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South African runner Caster Semenya won the women's 800m at the Rio Olympics in the fifth fastest time in Olympic history. Her win, and the from the runners she beat, has drawn renewed attention to the problems facing international sports bodies as they struggle to maintain strict segregation by biological sex.

The problem is science. Despite widespread belief in a clear dichotomy between “male” and “female” there is, in fact, no clear dividing line.

Women first took part in international sporting competitions from the early 20th century and from the start were widely derided as “masculine”. At the Berlin Olympics in 1936, Polish sprinter Stella Walsh was openly accused of being a man when she won the 100m sprint in record time.

By the 1940s, international sports administrators began requiring female competitors to provide medical certificates verifying their biological sex.

In 1966, international bodies took over “gender testing” themselves, no longer trusting certificates provided by team doctors. Women athletes were obliged to expose their genitals before a panel of doctors in “nude parades” before being allowed to compete.

By the late 1960s, the International Olympics Committee (IOC) and International Association of Athletics Federations (IAAF) were pressured to dump the degrading nude parades and introduce a new “gender verification” strategy: a chromosome test by buccal (mouth) swab.

In 1985, 24-year-old Spanish hurdler Maria Jose Martinez Patino was told the night before her event at the World University Games in Japan that she had “failed” the sex test because she carried an XY chromosome. “Further investigation” revealed the exterior of her body was “fully female”.

Despite huge pressure to withdraw, Patino ran her race and won. Someone then leaked her test results and she was disqualified and thrown off the Spanish national team. Even her boyfriend abandoned her.

But Patino became the first athlete to challenge the chromosome test. She argued that the XY chromosome provided no athletic advantage because, although her body produced higher than average levels of testosterone for a woman, she also had a genetic condition such that her body could not make use of it.

The IAAF agreed and reinstated her — but she never competed in the Olympics.

The IOC and IAAF now admit that the presence of an XY chromosome does not necessarily determine biological sex and that many unsuspecting female athletes were unfairly, and cruelly, disqualified as a result of “failing” a buccal swab in the decades it was mandated.

“Gender verification” by buccal swab was dropped in the 1990s and replaced by hormonal screening for “hyperandrogenism” (high testosterone) where athletes were reported for, or suspected of, being “too masculine”.

Just how much testosterone makes you a man is highly contested. The “average female range” is reportedly 1.0 to 3.3 nanomoles per litre of blood, about one tenth of the average male range. By some method of scientific and political consensus, the IAAF and IOC have settled on a threshold of 10 npl, above which women athletes will be disqualified — unless they reduced it by hormone treatment and/or surgery.

In 2012, four young women athletes from a colonised country (whose identities were kept secret) were subjected to extensive testing by European endocrinologists. The women were “diagnosed” with a rare “disorder of sex differentiation” — SDRD5A2 — resulting in ambiguous genitalia, internal testes and higher than average testosterone levels.

In a in the Journal of Clinical Edocrinology and Metabolism the doctors concluded: “[O]ur 4 athletes wished to maintain their female identity and had many questions about menstruation, sexual activity, and child-bearing.

“Although leaving male gonads in SDRD5A2 patients carries no health risk, each athlete was informed that gonadectomy would most likely decrease their performance level but allow them to continue elite sport in the female category.

“We thus proposed a partial clitoridectomy with a bilateral gonadectomy, followed by a deferred feminizing vaginoplasty and estrogen replacement therapy, to which the 4 athletes agreed after informed consent on surgical and medical procedures. Sports authorities then allowed them to continue competing in the female category 1 year after gonadectomy.”

In other words, they were advised to submit, and did submit, to extensive surgery and hormone therapy despite the fact that they were healthy — indeed unusually fit — women in order to be allowed to compete in international sports competition.

In March last year, the international Court of Arbitration for Sport (CAS) — the Supreme Court for sports disputes — upheld a legal challenge to the IAAF's testosterone policy by Indian sprinter Dutee Chand.

Chand and her expert witnesses argued, successfully, that the policy was discriminatory and should be rescinded because there is insufficient evidence that naturally produced testosterone provides any significant competitive advantage.

The said: “Chand's witnesses also pointed out that researchers had identified more than 200 biological abnormalities that offer specific competitive advantages, among them increased aerobic capacity, resistance to fatigue, exceptionally long limbs, flexible joints, large hands and feet and increased numbers of fast-twitch muscle fibers — all of which make the idea of a level playing field illusory, and not one of which is regulated if it is innate.”

As a result, women athletes including, Semenya and Chand, were not subjected to hormone testing in Rio. But the battle is not over. In the wake of Semenya's gold medal win, IAAF president they intend to challenge the CAS decision.

To do this, they will need to bring evidence to support their claim that there is a sex binary, or that people who don't fit either category should not be permitted to take part in sporting competitions.

Defenders of a strict gender binary, in sport and in society in general, have much at stake here and are under pressure. The argument has long been framed as being about “fairness”. Yet it is clearly not fair that athletes from rich imperialist countries enjoy such huge competitive advantage over those from the impoverished South.

The Olympics are not “fair” — they are a ruthless, pitiless competition, and perhaps that is the real problem.

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