Scott Gleeson, and Erik Brady

USA TODAY

Caster Semenya is a South African runner who could emerge as one of the most compelling figures of the Rio Olympic Games. She is favored to win gold at 800 meters while perhaps breaking track’s longest-standing world record, even as her stunning speed is leading to uncomfortable controversy at the uncertain intersection of gender and athletics — and of human rights and athletic fairness.

Semenya has never said she is intersex — a word preferred to the stigmatizing hermaphrodite — but speculation follows her around the globe, her private parts a mortifying matter of public debate. (Intersex is an umbrella term for people who are born with sex characteristics “that do not fit typical binary notions of male or female bodies,” according to a definition by the human rights arm of the United Nations.)

Track observers believe Semenya is hyperandrogenous, meaning her body naturally produces high amounts of testosterone, the hormone that helps build muscle, endurance and speed. The International Association of Athletics Federation (IAAF), track and field’s governing body, has rules limiting the amount of naturally occurring functional testosterone allowed for female athletes. But today those limits are in limbo.

The Court of Arbitration for Sport (CAS) suspended them last summer, citing insufficient evidence that high levels give female athletes a boost in performance. The IAAF has until next summer to make a case for its regulations or the court will abolish them. The Rio Games, meantime, fall during an interregnum where the rules don’t apply.

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“This is a huge human rights victory,” intersex studies expert Joanna Harper tells USA TODAY Sports, “but sports, not so much.”

Harper, chief medical physicist of radiation oncology at Providence Portland (Ore.) Medical Center, means that some intersex athletes may have hormone-fueled advantages over other female competitors in Rio.

Maria José Martínez-Patiño refers to it as a “free-for-all.” She was the world’s most famous intersex athlete in the mid-1980s when, as an elite hurdler for Spain, so-called gender testing found that she had XY chromosomes. She soon learned that her outwardly female form hid internal testes. She lost her place on the national team, her scholarship, her fiancé, her privacy, her sense of self.

“Everything taken away,” Martínez-Patiño says in Spanish, “as if I never existed.”

Today she is a professor of science education and sport at Spain’s University of Vigo and an advisor to the International Olympic Committee’s medical commission. And she is strongly in favor of the since-suspended limits on testosterone.

“The reality of sports is someone will always have an advantage,” she says. “It’s very difficult to establish who has it and who does not. We need to have a rule that applies to everybody.”

Martínez-Patiño testified in favor of the IAAF’s upper limits before the arbitration court. That case was brought by Dutee Chand, India’s first female sprinter in 36 years to qualify for the Olympics 100 meters. She was suspended for high levels of testosterone in 2014 — echoes of Martínez-Patiño, who won an appeal of her own decades ago.

Martínez-Patiño was dismissed from the Spanish team ahead of the 1988 Seoul Games because of her sex chromatin test. She appealed based on a condition called complete androgen insensitivity syndrome, which prevents her body from responding to testosterone, negating any advantage. She won her appeal and regained her status. But she failed to make the 1992 Spanish Olympic team; her moment had passed.

“It’d be easy to believe because of the difficulties of that past that I would be opposed to any rules,” Martínez-Patiño says. “That’s not the case. That would not be fair, not be ethical. I understand the positions of other people. I am in favor of rules.”

The difficulty, she says, is balancing the human rights of intersex athletes with the competitive rights of other athletes.

British marathoner Paula Radcliffe made news this month when she said on the BBC that if Semenya is guaranteed to win the 800 “then it’s no longer sport.” She later said in a statement that audio snippets did not capture the complexity of her overall point: “I tried to get across how difficult and complicated the situation is and how finding a solution where nobody gets hurt is pretty much impossible.”

The IAAF said in a statement to USA TODAY Sports that it does not comment on individual athletes: “On Hyperandrogenism Regulations the IAAF has publically confirmed that its regulations were suspended for two years by CAS in 2015 until more evidence is provided as to the precise degree of performance advantage that hyperandrogenic female athletes enjoy over athletes with normal testosterone levels.”

South African track officials did not respond to attempts for comment.

Chance to break world record

Semenya won the 800 meters at the 2009 world championships when she was 18. Her time of 1:55.45 was among the fastest in history. Competitors raised questions. One called her a man. Word leaked that she had elevated levels of testosterone. She was subjected to unfair and unseemly comments.

The IAAF’s and IOC’s vague policies on gender verification at the time considered testosterone levels, though that was only part of it. After Semenya’s case, the IAAF developed a rule that specified female athletes could not compete with functional testosterone levels above 10 nanomoles per liter, an upper limit determined to be three times higher than 99% of the women who had competed at recent world championships.

The IOC adopted the IAAF rule in time for the London Games, where Semenya won silver at 800 meters, behind Russia’s Mariya Savinova, since caught in her nation’s state-sponsored doping scandal. Semenya was performing at an elite level, but well shy of the promise of her astonishing performances in 2009. Harper says short of surgery that medication — typically Spironolactone and external estrogen — is the most likely way to reduce naturally high testosterone levels.

