Caster Semenya was greeted by a rapturous crowd on Tuesday when she returned to her native South Africa after claiming the women's 800-m gold medal at the World Athletics Championships in Berlin. But speculation surrounding the legitimacy of her title continues to rumble on after a British newspaper revealed that doping officials had found the 18-year-old athlete's testosterone levels to be three times as high as those normally expected in a female.
On Tuesday, The Daily Telegraph reported that the hormone tests had been carried out in South Africa before the World Championships and that the results had contributed to the decision by the International Association of Athletics Federations (IAAF) to request a detailed gender-verification test of the athlete. Semenya came to the world's attention after winning the African Junior Championships in Mauritius and then the World Championships by a massive 2-sec. margin.
Responding to speculation that Semenya is a man, South African officials defended their champion on Tuesday, calling for the matter to be dropped. "It's very simple: she's a girl," said Leonard Chuene, president of Athletics South Africa.
Gender disputes in athletics can be very complicated, however. In his paper "Intersex and the Olympic Games," Rob Ritchie, a urological surgeon at Oxford University, notes that in the 1996 Summer Olympics in Atlanta the last Games in which all female athletes were subjected to gender testing eight female athletes were found to be genetically male. Seven of them had androgen-insensitivity syndrome (AIS), a condition in which a genetic male is resistant to androgens, the male sex hormones that include testosterone. In such cases, the testes never descend from the abdomen and the genitalia may resemble female genitalia.
Genetic males with AIS produce testosterone like normal males, but their bodies are insensitive to its effects. So people with AIS often have high levels of testosterone as the body produces more to try to exert its actions. For this reason, Semenya's high testosterone levels could be in keeping with an AIS diagnosis.
"It's very difficult to say whether AIS confers an athletic advantage," Ritchie says. Those who have complete AIS, despite being genetically male, display fewer signs of the presence of testosterone than the average female, who produces and absorbs a small amount of the hormone. There is such a condition as partial AIS, however, in which a person has some sensitivity to testosterone and so develops masculine features such as larger muscles alongside feminine features.
Olympic officials do not consider AIS to necessarily confer an advantage. The seven genetically male athletes with AIS at the Atlanta Olympics were allowed to compete as women. However, the incidence of AIS in Atlanta seven cases among 3,000 athletes compared with the rate in the general population, which is 1 in 20,000, suggests that partial AIS can boost athletic ability, Ritchie says. "But," he adds, "it's never been proven that women found to be genetically male have any physical advantage above what might otherwise be seen in the extremes of genetically female women."
Because gender and its relationship to athletic advantage can be such a complex matter, the International Olympic Committee and the IAAF now use a comprehensive evaluation by a panel of specialists to determine whether an athlete can compete as a woman. The IAAF's evaluation of Semenya will include an endocrinologist, a gynecologist and a psychologist. Whether Semenya is genetically male will be only one of the factors considered. The test will also likely include a psychological profile to see whether she feels herself to be a woman.
Even if the IAAF rules Semenya ineligible to compete, Ritchie says, that does not mean she is a cheat. It is quite common for neither an individual with AIS nor her parents to realize that she is genetically male. Indeed, AIS is sometimes diagnosed at fertility clinics only when women seek help because of their inability to become pregnant. "If this girl turns out to have AIS, it's not her fault," he says. "As those with AIS often are, she was brought up as a girl by her parents, which was the right thing to do."
Test results for Semenya are not expected for several weeks. A diagnosis of AIS can be extremely difficult for a young person, says Ritchie, who adds that it is a "complete mess" that the IAAF leaked reports of Semenya's gender test to the media before the results are known. On Sunday, IAAF president Lamine Diack admitted that the affair could have been treated with more sensitivity. "It should not even have become an issue if the confidentiality had been respected," he said. "There was a leak of confidentiality at some point, and this lead to some insensitive reactions." Semenya has already overcome an incredible challenge by becoming a world champion. But as a result of the poor handling of what should have been a very private test, no matter the results, the most difficult stretch of her life may yet be ahead of her.