Caster Semenya of South Africa celebrates after winning the  womens 800m final at the Rio 2016 Olympic Games. Photograph:  Diego Azubel/EPA
    Caster Semenya, the    Olympic 800m champion, may be banned from competing at future    Games unless she undergoes hormone replacement therapy (HRT) or    even surgery in the wake of a landmark study into athletes with    raised testosterone levels which has just been published.  
    The International Association of Athletics Federations, the world governing    body, commissioned research which has produced the most    conclusive evidence yet that female athletes with very high    levels of naturally occurring testosterone receive significant    performance-enhancing benefits in competition.  
    It comes only weeks before the IAAF is set to challenge a ruling by the    court of arbitration for sport which, since 2015, has prevented    it from restricting permitted levels of testosterone among    female competitors.  
    The new study will not stop Semenya and other hyperandrogenic    athletes, such as the Indian sprinter Dutee Chand, from    competing at the world championships in London in August but it    could have a significant impact on the Cas hearing later this    month.  
    It is bound to reopen the controversial and emotionally charged    debate around the treatment of female athletes with    hyperandrogenism, a medical condition characterised by    excessive levels of male sex hormones such as testosterone.  
    Researchers measured blood testosterone levels in 1,332 female    athletes competing across 21 track and field disciplines at the    2011 and 2013 world championships. Those with the highest    levels of testosterone demonstrated significant advantages over    those with the lowest levels  notably in the 400m (2.7%    faster), the 400m hurdles (2.8% faster), the 800m (1.8%    faster), the hammer throw (4.5% longer) and in the pole vault    (2.9% higher).  
    Although these margins appear small, at the highest level a    performance boost of a few percentage points might mean the    difference between winning gold and missing out on a medal.  
    Stphane Bermon led the research from the Monaco Institute of    Sports Medicine and Surgery, together with Dr Pierre-Yves    Garnier, director of the IAAF health and science department.    Bermon said: This study brings new evidence [of] the    performance-enhancing effects of androgens in elite female    athletes. Although long suspected [to be the case], until now    there was no proof.  
    Our starting position is to defend, protect and promote fair    female competition.If, as the study shows, in certain events    female athletes with higher testosterone levels can have a    competitive advantage of between 1.8 and 4.5% over female    athletes with lower testosterone levels, imagine the magnitude    of the advantage for female athletes with testosterone levels    in the normal male range.  
    Among female athletes testosterone is the most widely abused    performance-enhancing drug, Bermon said. Of the 116 female    athletes serving a doping ban as of December 2016, 64 had    tested positive for androgens.  
    Chand, a 100m and 200m sprinter, successfully challenged IAAF    regulations restricting permitted testosterone levels in 2015.    These regulations mandated that affected individuals had to    receive hormone treatment to lower their testosterone levels    artificially if they wanted to compete in the female category    of competition. Cas ruled the    IAAF regulations must be suspended until evidence of the    impact of circulating androgens, like testosterone, on sporting    performance could be produced.  
    This missing evidence prompted the current study, published in    the British Journal of Sports Medicine.  
    Testosterone has several potential performance-enhancing    effects on the body, including boosting the oxygen-carrying    capacity of the blood, building lean muscle mass and increasing    mental drive and aggressiveness. The new study also found that    female competitors with high levels of androgens benefit from    improved visuospatial abilities.  
    Bermon believes the studys findings have significant    implications for future rulings on testosterone in elite    womens sport. We believe that these results could help the    CAS jury to better understand the relationship between androgen    levels and athletic performance. Additionally, our work    addresses the main CAS request: quantification of the advantage    experienced by female athletes with very high level of    circulating androgens when compared to athletes with normal    level of androgens.  
    The IAAF has commissioned a second piece of research and    sources told the Guardian it would look at the effect naturally    occurring testosterone has on 100m and 200m sprinters like    Chand, as well as middle distance runners and throwers.  
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Caster Semenya could be forced to undertake hormone therapy for future Olympics - The Guardian