Caster Semenya Hopes to ‘Run Free’ Again After Swiss Supreme Court Offers A Reprieve

Caster Semenya has won a temporary block against regulations that would require her to lower her testosterone levels artificially before being allowed to compete in some races.

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Updated at 2:30 p.m. ET

Switzerland’s Federal Supreme Court has temporarily blocked a rule that kept track star Caster Semenya from competing, saying she should be allowed to race while her appeal proceeds. Track and field’s international governing body has said Semenya can’t compete in her signature event unless she lowers her testosterone level.

The Swiss court ruled Monday that Semenya, an Olympic and world champion in the 800 meters, should be allowed to “compete without restriction in the female category” during her appeal.

The International Association of Athletics Federations recently changed its rules, with the result requiring that Semenya, 28, lower her testosterone level artificially before she can compete against other women in the 800 meters and other track events.

“I am thankful to the Swiss judges for this decision,” South Africa’s Semenya said in a statement about the ruling. “I hope that following my appeal I will once again be able to run free.”

Semenya’s attorney in the Swiss case, Dorothee Schramm of the Sidley Austin law firm, said the court had given Semenya “temporary protection.”

“This is an important case that will have fundamental implications for the human rights of female athletes,” Schramm said.

In the next step in the legal dispute, the Swiss Federal Supreme Court will give the IAAF a chance to submit its arguments for maintaining its regulation that effectively bans Semenya — who has refused to manipulate her testosterone level. The court will then issue what could be its final ruling on the IAAF’s prohibition that blocks female athletes with high testosterone levels, even in cases where those elevations occur naturally. The IAAF has warned those female athletes that they need to drop their testosterone levels to be eligible to compete.

“The IAAF suggests this reduction be done by taking hormonal contraceptives, and it emphasizes that surgical changes are not required,” as NPR’s Laurel Wamsley has reported.

Semenya’s case has raised complicated questions, including the nature of holding separate competitions for men and women, how much of athletes’ abilities might be due to hormones and how to reconcile a blanket fairness policy with athletes who have what are called differences of sex development, or DSDs — a term that also applies to people who are known as intersex.

As NPR’s Melissa Block has reported:

“Caster Semenya was raised as a female and is legally female. She’s fighting rules that affect DSD athletes who have what are typically male XY chromosomes, who were born with internal testes and who have testosterone levels higher than the typical female range.”

Last month, Semenya lost a separate case before the Court of Arbitration for Sport, which ruled that while the regulations regarding DSD athletes are discriminatory, they’re also “necessary, reasonable and proportionate” as a way to ensure fair competition through regulating hormone levels.

Semenya contends that the IAAF’s regulations unfairly discriminate against athletes on the basis of sex or gender, because they apply only to female athletes — and only to a subset of female athletes who have certain traits.

The IAAF’s regulations require female athletes in restricted events — from the 400 meters to the mile — to keep their testosterone below a certain level for at least six months before a competition and to maintain it below that threshold as long as they want to be eligible to race.

The testosterone limit kicks in at 5 nmol/L (nanomoles per liter).

“Most females (including elite female athletes) have low levels of testosterone circulating naturally in their bodies (0.12 to 1.79 nmol/L in blood),” the IAAF said when it announced the new rule, “while after puberty the normal male range is much higher (7.7 – 29.4 nmol/L).”

When Semenya lost her appeal last month, the IAAF said she and other female athletes who have testosterone levels above 5 nmol/L had one week to bring them down, urging the women to begin their “suppressive treatment as soon as possible.”

But instead of starting that treatment to preserve her eligibility, Semenya took her fight to another court.

“I am a woman and I am a world-class athlete,” she said last week. “The IAAF will not drug me or stop me from being who I am.”

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Saturday Sports: NBA Finals, French Open

The NBA Finals have had a surprising start, there are calls for safety nets at MLB games, and the French Open continues.



SCOTT SIMON, HOST:

And now it’s time for sports.

(SOUNDBITE OF MUSIC)

SIMON: Abhor the dinosaur – a surprise start to the NBA Finals, a sad reminder of dangers along the foul lines, French Open hedging with round 16. NPR’s Tom Goldman joins us. Good morning, Tom.

TOM GOLDMAN, BYLINE: Good morning, Scott.

SIMON: Bruce Allen (ph), a listener, writes us this morning. He suggests, revile the reptile. The – I’ve got disobey the dromaeosauridae. I can go all day.

