Running as equals

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Her Olympic dreams were crushed

Her vocation was derailed by unproven science

By Ivy Nyayieka, Christina Macfarlane and Jo Shelley

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As an ambitious, determined teenager, Annet Negesa urged her assemblage to tally faster, and her body, ever loyal, obliged her.

Even earlier the middle-distance runner had a coach, Negesa was qualifying for -- and winning -- large determination competitions. At 19, she would question to Daegu successful South Korea for the 2011 World Championships. After securing a top-three spot successful the 800 metre and 1500 metre categories, successful 4 planetary competitions, the Ugandan jock qualified to correspond her state astatine the 2012 London Olympics.

The pursuing year, the young pistillate from Iganga, a tiny colony successful eastbound Uganda, was named ‘Athlete of the Year’ by the Uganda Athletics Federation and seemed acceptable for a beingness successful the athletics spotlight.

That did hap -- but not successful the mode she had hoped. Much has been written each implicit the satellite astir Negesa. Not lone due to the fact that of her victories connected the track, but besides due to the fact that of what happened to her disconnected it.

'I felt my beingness is over': Negesa shares her harrowing communicative

In August 2011, portion astatine the World Championships, Negesa submitted to humor tests. According to the International Association of Athletics Federations (IAAF, present known arsenic World Athletics) this was a request for each athletes competing that year.

But Negesa says she ne'er received her trial results, and without them, beingness continued arsenic normal: With aggravated grooming for the London Games.

It was portion successful Europe, conscionable weeks earlier the competition, that Negesa would get a telephone from her manager, informing her that she could nary longer vie astatine the Olympics.

She says helium explained that the humor samples revealed levels of the hormone, testosterone, successful her humor that IAAF considered excessively precocious and that astatine the proposal of the athletics governing body, she would request to get further tests.

Negesa’s agleam aboriginal rapidly darkened from that point. She headed to a specializer infirmary successful the southbound of France, the sanction of which was provided by the IAAF. There, she underwent a aesculapian appraisal that progressive a further humor trial and an MRI scan.

Again, Negesa says she didn’t recognize what was happening, nor was she fixed immoderate paperwork. “No 1 gave maine proposal ... like: ‘If you bash this, you’ll get this later.’ No 1 explained to maine what the consequences are.”

World Athletics disputes this, saying successful an email that “Ms. Negesa and her squad were provided with the results of the tests undertaken.” The enactment besides adds that it subsequently advised Negesa by email “that it was important that a aesculapian doc successful Uganda follows up with her, and explains to her what the antithetic therapeutic options are.”

In November 2012, aft being taken to the Women’s Hospital International and Fertility Centre successful Kampala, Uganda, the past 20-year-old woke up from country to larn her interior testes had been removed.

“I woke up uncovering myself having cuts nether my belly and really, I was asking myself, ‘What happened to me? What they did to me?’”

Negesa says she had understood that she was being treated for hyperandrogenism -- the people precocious levels of testosterone her assemblage produced -- but the country was not what she’d consented to. She says: “They gave maine a proposition of going for elemental country oregon utilizing an injection [to remove] the excessive testosterone successful the body. My proposition was utilizing the injection.”

A aesculapian report, seen by CNN, states that the doctors successful Uganda “restrained from starting her connected estrogen therapy,” claiming that they were “awaiting further discussions” with an IAAF doctor.

Estrogen was indispensable for Negesa’s recovery. Retired endocrinologist Peter Sonksen has not treated Negesa but noted the value of estrogen successful treating patients similar her, saying: “Once the testes are removed, arsenic successful this case, the humor testosterone and estrogen levels autumn to zero and the jock is adjacent much hormone deficient than a post-menopausal woman.” Sonksen adds: “It is indispensable truthful to springiness estrogen 'replacement' therapy. In [its] absence, [the athlete] volition endure aggregate issues affecting astir assemblage systems.”

World Athletics told CNN it "had nary engagement successful Ms. Negesa’s treatment" and that CNN would "have to inquire [the doc successful Kampala] to explicate the notation successful this letter."

In pain, and without the after-care that she needed, Negesa’s assemblage could not execute arsenic it erstwhile did. In an relationship of her communicative published by Human Rights Watch, Negesa shared that she mislaid her assemblage scholarship, and past her manager dropped her.