Last year, Semenya failed to advance past the semifinals in the 800 at the world championships. This year Semenya is improving markedly. She won the 400-, 800- and 1500-meter runs — all on the same day — at the South African championships. Her time of 1:55.33 in the 800 this month is the world’s best since 2008.

That’s why Harper believes Semenya is now competing with elevated levels of testosterone, calling her “untouchable” and suggesting her 200 splits and lordly demeanor on the track make her a near-certain bet to win the Olympic 800, with a chance to break the world record of 1:53.28 set in 1983 by Jarmila Kratochvilova of what was then Czechoslovakia. (Allegations of doping against Kratochvilova were never proven.)

Eric Vilain, human genetics professor and chief of medical genetics at UCLA, says biological testing can differentiate between natural testosterone produced by an intersex athlete and injected testosterone from doping.

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“It was clear the IOC was shocked by the ruling of the CAS,” says Vilain, who attended an IOC-hosted meeting on the issue in May. “It was an absolutely unexpected outcome.”

Harper watched in person as attorneys argued Chand’s CAS case in Switzerland. “We were all shocked,” Harper says, at the outcome.

Unfair to transgender athletes?

If intersex athletes produce testosterone naturally, how is that different from other genetic advantages in sports — height in basketball, for instance, or long arms in swimming?

“We allow certain amounts of advantage” in sports, Harper says, “but not overwhelming advantage. For instance, left-handed baseball players against right-handed baseball players. But we don’t let 200-pound boxers get in the ring with 100-pound boxers. At some point, advantages become too great and we need two categories.”

That’s why sports are divided into men’s and women’s.

“The reason why women can’t excel against men is a testosterone-based advantage,” Harper says. “The essence of dividing sport is largely based on the testosterone advantage. Using a testosterone-based divide (for women’s sports) is the best that we can do. It’s a compromise of trying to protect female athletes and also giving intersex and transgender athletes the chance to compete. There’s no perfect solution. It’s very difficult. It’s absolutely not the same case as being a very tall or very fast athlete.”

Harper, who identifies as a transgender woman, became interested in intersex and transgender studies after starting hormone replacement therapy — a testosterone blocker and estrogen — that caused her running times to dwindle. She says as a transgender woman she has taken the same medications that an intersex athlete would take to lower testosterone levels.

Transgender athletes who transition from male to female are eligible to compete in the Rio Games without gender reassignment surgery. However, they are required to maintain certain testosterone levels, while intersex athletes do not have such restrictions.

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“If you were born female, then any natural advantage is perfectly legal,” Harper says of Rio. “There’s no testing, no regulations.”

UCLA’s Vilain sees that as an unfair contradiction. “I’d fully expect a transgender athlete to challenge the rule,” he says.

If the CAS reinstates the IAAF rule next year, intersex athletes will once again face surgery or medication to alter their bodies in order to compete. That’s what Chand’s attorneys and gender activists argue is fundamentally unfair.

'A good mistake'

Martínez-Patiño’s gender test came at the 1985 World University Games. Three decades later, sports officials find themselves still struggling to define gender and detect advantage. Martínez-Patiño says her experiences as an athlete, trainer, TV commentator, scientist and professor give her a unique perspective on all this.

“I had everything taken from me, but now I have regained everything and more,” she says. “I see this through the passage of time, as someone who can see both sides — both as a scientist and someone who was affected by (gender testing). … I think this is why I’m on the medical commission, because I have such a wide perspective, perhaps way more than people who have (only a) medical point of view. I believe my opinion has a heavier weight.”

The arc of her life’s story is remarkable. “I’ve gained everything back with my position on the medical commission,” she says, voice choking with emotion. “If I had been an American, they would have made a movie about me.”

She feels a bond with Semenya and Chand. “We are three different women, at different times in history, with three different perspectives,” she says. “All three of us have been stigmatized.”

Martínez-Patiño expects an “astonishing” performance from Semenya in Rio — and controversy to match it. She sees a silver lining in all this. Instead of trial by error — which is how Harper characterizes the IAAF’s and IOC’s efforts over the past three decades — Martínez-Patiño sees Rio as “trial by fire.”

She expects these Games to provide a roadmap on how to determine rules and regulations on hyperandrongenism — by showing the world how it works without regulation.

“I have a double perspective,” Martínez-Patiño says. “The rules have basically been removed. This also provides a marvelous test. It gives us a chance to leave theory aside and focus on the practical, based on what happens in Rio. There are women from more than 200 countries and it’s very difficult to establish rules that satisfy everybody. We get to see what happens when the rules are suspended. Human beings learn from good and bad mistakes.

“This is a good mistake.”

Contributing: Jorge Ortiz