GOLDMAN: (Laughter) Oh, my God.

SIMON: Raptors are up 1-0 in the best-of-seven series – Game 2 tomorrow night in Toronto. But the Dubs are still the Dubs, aren’t they?

GOLDMAN: Look, the Dubs flubbed. But don’t snub the Dubs, bub.

SIMON: (Laughter).

GOLDMAN: Two can play, Scott. OK. Look. Golden State – they’re still the champs.

SIMON: Like I said, I could go all day. It sounds like you and I will go all day, but go ahead. Yes.

GOLDMAN: Golden State – still the champs. They’re in their fifth-straight finals. And I think we owe them, as one of the all-time great teams, to not pronounce them in serious trouble yet. They do need to play with more urgency and hurry back on defense. And Draymond Green needs to play – you know, he gets – needs to get back playing like a wrecking ball, rather than a whiffle ball. But I think you will see Golden State react and adjust tomorrow. But Scott, Toronto is a very good defensive team and certainly has Golden State’s attention.

SIMON: I love Pascal Siakam.

GOLDMAN: Oh. Who doesn’t?

SIMON: What a story he is, too.

GOLDMAN: The star of Game 1 of the NBA Finals – 32 points, eight rebounds, a bunch of other great stuff. He’s been playing organized basketball for about eight years. That’s fairly stunning. He’s from Cameroon – was studying for the priesthood, although when he was 15 – 10 years ago – he realized he didn’t want to be a priest. And we’re all thankful for that – NBA fans. So he started behaving badly at his seminary in hopes of getting kicked out. But he was a really bright student, so he stayed and graduated.

He then gravitated to basketball, which wasn’t a stretch since his brothers played college ball in the U.S. He got noticed by the right people, paid his dues in the minor leagues. And now, Scott, here he is – Game 1 star. He certainly got noticed by Draymond Green, who said he has to take Siakam out of the series. And that looks like a pretty big challenge right now.

SIMON: Alarming moment Wednesday night in Houston – Albert Almora Jr. of the Cubs hit a foul ball that unfortunately struck a young girl. She was hospitalized. His reaction was heart-stopping. He is the father of two. He immediately screamed. He threw his arms over his head and knelt. This tragedy rekindles a long-running argument in Major League Baseball about fan safety.

GOLDMAN: A study published last year said about 1,750 fans are hurt each year by foul balls at major league games. We notice when tragic things like what happened this week happen, or last year when a woman died after being hit at Dodger Stadium – you know, all ballparks had their netting extended to improve safety along the foul lines.

But there are those who say that’s still not enough. Almora, who you mentioned, and Cubs star Kris Bryant, among others, said they want to see nets all around the field. And that may take away a little of the sense of physical connection fans want to feel with players in the game, but, you know, it appears to be getting too dangerous not to.

SIMON: In Paris, third round of the French Open. Nadal and Federer look to be on course for meeting in the semifinals. Let me ask you about the women’s side.

GOLDMAN: Yeah. Sure.

SIMON: Sloane Stephens struggled but made it through to the round of the final 16.

GOLDMAN: Yes. And you know, it’s so wide-open with the women. I – watch Croatian Petra Martic. Why not? She beat the No. 2 seed, Karolina Pliskova. Martic has won more clay court matches this season than anyone in the women’s tour. She’s only seeded 31st, but what the heck? In the last nine major championships, eight different women have won. So it’s pretty wide-open on the women’s side.

SIMON: And finally, footy.

GOLDMAN: Yeah.

SIMON: Champions League Final today between Liverpool and Tottenham…

GOLDMAN: Yeah.

SIMON: …Taking place in Madrid. Gosh, couldn’t they find a place closer to home? In any event, who do you see? We’ve got about 30 seconds.

GOLDMAN: Oh, sure. OK. Well, let me vamp a little bit. No. Liverpool – 119-105. Sorry. Still thinking hoops.

SIMON: (Laughter).

GOLDMAN: Liverpool, I’ll say, 4-1.

SIMON: Liverpool – I have no idea. So I’ll say Tottenham 7-3, OK?

GOLDMAN: (Laughter) OK.

SIMON: NPR’s Tom Goldman, thanks so much.

GOLDMAN: You’re welcome.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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What’s Doctor Burnout Costing America?

Doctors who experience burnout are prone to cut back on hours or quit practicing medicine. This costs the health care system billions, new research finds.

