Anja Niedringhaus, AP
South Africa's Caster Semenya celebrates after winning the gold medal in the final of the women's 800m during the World Athletics Championships in Berlin on Wednesday, Aug. 19, 2009.
If, as the study shows, in certain events female athletes with higher testosterone levels can have a competitive advantage of between 1.8-4.5 percent over female athletes with lower testosterone levels, imagine the magnitude of the advantage for female athletes with testosterone levels in the normal male range. —Dr. Stephane Bermon

The world is struggling with a lot of strange, complicated issues, but few are more complex than the one that is shaping up in sports: What, if anything, do you do about female athletes who produce testosterone in the male range — a condition known as hyperandrogenism?

The issue has become another showdown for rights — but for whom? Female athletes or hyperandrogenous/transgender women? It’s a confrontation that pits political correctness versus political correctness.

The World Track and Field Championships will begin in London next week, and once again Caster Semenya, the controversial intersex athlete from South Africa, will return to compete in the 800-meter run. Last summer Semenya won the gold medal at the Rio Olympics. The next two places were taken by Burundi’s Francine Niyonsaba and Kenya’s Margaret Wambui, who are also believed to be intersex athletes.

If officials at the International Association of Athletics Federations had their way, Semenya would’ve been sidelined or medicated years ago. After she won the 2009 World Championships by a whopping 2½ seconds, the IAAF ordered her to undergo gender testing and then banned her from competition.

The IAAF reluctantly cleared her return less than a year later, but in 2011 the federation established limits on testosterone for female athletes and required those who exceeded those limits to take medication to reduce testosterone levels. Ironically, a sport that had tried to rid its sport of drug use was now ordering certain athletes to take drugs.

It's unknown if Semenya took the medication, but her times changed dramatically — from a best of 1:55.45 in 2009, to 1:56.35 in 2011, 1:57.23 in 2012, 1:58.92 in 2013, 2:02.66 in 2014.

In July 2015, the Court of Arbitration for Sport (CAS) suspended the IAAF rules for two years to allow time to study the issue. Those two years are up, and the results of the IAAF study are in. The research, which studied 2,127 male and female athletes from the 2011 and 2013 World Championships, shows that women with high levels of testosterone have a “significant competitive advantage” — a 1.8 to 4.5 percent advantage to be precise. That might not sound like much, but in the 800 that would mean up to 5 seconds. The research doesn’t even consider women with testosterone levels in the male range.

"If, as the study shows, in certain events female athletes with higher testosterone levels can have a competitive advantage of between 1.8-4.5 percent over female athletes with lower testosterone levels, imagine the magnitude of the advantage for female athletes with testosterone levels in the normal male range," Dr. Stephane Bermon said.

The research will be presented to the CAS this month in an attempt to overturn its ruling of 2015. Meanwhile, Semenya, Niyonsaba and Wambui will run in the World Championships.

Several female athletes condemned the presence of intersex athletes in women’s competition, but nobody summed up the situation better after the CAS reversed the IAAF suspension than medical physicist Joanna Harper, who told USA Today, “This is a huge human rights victory, but sports, not so much.”

Harper is uniquely qualified to address this subject. She was a transgender athlete before she became a scientist and underwent hormone therapy to reduce testosterone levels. She favors some restrictions on intersex athletes.

“While human rights advocates are deliriously happy over the CAS ruling, those who love women’s sport are mortified,” Harper said in a Q&A with exercise physiologist Ross Tucker. “… Allowing these athletes to compete in women’s sport with their serious testosterone-based advantage threatens the very fabric of women’s sport.”

It’s a complex and sensitive issue. Some of the intersex athletes have been vilified, but they have done nothing wrong. Unlike steroid users, they have not elevated their levels of testosterone with drugs; they were born with elevated levels of testosterone. But the question of fairness remains.

Women’s sports were created to provide them with a level playing field because they could not keep up with testosterone-fueled men. Women’s sports have flourished, but what happens if hyperandrogenous women and transgenders compete in women’s sports?

It could be argued that hyperandrogenous women — who have a natural predisposition to high levels of testosterone — simply enjoy a natural competitive advantage similar to other more recognized advantages in other athletes — narrow hips, slender body types, height, a superior neuromuscular system, a high V02 max, long legs, etc. Should Usain Bolt be penalized because he is 6-foot-5 and has the neuromuscular system of a small man?

Blessed with high levels of testosterone, male athletes have superior cardiovascular systems, longer and larger bones and stronger ligaments, more muscle mass and so forth. Testosterone creates a wide gulf between male and female athletes. John McEnroe got in trouble because he said Serena Williams, the women’s tennis champion, would rank 700th on the men’s tour — but that was actually generous.

Former track star Sonia O’Sullivan, writing in the Irish Times recently about hyperandrogenism in her sport, noted in an aside, “… if Williams was ranked 700th in the world (among men), she’d be doing well compared to Semenya, who would barely make the top 8,000 runners over 800m, and the world record would only come in around 5,000 mark.”

The point is, since testosterone creates an immense advantage, what happens when a female has a male’s body chemistry?

More irony: Semenya, the 2016 Olympic champ, placed second to Russia’s Mariya Savinova in the 2012 Olympics — until a retest late last year revealed she had used performance-enhancing drugs and her gold medal was awarded retroactively to Semenya. Savinova reportedly used steroids — which raises the levels of testosterone, the very thing that Semenya produces in abundance naturally.