Who decides what it means to be a woman in competitive sports?

South African athlete Mokgadi Caster Semenya , at the center of controversy and a legal dispute since 2018, when she was banned from competing for refusing hormone treatments imposed by World Athletics on athletes with high natural testosterone levels, has obtained a partially favorable ruling from the European Court of Human Rights . The ECHR recognized that the athlete did not receive a fair trial in Switzerland, ordering the country to pay her €80,000. However, the European Court also declared inadmissible the part of her appeal alleging discrimination and violation of privacy.

World Athletics rules prevented her from competing without first lowering her testosterone levels . Semenya challenged these rules in 2019, losing first to the International Court of Arbitration for Sport (CAS) in Lausanne and then to the Swiss Supreme Court. In both cases, the Swiss courts found the rules necessary to ensure competitiveness in the professional women's arena.

This is not an isolated case: in the world of sports, the idea of fair competition increasingly clashes with the complexity of human nature. Hyperandrogenism —the condition that affects Semenya and other athletes like Dutee Chand—is characterized by elevated levels of androgen hormones , particularly testosterone, in women who were assigned this at birth. The presence of athletes with these characteristics has sparked intense international debate in recent years: is it simply a biological advantage, like so many others in sports, or a significant alteration requiring regulation?

The issue is far from theoretical: it involves real athletes, with personal stories often marked by discrimination, legal battles, and imposed medical decisions.

What is hyperandrogenism?

Hyperandrogenism is a medical condition that falls under the category of Disorders of Sexual Differentiation (DSD): "Athletes who have DSDs (including hyperandrogenism, for example) present congenital physical problems linked in most cases to excessive testosterone levels . During puberty, hormone levels change physically, but also physically, meaning that male organs develop within the female body," Stella Riberti, an expert in sports law, explained to Luce . Although women also naturally produce a small amount of androgen hormones, in cases of hyperandrogenism, the levels are significantly higher than average. This condition can have various causes : it can be linked to pathologies such as polycystic ovary syndrome (PCOS), but it can also be congenital and non-pathological—that is, part of the natural hormonal profile of a perfectly healthy person. It is precisely this last case that is at the center of the sports debate: some athletes, like Caster Semenya, possess naturally high testosterone levels, without ever having used banned substances. The key issue is that testosterone has direct effects on physical performance : it can increase muscle mass, strength, bone density, and recovery ability, characteristics that potentially offer a competitive advantage in athletic disciplines. However, there is no unanimous consensus on the extent to which these hormone levels alone impact athletic success, as many other factors (training, genetics, technique, strategy) contribute to an athlete's performance.

The rules of the federations

In an effort to ensure fairness in women's competitions, several international sports federations have introduced specific rules for athletes with hyperandrogenism. Among these, the most controversial is that of World Athletics , the international athletics federation, which has imposed limits on the testosterone levels allowed for participation in women's events. According to the regulation introduced in 2018, athletes with DSD who exceed a set testosterone threshold (5 nanomoles per liter, later lowered to 2.5) cannot compete in certain disciplines—particularly between 400 and 1500 meters—unless they undergo medical treatments to artificially lower their levels. These treatments can include hormonal drugs or surgery, raising significant ethical and medical questions. "The invasive approach has been the subject of controversy, given the risks and psychological and physical consequences resulting from such an imposition," explains Riberti. Criticism also concerns the possibility that these rules are discriminatory and violate human rights, particularly the right to physical integrity and freedom of self-determination. Federations, however, defend these limits as necessary tools to maintain competitive equality among athletes, distinguishing between acceptable natural advantages and those deemed excessive. The debate remains open, also because not all federations apply the same rules. The International Olympic Committee (IOC), for example, adopted a new, more inclusive framework in 2021, "underscoring the impossibility of issuing a single regulation defining eligibility criteria applicable to every sport and, therefore, limiting itself to indicating the guiding principles for each Federation based on a balance of opposing interests: inclusion on the one hand, and the protection of athletes' health and competitive equity on the other," the lawyer states.

The Sports Dilemma: Natural Advantage or Inequality?

At the heart of the debate over hyperandrogenism in women's sports is a difficult and controversial question: when does a natural advantage cease to be acceptable and become a form of competitive injustice? In the world of sports, natural advantages are everywhere. There are athletes with extraordinary height, exceptional lung capacity, a genetic predisposition for speed or endurance. No one questions the legitimacy of their participation. But when that advantage has to do with hormone levels—specifically testosterone—the situation is different, because it enters a territory that touches on gender identity , biology, and sporting regulations.

As mentioned, testosterone is a hormone that can affect physical performance, and sports federations argue that high levels offer such an advantage that they compromise equality among female athletes. But establishing a "fair" threshold is extremely complex, because athletic performance depends on a multitude of factors—genetic, environmental, psychological, and technical—that cannot be reduced to a single biological value.

On the other hand, some see the restrictions imposed on hyperandrogynous athletes as a form of discrimination , penalizing women with abnormal, yet no less legitimate, natural characteristics. Forcing them to undergo hormone treatments to compete, many argue, denies them the right to compete in their own category, calling into question their identity and physical integrity.

Ethics, rights, and science: a difficult balance

The solution seems to be balancing the ethics of competition with respect for individual rights, without ignoring scientific data: a difficult balance that divides not only public opinion but also athletes, doctors, lawyers, and sports managers. From a scientific standpoint, testosterone is recognized as a factor that can influence physical performance. But the data is not always clear or unanimous : several studies have shown that the impact of testosterone varies greatly from person to person, and that it is not possible to establish a precise threshold beyond which an athlete has an "unfair" advantage. Science, in short, does not offer absolute certainties , and is often used to justify decisions that respond more to regulatory or political logic than to unequivocal evidence.

Ethically, the restrictions imposed on hyperandrogynous athletes raise profound questions. Is it right to ask a healthy person to modify their body in order to compete? Is it legitimate to ask them to undergo invasive hormone treatments to fit within artificial parameters? And above all: who decides what is "natural" and what is not in a competitive context? From a human rights perspective, many of these rules have been criticized for being discriminatory and violating the right to privacy, physical integrity, and self-determination. As in many other areas , bodies that "do not fit the norm," especially when it comes to characteristics that challenge the sexual and gender binary, are seen as a problem to be solved .

Amid these tensions, the world of sport today finds itself at a crossroads: either continue to rely on rigid, biological categories, or rethink participation criteria in a more inclusive way , taking into account individual diversity without sacrificing the fairness of competition. There is no simple solution. But it is increasingly clear that any decision regarding hyperandrogenism cannot ignore a serious discussion of science, rights, and the fundamental values of sporting and social coexistence.