Sex, Drugs and Athletics: Should female athletes like Caster Semenya be required to take drugs to lower their performance levels?

By Sebastian Jon Holmen, Thomas Søbirk Petersen and Jesper Ryberg

The South African middle-distance runner Caster Semenya, former winner of two Olympic gold medals, recently participated in the 2022 World Athletics Championships. Semenya was permitted to run in the women’s 5,000m competition, where she did not qualify for the final. However, she was not allowed to participate in her favorite discipline, the 800m race, because World Athletics (WA), the international governing body for athletics, believes it would be unfair for her to compete over that distance unless she takes medication to reduce her testosterone level. As a result of a disorder of sex development (DSD) Semenya produces more testosterone than most other women. However, is it fair to treat her, and other female athletes with DSD, like this? Has the WA offered persuasive reasons supporting such treatment? In our article ‘Leveling (down) the playing field: Performance-diminishments and fairness in sport’ we argue that it has not yet done so, and that this restriction on female DSD athletes is unfair for several reasons.

One source of unfairness here is the fact that male athletes with huge competitive advantages conferred by their genetic inheritance, such as the swimmer Michael Phelps, have not been required to use performance-diminishing drugs in order to compete. Is there something special about testosterone levels, then? Is there something about them that makes it more reasonable to demand that they (unlike other advantageous characteristics) be reduced? In our view, it is hard to see how they could be regarded as special in this way, and in our paper, we reject one account purporting to explain why testosterone levels are more significant than other biological advantages.

We also argue that the conclusion of the WA’s fairness-based argument – namely, that athletes with heightened levels of blood testosterone should use drugs to lower these levels – is not adequately supported by its premises. Specifically, we demonstrate that the fairness-based argument would equally well support the view that athletes with blood testosterone levels within the normal range should be allowed to use drugs to heighten their testosterone levels.

In 2021, Semenya filed an appeal to the European Court of Human Rights (ECHR) in an attempt to outlaw what she calls a discriminatory testosterone limit imposed on female athletes. The Court has yet to give its verdict. The conclusion it arrives at is one we are waiting for. It is also one that will be, not only interesting for scholars of medical ethics, but also be important in determining which athletes are allowed to compete in women’s sport. On the other hand, we believe the critical analysis set out in our paper shows that, regardless of the outcome of the ECHR hearing, the WA will be on ethically shaky ground if it chooses to continue to require athletes like Semenya to reduce their level of testosterone in order to be able to compete.


Paper title: Leveling (down) the playing field: Performance-diminishments and fairness in sport

Author(s) (do not include qualifications): Sebastian Jon Holmen, Thomas Søbirk Petersen and Jesper Ryberg

Affiliations: Department of Philosophy and Science Studies, Institute for Communication and Arts, Roskilde University, Denmark

Competing interests: None

Social media accounts of post author(s): Thomas Søbirk Petersen FB:

Sebastian Jon Holmen FB:


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