Also facing nationalist scrutiny for her sex, Negesa soon fell into depression, explaining that successful Uganda, it was “very hard for a idiosyncratic similar me… an intersex person.” In 2019, she was granted asylum by the German government.

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At a way successful Berlin, successful the shadiness of the 1936 Olympic stadium, Negesa is inactive visibly stung by her experience. She tells CNN astir feeling confused astatine the find that her assemblage was antithetic from what she understood it to be, and feeling powerless and wholly unsupported arsenic her beingness unraveled. “I was inactive a teenager, had nary prime due to the fact that I had a emotion of the athletics ... and they knew each the consequences which would travel retired from them.”

Referring to the IAAF, she adds: “They violated my rights arsenic a quality being. They treated maine similar a guinea pig.”

The infirmary declined to comment, citing confidentiality. In an email to CNN, World Athletics says: “The IAAF hyperandrogenism regulations authorities that the attraction indispensable beryllium prescribed by a doc who is autarkic from the IAAF, and that the IAAF is successful nary mode progressive successful the process. Under nary circumstances whitethorn the jock beryllium forced to acquisition immoderate circumstantial treatment.”

In 2013, arsenic Negesa struggled to travel to presumption with what had happened to her, successful neighboring Kenya, Maximila (Max) Imali was learning that diversion occurrence could assistance her and her household retired of a beingness of poverty.

She remembers her precocious schoolhouse manager encouraged her to bid for the 800m race, alternatively than the sprints, telling her: “You spot that you tin marque your household beryllium connected different level of living.”

“I conscionable wanted to tally bully truthful that I tin provender them,” Imali says of her family: Her mother, 2 siblings, and 2 orphans she besides provides attraction for. “I was truthful motivated.”

In July 2014, Imali got a accidental to vie astatine the World Junior Championships successful Oregon. “It was my archetypal clip to spell to specified a large race,” she recalls. “And aft that, I realized that I tin bash good.”

She excelled successful the heats but fell successful the finals of the 800m event.

“After I came backmost home, [I] sat and discussed with the manager however I tin amended and what is the champion happening for maine to do, truthful that I tin bash bully successful 800m and 1500m,” she says.

But Imali didn’t get that chance. The young woman, who was rapidly gaining nationalist and planetary recognition, besides got caught successful the crosshairs of IAAF regulations.

Once successful Kenya, Imali says she received a telephone from an authoritative with Athletics Kenya, telling her: "Maximila, they privation you to beryllium tested from the IAAF.”

So, Imali took a matatu minibus from Eldoret to a infirmary successful an upscale Nairobi vicinity for a humor trial and a carnal examination.

Consistent with Negesa’s account, Imali says she was fixed small accusation astir the procedures oregon their consequences. Referring to the hospital’s physicians, she says: “They did not archer maine thing concerning my body. After we did each examination, they were conscionable putting the results successful the envelope. Then they instrumentality that envelope to Athletics Kenya."

It would beryllium respective months earlier Imali would larn from her manager, implicit a telephone call, that she would not beryllium allowed to vie successful the 800m category.

She says she was told: “Max, you cannot tally due to the fact that you person precocious testosterone successful your blood.” He went connected to database each the races she could not vie successful and shared a missive from IAAF explaining the regulations.

Weighed down by the questions astir her sex individuality that the assessments had thrown up, Imali went to talk to her mother. What she heard reassured her. “For me, I've been raising you similar a miss from the commencement erstwhile you were born, and that is it. I cognize you are a girl,” she recalls her parent saying.

But Imali says that being rejected for however God made her, arsenic good arsenic the questions astir her sporting, aboriginal each took a toll connected her mother’s health, and successful September 2016, Eunice Khaleha died.

“My ma was hospitalized due to the fact that of me, due to the fact that of the pressure,” Imali says, her dependable filled with sorrow and regret. “She died due to the fact that of me. It inactive affects maine due to the fact that I ever consciousness that I'm the origin of her death.”

Many sporting events, from way and tract to gymnastics, swimming to basketball, are divided according to a binary separation of genders. Modern aesculapian statement notwithstanding, arsenic acold arsenic overmuch of the sports satellite is concerned, determination are lone 2 recognized categories: Men and women.

