[5] The 2011 IAAF 'hyperandrogenism policy' stated that: The policy mentioned a three step process, the first a physical examination 'including clinical signs of virilization (physical appearance, deepness of voice, body hair etc), genital characteristics (clitoral hypertrophy)', the second a hormone test, principally the androgenic sex steroids, but also possibly other hormones, and the final stage a full genetic test.
An athlete would be eligible to compete if her testosterone level was below 10 nmol/L, or if she could prove that 'she has an androgen resistance such that she derives no competitive advantage'.
This shows that the recent decision of the IOC and IAAF to limit participation in elite events to women with a 'normal' serum testosterone is unsustainable."
These regulations stated that "intersex female sports persons with elevated androgen production give rise to a particular concern".
A case was filed with the Court of Arbitration for Sport,[11] and it was found that the IAAF and Indian authorities had failed to prove that the regulations were proportionate, fair and necessary.
The suspension of the IAAF test for testosterone levels led to controversy in the Rio 2016 Olympic Games,[12] in particular related to the participation and performance of South African middle distance runner Caster Semenya.
This brought into question the legitimacy of the silver and bronze medallists who were suspected of also having XY-specific Differences of Sexual Development (DSD) like Semenya.
[13][14] The 2015 interim CAS ruling gave the IAAF two years to find evidence that endogenous (as distinct from exogenous, aka doping) testosterone is a benefit to female athletes.
The IAAF also revealed that: "The DSD Regulations expressly and emphatically stress that they do not connote any judgment or questioning of an individual's sex or gender identity.
Despite this, the IAAF revised the rules[24] to exclude the XX DSD CAH, and released an accompanying statement[25] and FAQ[26] explaining that the regulations ONLY apply to individuals with XY DSDs and testes.
[34] In November 2020 Semenya announced that she will file an appeal against the IAAF testosterone rule at the European Court of Human Rights.
[36] At the 2020 Olympics a number of athletes, all from African countries, were withdrawn from their events because they did not meet the eligibility regulations:[37][38] The three 400m runners switched to the 200 m, where Mboma won the silver medal, with Masilingi also reaching the finals, while Seyni was eliminated in the semi-finals.