The Court of Arbitration for Sport ruled Wednesday that two-time Olympic champion Caster Semenya, and female runners like her, must take medications to suppress testosterone output.

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An organization referred to as the supreme court of international sports has ruled against the controversial female track athlete Caster Semenya. The Court of Arbitration for Sport says Semenya, a two-time Olympic champion from South Africa, has to take medication to reduce her testosterone levels if she wants to keep competing in her preferred running events.

Semenya has been at the forefront of a debate about gender and sport. NPR’s Tom Goldman reports.

TOM GOLDMAN, BYLINE: Caster Semenya exploded on the track and field scene with a dominating 800-meters win at the 2009 World Championships. Since then, her athletic career has been clouded by questions about her power and speed and her gender.

Her lopsided victories, muscular build and deep voice led track and field’s international governing body, the IAAF, to ask her to take a sex test. The official results were never revealed, but leaked information said she had what’s called an intersex condition, where she has much higher testosterone levels than most women.

Semenya has been a lightning rod on the issue of sex-gender in sport. She’s been the subject of humiliating criticism. And last year, an IAAF decision threatened her future as an athlete.

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UNIDENTIFIED REPORTER: The athletics world body controversially ruled that the testosterone levels of female middle-distance runners should be restricted. The rule will apply to women in track events from the 400-meters up to a mile.

GOLDMAN: Semenya appealed the rule, and now the Court of Arbitration for Sport, or CAS, has rejected her appeal. CAS fully admits the testosterone restrictions discriminate against one group of women to protect another group and that discrimination is necessary. The IAAF says it’s grateful for the decision and says it’ll preserve the integrity of female athletics in the events covered by the rule.

Among those upset by the decision, Professor Roger Pielke.

ROGER PIELKE: Clearly, scientific integrity was a loser in this case.

GOLDMAN: Pielke directs the Sports Governance Center at the University of Colorado in Boulder. He describes himself as a scholar who studies the use and misuse of science in decision-making. Last year, his center published a paper criticizing the testosterone regulations.

Prior to coming up with the rule, IAAF was asked to show the performance advantage female athletes with higher levels of testosterone had over female athletes with lower levels. Pielke says the data he reviewed was, in his words, garbage.

PIELKE: Didn’t match up to performances. There was repeated data, phantom data. And in any data set where you have that many flawed data points, it’s enormously problematic for coming up with a robust conclusion.

GOLDMAN: Semenya’s lawyers reportedly are mulling another appeal. In a statement, Semenya said the CAS ruling won’t slow her down but will make her stronger. Over the years, Semenya hasn’t said much publicly about the controversy. After she won the 800-meters at the 2016 Olympics, she alluded to it as she spoke about the unifying power of sport.

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CASTER SEMENYA: It’s all about loving one another. It’s not about discriminating people. It’s not about looking at people – how they look, how they speak. You know, it’s not about being muscular. It’s all about sport.

GOLDMAN: Now the 28-year-old track star has to decide what her future is in sports – whether to comply with the rule and start taking medication to reduce her testosterone level or perhaps competing in a running event not covered by the rule. And while she mulls her decision, the debate surrounding her dominating and controversial career is unlikely to end anytime soon. Tom Goldman, NPR News.

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