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A court ruled Tuesday that a female Olympic track and field champion with elevated levels of the male sex hormone must medically change her natural physiology in order to participate in the highest levels of competition. The ruling by Switzerland’s supreme court means that Caster Semenya must “lower her testosterone level through medication or surgery” in order to defend her Olympic 800-meter title at the Tokyo Games next year, the Associated Press reported.

Semenya, of South Africa, has claimed that such a requirement is tantamount to discrimination.

“I am very disappointed by this ruling, but refuse to let World Athletics drug me or stop me from being who I am,” Semenya said after the ruling Tuesday. “Excluding female athletes or endangering our health solely because of our natural abilities puts World Athletics on the wrong side of history.”

The two-time Olympic champion was at the center of a 2018 ruling by the International Association of Athletics Federations (IAAF) that mandated female runners with naturally occurring high testosterone levels and specific “differences of sex development” must lower their testosterone in order to compete in events ranging from 400 meters to one mile.

She challenged that rule but it was ultimately upheld by the Court of Arbitration for Sport last year. Tuesday’s ruling was the result of Semenya’s appeal against the Court of Arbitration for Sport.

The controversy surrounding Semenya began more than a decade ago when international track officials in 2009 said Semenya needed to undergo sex-determination testing to confirm her further eligibility. The tests, ordered by The International Association of Athletics Federations after Semenya’s 800-meter victory in the World Championships that same year, reportedly determined she’s a hermaphrodite – having both male and female organs. However, she was allowed to keep her 800-meter gold medal and the results of her gender tests were never officially released.

The following year, Semenya’s lawyers told South African television that gender test results showed she can compete as a woman.

Years later, the IAAF renewed its scrutiny of Semenya, finally bringing us to this point.

There are apparently three ways for Semenya to lower her testosterone: taking birth control pills, having testosterone-blocking injections, or undergoing surgery. She previously took birth control pills for about five years but later said she suffered side effects that affected her athletic ability.

While it was unclear what Semenya will choose to do following the court ruling, the AP noted that “she had already switched her training this year to 200 meters, hinting that she was prepared to lose in court.”

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