya is an intersex individual, meaning that she does not fall entirely into either of the typical classifications schemes for a male or female. Consider the example of Maria Martinez Patino, the 1986 Spanish national champ in the 60-meter hurdles. She was stripped of her title when a genetic test from a cheek swab showed that she had the XY chromosomes of a man. It was news to Martinez Patino, who appeared female and lived as a female. As it turned out, Martinez Patino had internal testes and her body was producing male doses of testosterone. But she had complete "androgen insensitivity," meaning that her body could not use the testosterone. Hence, she did not have an unfair advantage over other women, and was reinstated long after her career had been derailed. Unlike Martinez Patino, though, Semenya possesses some external physical characteristics that are typically seen in men.

One physiologist speculated to SI that Semenya, (if the report that she has three times a "normal" woman's testosterone is accurate) could have a body that is largely able to use the hormone -- giving her the carved appearance that ignited the ire of her rivals -- except that, for some reason, the internal testes she reportedly has never responded to testosterone and did not develop into a man's external genitalia.

So just for argument's sake, let's say that speculation is in fact true, that Semenya has, and is able to use, three times the testosterone of a "normal" woman. The definition for normal, in terms of testosterone output, is not cut and dry. Hormone levels vary widely between individuals, and even throughout a day. If one were to test the testosterone levels of female shot putters, for example, it is likely that they would be higher than those of random women.

However, the IAAF does have a hormone policy when it comes to dealing with men who change sex to become women. In that case, the IAAF policy says that the subject of the sex change must wait to compete until two years after the male genitalia are removed and hormone therapy is commenced, with "the crux of the matter ... that the athlete should not be enjoying the benefits of natural testosterone predominance normally seen in a male." So, even though hormone levels fluctuate, they are obviously important to the IAAF, and will likely factor into the ultimate decision.

The Science of Sport blog did a great post in September showing the common range of testosterone values for men and women. The ranges shown are wide, but notice that the ranges for men and women are not even close to overlapping, indicating that the genders are, in fact, distinct in testosterone terms. That Semenya (again, always assuming that the Daily Telegraph report is accurate) has three times the normal testosterone for a woman means that if "normal" is the lower limit, then three times that is still in the range for females. If "normal" is the upper limit, then three times that would place Semenya well below the male range, but in the zone that is considered to indicate a medical problem that requires treatment.

If Semenya does indeed have internal testes that are producing excess testosterone, then doctors might recommend that they be removed for health reasons, as women with testes run a risk of testicular cancer. But what if Semenya declines to have such surgery? Several doctors who, in the 1990s, advised the IAAF to cease regular sex testing say that they consider it unjust to hold a medical problem against a competitor.

One of those doctors, Joe Leigh Simpson, an associate dean at Florida International's medical school, and professor of obstetrics, gynecology and molecular genetics, likened it to calling unfair a pituitary tumor that causes someone to grow to be 7-foot-5 and play in the NBA. At the same time, it would be hard to argue that other 800-meter runners should not be upset, and presumably IAAF would not particularly want to allow an athlete with a known and dangerous medical problem to let it go untreated because of the performance boost it provides.

This is all to say that many possible scenarios exist, even if the Daily Telegraph report is true and Semenya is, indeed, intersex. The IAAF has no published guidelines for dealing with naturally intersex competitors and, barring more leaks, the next important information the track world is likely to get will be whether Semenya shows up on a starting line next season.

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