Sports Gazette

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Athletics DSD regulations are flawed, Christine Mboma is the next victim.

For the sake of clarity, IAAF will be referred to by the current name World Athletics in all instances.

Christine Mboma is the future of Namibian athletics. The 18-year-old announced herself on the global stage with an Olympic 200m silver in Tokyo but looks set to have a career governed as much by politics as performance.

Mboma and her compatriot, Beatrice Masilingi, are athletes with DSD (differences in sexual development).

As regards these regulations they are defined as meeting each of the following criteria:

  • a. she has one of the following DSDs:
i. 5α-reductase type 2 deficiency;
ii. partial androgen insensitivity syndrome (PAIS);
iii. 17β-hydroxysteroid dehydrogenase type 3 (17β- HSD3) deficiency
iv. ovotesticular DSD; or
v. any other genetic disorder involving disordered gonadal
steroidogenesis; and
  • b). as a result, she has circulating testosterone levels in blood of five (5)nmol/L or above; and
  • c). she has sufficient androgen sensitivity for those levels of testosterone to have a material androgenising effect.

World Athletics bans athletes from all female international level events between 400m and one mile unless they artificially lower their testosterone.

They require a mark below five nmol/l for a period of six months, during which the athlete is unable to compete and after which they are required to maintain.

“The drugs take the soul out of my body” – Caster Semenya

But lowering testoterone is not without controversy.

The World Medical Association went as far as to demand the immediate withdrawal of World Athletics’ regulations in April 2019. The body cited ‘flagrant discrimination’ that is ‘contrary to international medical ethics and human rights standards.’

Those who are forced to take World Athletics measures contest they can cause serious harm.

The most high-profile example is Caster Semenya. The two-time Olympic champion has essentially been sidelined from the sport due to the regulations.

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The South African, in her appeal to the Court of Arbitration for Sport (CAS) outlined side effects including:

  • Weight gain
  • Regular fevers
  • Constant abdominal pain
  • Significant impact on mental health.

Due to these experiences Semenya is no longer willing to take the medication, forcing her to compete in events outside the affected events.

This has effectively ended her career as a world-class athlete, having failed in subsequent attempts to qualify for the 5000m in Tokyo.

Surgical intervention

Semenya is not the only one. Annet Negesa was a World Junior Bronze medalist with the London Olympics in her sights.

High testosterone levels stopped her Olympic participation. A few months down the line she took one of World Athletics other proposed options and had surgery to remove her internal testes.

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For Negesa what was meant to allow her to compete has in effect ended her career. She has since never been close to the level she achieved before the operation.

I tried to train but the body refused to turn up.

Annet Negesa on her training since surgery.

Why do World Athletics regulate DSD athletes?

World Athletics contend that:

“exposure to higher levels of circulating testosterone is the primary cause of the physical advantages that account for the sex difference in sport performance.”

World Athletics in Mokgadi Caster Semenya v. International Association of Athletics federations

DSD athletes are exposed to higher levels of circulating (or free) testosterone and are therefore, in World Athletics eyes, at a performance advantage.

But proving this advantage is not without debate. Scientists are not unanimous that female athletes with DSD are equivalent to biological males.

This was the subject of dispute in Semenya’s CAS appeal.

To summarise a highly complex case, CAS decided in favour of World Athletics. In CAS’s view there were strong enough arguments that DSD athletes did have a performance advantage when their testosterone was unregulated.

World Athletics regulations were therefore proportionate.

As we shall see, however, such reasoning is not without controversy.

What does this mean for Christine Mboma?

One key bone of contention in the Semenya case was a study called BG17 which World Athletics said provided evidence of the performance advantage of DSD athletes across the affected events.

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This study was of two World Athletics Championships in 2011 and 2013. It found that:

“In female athletes, a high free testosterone concentration appears to confer a 1.8%-2.8% competitive advantage in long sprint and 800m races.”

Bermon et al, British Journal of SPorts Medicine 2017

A flawed study

The study has been shown to be highly problematic.

Ross Tucker Ph.D., a sport scientist who was an expert witness on the Semenya trial, has described it as a “bang average study”.

It included duplicated, missing and phantom data points (times that weren’t even run and were included).

World Athletics even came out in August to confirm they were wrong. You cannot, from this study, imply a causal inference between higher testosterone and performance in these events.

But this study did play a part that ultimately led to the upholding of the regulations. The Panel in Semenya’s CAS case concluded:

“BG17 (even as an observational study) provides empirical data which demonstrate that World Athletics’s scientific evidence concerning the physiological effects of increased testosterone levels translates, in a real world competitive context to a significant and often determinative performance advantage.”


And this is important. For Mboma it could be crucial.

CAS sided with the arguments of World Athletics and part of the supporting argument was the number of such DSD athletes performing and having success at that particular time (2011 and 2013).

If Mboma or any other DSD athletes continue to enjoy success in years to come those achievements, using the same logic, could be used to provide support to the argument they are at an advantage.

DSD athletes face the paradox that it may be in their long-term interest not to win.

World Athletics’ next step in DSD regulations

It seems illogical to think that, after pushing so hard to push DSD athletes out of the middle-distances, World Athletics will sit back if they start to dominate outside the prescribed distances.

This is already happening. Mboma is the World U20 200m Record Holder. Francine Niyonsaba, competing in the 5000m is undefeated since the Olympics.

Athletics is at a crossroads, one where few can claim to have the answer. DSD regulations are flawed and Mboma is the next to suffer.

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With two DSD athletes set to dominate the sport, World Athletics faces a conundrum it has shown little signs of being able to resolve.

This article provides an introduction to a topic the Sports Gazette will be exploring in greater detail over the coming months. Stay tuned for our developing coverage of DSD athletes.

Featured image Image by Nottingham Trent University is licensed under CC BY-NC-ND 2.0


  • George Mallett

    Writing the stories behind characters in the world of boxing and athletics, I'll aim to bring you the best from two fascinating sports.