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“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 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.

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For instance, left-handed baseball players against right-handed baseball players.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. 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.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. She won the 400-, 800- and 1500-meter runs — all on the same day — at the South African championships.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.

“We were all shocked,” Harper says, at the outcome.

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?

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.

It’s a compromise of trying to protect female athletes and also giving intersex and transgender athletes the chance to compete. She says as a transgender woman she has taken the same medications that an intersex athlete would take to lower testosterone levels.