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Doctor burnout is costing the U.S. health care system a lot — roughly $4.6 billion a year, according to a study published this week in the Annals of Internal Medicine.

“Everybody who goes into medicine knows that it’s a stressful career and that it’s a lot of hard work,” says Lotte Dyrbye, a physician and professor of medicine at the Mayo Clinic in Rochester, Minn., who co-authored the study.

She says the medical profession now carries an increasing load of paperwork and bureaucracy, adding stress to doctor’s lives. “We want to be able to deliver good quality care to our patients, and our systems get in the way,” Dyrbye says.

The study defines burnout as substantial symptoms of “emotional exhaustion, feelings of cynicism and detachment from work, and a low sense of personal accomplishment.” This description tracks closely with the World Health Organization’s newly updated definition for burnout.

To put a price on burnout, the study authors culled data from recent research findings and reports — including direct or inferred findings on doctors cutting back on hours or quitting as a result of burnout. They ran a mathematical model to estimate the costs associated with burnout, focusing on the costs of replacing physicians and lost income from unfilled positions.

A previous study, which shares some of the same authors, found that 54% of doctors reported experiencing at least one symptom of burnout, from the Maslach Burnout Inventory, a validated tool for measuring burnout.

Dyrbye says research shows that doctors find meaning in helping patients but are taxed by systemic burdens they consider tangential to patient care. “Cumbersome, inefficient” electronic health record systems; increased reporting requirements; and hectic, irregular schedules cause doctors to feel that they’re socially isolated and lack autonomy.

“There is a general sense of loss of meaning [to the work],” she says.

The study authors calculate that for health care organizations, the cost of burnout comes out to $7,600 per physician per year. The study notes that their cost estimate is conservative, only taking into account lost work hours and physician turnover. But other research shows burned out doctors are also more likely to make medical mistakes, have less satisfied patients, and get sued for malpractice, all of which have indirect costs.

Constance Guille, a doctor and associate professor at the Medical University of South Carolina, who was not involved in the study, says that highlighting the economic costs associated with burnout is important work. However, she says, a weakness of the study is that it drew from inconsistent data, an issue baked into the literature: “We’re not actually able to measure burnout well,” she says.

Guille co-authored a paper, published last year in JAMA, that found at least 47 definitions of “burnout” across 182 studies. From Guille’s perspective, mental health diagnoses offer clearer metrics.

“Burnout is highly, highly associated with major depression,” she says. “It’s measurable, and we have really good interventions for it.” She adds that focusing on depression “could improve physician health, and reduce the financial impact of burnout.”

The current study is accompanied by an editorial also published in the Annals of Internal Medicine by Edward Ellison, executive medical director of Southern California Permanente Medical Group, a health care provider in the Kaiser Permanente network that employs over 8,500 physicians.

He writes that burnout is associated with “anxiety, depression, insomnia, emotional and physical exhaustion, and loss of cognitive focus.” But most concerning, Ellison notes, is that the physician suicide rate is much higher than the general public’s and even exceeds that of combat veterans. “[W]e cannot underestimate the urgency, severity, and tragedy of the human cost,” he writes.

Doctor burnout has been a known problem for years, the study authors note, and by putting a cost to the problem and using the language of policymakers and CEOs, they aim to compel organizations to act.

“We hope that people will think about these numbers and say: ‘If I invested half that amount of money in systems that improve work efficiency, or ways to build better teams to offload some of the workload from the physician, not only is it the right thing to do, but it’s also going to improve my quality and safety, and save me some dollars in the end,'” says Dyrbye.

Bottom line, she says, addressing burnout is not just a moral responsibility: It could also be money-saving.


Pien Huang is NPR’s Reflect America Fellow, helping to bring more diverse voices to air and online.

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Koffee Takes Her ‘Rapture’ To The Streets With New Remix

Koffee’s “Rapture” remix pours the gasoline of adrenaline onto an already fire track.

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Koffee is waking up new generations to the style, complexity and power of reggae. The Jamaican-born rising star and 2019 NPR Slingshot artist has only been at this professionally for a couple years — the 19-year-old recently graduated from high school — but her passion for her culture is palpable and the momentum of her music is only building.

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After dropping the five-song EP Rapture in March — the project was easily one of the best releases in 2019 so far — Koffee is back with a remix to the title track. “Rapture (Remix),” featuring fellow Spanish Town native Govana, adds an extra shot of adrenaline, throwing gasoline onto an already fire track. For the official remix video, the duo took it to the streets of their hometown to show how community, beauty and danger all intermingle on their island.

