In 2009, the South African middle-distance runner Caster Semenya was barred from competition and obliged to undergo intrusive and humiliating “sex testing” after fellow athletes at the Berlin World Championships questioned her sex. Ms. Semenya was eventually allowed to compete again, but the incident opened the world’s eyes to the process of sex testing and the distress it could bring to an athlete who had lived her whole life as a girl. When an endocrinologist, a gynecologist and a psychologist were brought in to determine whether the teenager was really a woman, she simply asserted, “I know who I am.”

From 2011, major sports governing bodies, including the International Olympic Committee, the Fédération Internationale de Football Association and the International Association of Athletics Federations, instituted new eligibility rules that were intended to quell the outrage over the handling of the Semenya case. Instead, as recent cases attest, they may have made things worse.

Rather than trying to decide whether an athlete is “really” female, as decades of mandatory sex tests did, the current policy targets women whose bodies produce more testosterone than is typical. If a female athlete’s T level is deemed too high, a medical team selected by the sport’s governing bodies develops a “therapeutic proposal.” This involves either surgery or drugs to lower the hormone level. If doctors can lower the athlete’s testosterone to what the governing bodies consider an appropriate level, she may return to competition. If she refuses to cooperate with the investigation or the medical procedures, she is placed under a permanent ban from elite women’s sports.

The first evidence of this new policy in action was published last year in The Journal of Clinical Endocrinology and Metabolism. Four female athletes, ages 18 to 21, all from developing countries, were investigated for high testosterone. Three were identified as having atypically high testosterone after undergoing universal doping tests. (They were not suspected of doping: Tests clearly distinguish between doping and naturally occurring testosterone.)