The Court of Arbitration for Sport (CAS) on Wednesday dismissed an appeal by Olympics 800 metres champion Caster Semenya against the introduction of regulations to restrict testosterone levels in female athletes.
The court ruled that regulations were needed for athletes with differences in sexual development (DSDs) to ensure fair competition.
The rules cover events ranging from 400m to a mile.
The case is likely to have wide-reaching consequences, not just for the future of athletics, but all women’s sport, and has split opinion around the globe.
But while dismissing the appeal, CAS also voiced concerns about the application of the new International Association of Athletics Federations (IAAF) regulations.
The rules mean Semenya and others with DSD hoping to compete at the Doha World Championships in September would have to start taking medication to lower their testosterone levels within one week.
Semenya has said she does not wish to undergo medical intervention to change who she is and how she was born and wants to compete naturally.
But her dominance of the middle distances has been labelled unfair by some of her competitors.
“Sometimes it is better to react with no reaction,” Semenya tweeted after the verdict.
“The IAAF … is pleased that the regulations were found to be a necessary, reasonable and proportionate means of achieving the IAAF’s legitimate aim of preserving the integrity of female athletics in the restricted events,” the global governing body said in a statement.
“No athlete will be forced to undergo an assessment and/or treatment under these regulations.
“It is each athlete’s responsibility, in close consultation with her medical team, to decide whether or not to proceed with an assessment and/or treatment,” it said.
However, in the 165-page ruling, the CAS Panel expressed some concerns as to the future practical application of these regulations.
“The Panel found that the DSD regulations are discriminatory.
“But the majority of the Panel found that, on the basis of the evidence submitted by the parties, such discrimination is a necessary, reasonable and proportionate means of achieving IAAF’s aim of preserving the integrity of female athletics in the restricted events,” the statement said.
Under the rules, female athletes who have high natural levels of testosterone will have to reduce their levels through medication to under 5 nmol/L, which is double the normal female range of 2 nmol/L.
Testosterone is a hormone that increases muscle mass, strength and haemoglobin —- which affects endurance.
The athletics world governing body believes the regulations are necessary to “preserve fair competition in the female category”, and has received support from some current and former athletes.
But IAAF has also come in for criticism from human rights organisations over its wish to medically alter naturally-produced levels of testosterone.
The UN Human Rights Council adopted a resolution in support of Semenya in March.
The South African will be the most high-profile athlete to be affected by the rules, but others include 2016 Olympic silver medalist in the 800-metres, Francine Niyonsaba of Burundi.
Semenya took potential steps to reinvent her career last week when she won the 5,000m at the South African Athletics Championships in a modest time of 16:05.97.
It is an event that will allow her to compete outside of the IAAF regulations.
Following the CAS case, other sports bodies may now choose to set their own parameters for participation by DSD and transgender athletes in their individual codes.