“Koffee anna coffee, mi say no gimmicks / She a pro widit, treat di ridddim like she grow wid it,” Govana rhymes, propping up young Koffee as she awaits stardom.

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Richer Medicare Payments For Rural Hospitals Could Come At Urban Centers’ Expense

A proposed change in a formula for Medicare payments could help rural hospitals but would mean less money for hospitals in cities.

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As rural hospital closures roil the country, some states are banking on a rescue from a Trump administration proposal to change the way hospital payments are calculated.

The goal of the proposal, unveiled by Centers for Medicare & Medicaid Services Administrator Seema Verma in April, is to bump up Medicare’s reimbursements to rural hospitals, some of which receive the lowest rates in the nation.

For example, Alabama’s hospitals — most of which are rural — stand to gain an additional $43 million from Medicare next year if CMS makes this adjustment.

“We’re hopeful,” said Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association. “It’s as much about the rural hospitals as rural communities being able to survive.”

The proposed tweak, as wonky as it may seem, comes with considerable controversy.

By law, any proposed changes in the calculation of Medicare payments must be budget-neutral; in other words, the federal government can’t spend more money than previously allocated. That would mean any change would have a Robin Hood-like effect: a cut in payments to some hospitals to make it possible to increase payments to others.

“There is a real political tension,” said Mark Holmes, director of the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. Changing the factors in Medicare’s calculations that help hospitals in rural communities generally would mean that urban hospitals get less money.

The federal proposal targets a long-standing and contentious regulation known in Washington simply as the “wage index.” The index, created in the 1980s as a way to ensure that federal Medicare reimbursements were equitable for hospitals nationwide, attempts to adjust for local market prices, said Allen Dobson, president of the consulting firm Dobson, DaVanzo & Associates.

That means under the current index a rural community hospital could receive a Medicare payment of about $4,000 to treat someone with pneumonia while an urban hospital received nearly $6,000 for the same case, according to CMS.

“The idea was to give urban a bit more and rural areas a bit less because their labor costs are a bit less,” said Dobson, who was the research director for Medicare in the 1980s when the index was created. “There’s probably no exact true way to do it. I think everybody agrees if you are in a high-wage area you ought to get paid more for your higher wages.”

For decades, hospitals have questioned the fairness of that adjustment.

Rural hospitals nationwide have a median wage index that is consistently lower than that of urban hospitals, according to a recent brief by the Sheps Center. The gap is most acute in the South, where 14 of the 20 states that account for the lowest median wage indexes are located.

Last year, the Department of Health and Human Services Office of Inspector General found that the index may not accurately reflect local labor prices and, therefore, Medicare payments to some hospitals “may not be appropriately” adjusted for local labor prices. More plainly, in some cases, the payments are too low.

In an emailed statement, Verma said the current wage index system “has partly contributed to disparities in reimbursement across the country.”

CMS’s current proposal would increase Medicare payments to the mostly rural hospitals in the lowest 25th percentile and decrease the payments to those in the highest 75th percentile. The agency is also proposing a 5% cap on any hospital’s decrease in the final wage index in 2020 compared with 2019. This would effectively limit the loss in payments some would experience.

Dobson, a former Medicare research director, said he expects “enormous resistance.” (The CMS proposal is open for public comment until June 24.)

HHS Secretary Alex Azar, foreshadowing how difficult a change could be, said during a May 10 Senate budget hearing that the wage index is “one of the more vexing issues in Medicare.”

It’s problematic, agreed Tom Nickels, an American Hospital Administration executive vice president, noting in an emailed statement that there are other ways “to provide needed relief to low-wage areas without penalizing high-wage areas.”

It’s this split that appears to be dictating the range of reactions.

The Massachusetts Health & Hospital Association’s Michael Sroczynski, who oversees its government lobbying, questioned in an emailed statement whether the wage index is the correct mechanism for providing relief to struggling hospitals. The state’s hospitals have historically been at the higher end of the wage index.

In contrast, Tennessee Hospital Association CEO Craig Becker applauded the proposed change and said the Trump administration is recognizing the “longstanding unfairness” of the index. Tennessee has been among the hardest hit with hospital closures, counting 10 since 2012.

In Alabama, where four rural hospitals have closed since 2012, Howard said that without the change she “could see a dozen or more of our hospitals not being able to survive the next year.” Indeed, Howard said, hospitals in more than 20 states could gain Medicare dollars if the proposal passes and “only a small number actually get hurt.”

Kaiser Health News asked the Missouri Hospital Association, in a state where most hospitals do not stand to gain or lose significantly from the rule change, to calculate the exact differences in hospital payments under the current wage index formula.

Under the complex formula, a hospital in Santa Cruz, Calif., an area at the top end of the range, received a Medicare payment rate of $10,951.30 — or 70% more — for treating a concussion with major complications in 2010 as compared with a hospital in rural Alabama, at the bottom end, which received $6,441.76 to provide the same care.

Even more, MHA’s data analysis showed that the lower payments to Alabama hospitals have compounded over time. In 2019, Medicare increased its pay to the hospitals in the area around Santa Cruz for the same concussion care. It now stands at $13,503.37 — a nearly 23% increase above the 2010 payment. In contrast, rural Alabama hospitals recorded a 3% payment increase, to $6,646.80, for the same care.

For Alabama, addressing the calculation disparity could be “the lifeline that we’ve been praying for,” Howard said.


Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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‘I Am A Woman’: Track Star Caster Semenya Continues Her Fight to Compete As A Female

Caster Semenya of South Africa races to the line to win the Women’s 800 meters during the IAAF Diamond League event at the Khalifa International Stadium on May 03, 2019 in Doha, Qatar. Semenya has appealed a ruling that requires her to reduce her testosterone levels by drugs or surgery.

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This week, the Olympic champion runner Caster Semenya of South Africa filed an appeal in a case that hinges on her right to compete as a woman. It’s the latest chapter in a fight that’s gone on for years, and that raises thorny questions about fairness and ethics in sport.

Semenya, 28, is a two-time gold medalist in the 800 meter event. She is asking the Swiss Federal Supreme Court to throw out a ruling issued earlier this month by the Court of Arbitration for Sport, or CAS, which is based in Lausanne.

That ruling upheld regulations that will require some female track athletes with naturally-elevated testosterone levels to lower those levels with drugs or surgery, if they want to compete in certain women’s events on the international stage.

Just two days after losing that court fight, Semenya took to the track in the Diamond League championships in Doha, Qatar, and blistered past the competition in her marquee event, the 800 meters.

Caster Semanya competes in the Diamond League championships in Doha, Qatar.

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“My word! Is there any end to her talent?” marveled an announcer as he watched Semenya pull away from the pack in the home stretch. “Is this, as some people have suggested, something of an act of defiance, given what’s been going on?”

In a statement when she filed her appeal, Semenya said, “I am a woman and I am a world-class athlete. The IAAF will not drug me or stop me from being who I am.”

The IAAF is the International Association of Athletics Federations, the international governing body for track and field, which imposed the regulations, arguing that the rules are necessary to create a level playing field in women’s events.

In its 2-1 ruling, CAS found that while the regulations are discriminatory, “such discrimination is a necessary, reasonable and proportionate means of achieving the legitimate objective of ensuring fair competition in female athletics.”

It’s not simple to define sex

The IAAF regulations apply to certain athletes with what are known as Differences of Sex Development, or DSDs, which means they were born with anatomy that doesn’t neatly fit into the binary, male or female categories. These individuals are also known as intersex.

“People think that it’s simple to define sex. It’s not,” says Dr. Eric Vilain, a geneticist who specializes in the study of sexual development at Children’s National Health System and George Washington University in Washington, D.C.

Dr. Vilain, who testified as an expert witness on Caster Semenya’s behalf, explains that the biology of sex classification is anything but straightforward; there can be a wide spectrum of variations.

“It’s really difficult to support a rule that seems to be based more on a preconceived idea of what a woman should be, rather than who a woman is,” he says.

Caster Semenya was raised as a female and is legally female. She’s fighting rules that affect DSD athletes who have what are typically male, XY chromosomes; who were born with internal testes; and have testosterone levels higher than the typical female range.

An unfair advantage?

Supporters of the rules say higher testosterone gives these athletes an unfair performance advantage, since it provides a boost in power, endurance, and speed.

So, they say, if you want to create a level playing field, the new restrictions make sense.

“Fairness is an extremely subjective word,” says Joanna Harper, who researches gender and sport, and testified on behalf of the IAAF. “I prefer the word equitable.”

Harper says, “We separate male athletes and female athletes not on the basis of gender identity, or legal sex, or how people are identified at birth, but rather on biological characteristics that make men so much better at sport than women.”

Harper, author of a forthcoming book entitled Sporting Gender: the History, Science and Stories of Transgender and Intersex Athletes, argues that the rules should not be seen as stripping a female athlete of her identity.

“Whether someone is a woman or someone is a man or perhaps somewhere in between, is a very complicated thing,” Harper says. “The separation of athletes into male and female categories is something that I call creating an ‘athletic gender.’ And it’s merely one component of a human being’s existence.”

Creating a ‘protected space’ for women to compete

For Duke Law School professor Doriane Coleman, the IAAF rules guarantee a “protected space” for women to compete. Coleman is a former 800 meter runner who studies sex and sport.

“If eligibility for women’s sports events can’t be based on biological sex traits, or at least one biological sex trait,” she says, “then you won’t see females on the podium.”

Silver medalist Francine Niyonsaba (L) of Burundi, gold medalist Caster Semenya (R) of South Africa and bronze medalist Margaret Nyairera Wambui (C) of Kenya stand on the podium during the medal ceremony for the Women’s 800 meter at the Rio 2016 Olympic Games.

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Coleman points to the women’s 800 meter final at the 2016 Olympic games in Rio de Janeiro, where all three podium spots were won by women who say they will be affected by the new rules on DSD athletes: Caster Semenya, who took gold; Francine Niyonsaba of Burundi, who won silver; and Margaret Wambui of Kenya, who won bronze.

“It was very frustrating to watch it happen,” Coleman says. “It wasn’t about the individuals; it was about the goals of women’s sport … And it was really hard to know that on that day there would not be a female, biologically speaking on the podium in the women’s 800.”

Definitions are difficult

But how to define exactly who is a biological woman is not at all clear-cut.

“Sex is not defined by one particular parameter,” says geneticist Eric Vilain. What’s more, he says, “for many human reasons, it’s so difficult to exclude women who’ve always lived their entire lives as women — to suddenly tell them ‘you just don’t belong here.’ Because the implication is to tell them ‘well, you’re not really a woman.’ And I think society should not accept that easily.”

The new rules apply only to certain distance events, from 400 meters to one mile, where, the IAAF claims, runners get the most performance benefit from testosterone. Scientists who testified on behalf of Semenya dispute those data.

If the affected athletes want to race in those restricted events, the IAAF says, they can compete in the male classification.

Dr. Vilain says that’s absurd: “If the same athlete could be a woman in one and a man in another, it makes absolutely no sense,” he says.

Medically suppressing testosterone

As for how the DSD athletes can suppress their testosterone, they have three choices: they can have their testes surgically removed; they can get a monthly injection that blocks testosterone; or they can take birth control pills.

But all of those options — even birth control pills — come with risks, says Dr. Veronica Gomez-Lobo, the founder of the Differences of Sex Development clinic at Children’s National Health System.

“Even though we tend to think of [oral contraceptives] as being very safe,” she says, “they can cause blood clots that can travel to your lung and and can be very dangerous. And although that’s very rare, that can happen. So you’re forcing somebody to take a medication she doesn’t need and she doesn’t want to take, and she’s incurring the side effects and risks of that medication only to compete.”

‘Inverse doping’

The World Medical Association, or WMA, is so angered by the IAAF regulations that they’ve urged doctors around the world to refuse to comply. The WMA calls the regulations unethical and a violation of human rights.

“There is no medical need and no medical indication for this therapy, and therefore, doctors should not prescribe it,” says Dr. Frank Montgomery, the WMA’s chair of council.

Montgomery calls it “inverse doping” to require athletes to take drugs that will sabotage their performance.

“We are against doping of any sort,” Montgomery says. “Ethically and medically this fairness argument doesn’t carry. It is definitely not a way to tell someone you’re a woman only if you take certain medications.”

None of this is simple.

“No matter what you do, you’re going to end up hurting someone. And I think that’s what makes this topic so difficult,” says Steve Magness, who coaches professional runners and writes about the science of performance.

“You can at the same time feel incredible compassion toward Semenya and DSD athletes and say that ‘hey, what’s happening isn’t right’. But at the same time, you can say we protect the women’s division of sport for a reason and we have to decide somewhere where we want to divide that.”

For now, these rules apply only to track and field. It will be up to other sports federations to decide whether to follow suit.

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