However, Negesa and Imali some person -- oregon had -- levels of testosterone that their sports’ governing assemblage officials deemed excessively precocious for immoderate of the women’s competitions.

World Athletics present has a acceptable of rules for athletes with what it calls differences of enactment improvement (DSD), requiring them to little the people occurring levels of testosterone successful their humor to 5 nanomoles per liter of humor (5 nmol/L) done medicine oregon country if they privation to vie successful definite races.

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Non-compliance means that athletes with DSD cannot vie successful events specified arsenic the 400m oregon 800m races enactment connected by World Athletics.

Most high-profile among the athletes affected by the DSD regulations is South African runner and Olympic champion Caster Semenya, whose long-fought legal battle to beryllium capable to vie successful the 800m lawsuit is presently earlier the European Court of Human Rights.

After her lawyers filed their suit to the tribunal connected February 25, Semenya tweeted: “This combat is not conscionable astir me, it's astir taking a basal and warring for dignity, equality and the quality rights of women successful sport.”

While Semenya’s quality with World Athletics is over a decennary old, the combat to vie connected adjacent presumption goes backmost astir a century.

After overmuch absorption (the laminitis of the modern Olympics movement, Baron Pierre de Coubertin, was against the inclusion of women successful the Games), women’s information successful athletics began to turn aboriginal successful the 20th century. As contention successful the women’s class intensified, the bodies of athletes -- and successful particular, palmy ones -- were scrutinized.

      • Scrutiny of women's bodies has played retired successful the nationalist oculus astatine slightest since the 1930s, arsenic women's athletics gained greater visibility. Ahead of the 1936 Berlin Olympics, erstwhile International Olympic Committee (IOC) President Avery Brundage advocated for systematic aesculapian examinations of athletes competing successful women's events.

        At the 1936 Games, 100m golden medalist Helen Stephens was accused of being a man. The American runner underwent -- and passed -- the archetypal enactment trial administered astatine an event. She is pictured present (left) with Poland’s Stella Walsh, the 100m metallic medalist.

      • The archetypal systematic enactment tests took spot astatine the 1966 European Athletics Championships successful Budapest, wherever women underwent a ocular introspection of the genitals and secondary intersexual features, carried retired by a sheet of 3 women doctors. The exams person been referred to arsenic "nude parades."

        "You had to spell successful and propulsion up your garment and propulsion down your pants," said Maren Sidler, an American shotputter astatine the 1967 Pan-American Games successful Winnipeg. "I retrieve 1 of the sprinters -- a tiny, skinny miss -- came retired shaking her caput backmost and distant saying, ‘Well, I failed. I didn’t person capable up top.'”

      • Polish sprinter Ewa Klobukowska, an Olympic golden medalist, failed a enactment trial astatine the 1967 European Cup successful Kiev. It included a chromosomal trial aft a ocular exam was determined to beryllium ambiguous.

      • The IOC introduced Barr assemblage investigating astatine the Mexico City Olympics, calling it “simpler, nonsubjective and much dignified.” The trial was based connected cells collected from the wrong of athletes' cheeks and was thought to bespeak an athlete's chromosomal makeup.

        Medical experts present knock the Barr assemblage trial arsenic inaccurate and harmful; failing to admit the complexity of factors that find sex.

      • Spanish hurdler María José Martínez-Patiño was banned from contention successful 1985 aft a trial revealed a Y chromosome. She was reinstated 3 years later, aft proving she had implicit androgen insensitivity, meaning her assemblage doesn’t respond to testosterone.

      • The International Association of Athletics Federations (IAAF) ended mandatory enactment investigating successful 1992 and the IOC dropped broad investigating successful 1999 -- but they continued to behaviour aesculapian evaluations connected a case-by-case basis.

      • South Africa's Semenya won the 800m astatine the World Championships successful Berlin successful 1:55.45. Afterwards, the IAAF required Semenya to acquisition a "gender verification" process. The ANC -- South Africa's ruling enactment -- called the tests "sexist and racist."

      • The IAAF released caller regulations declaring that an jock could lone vie successful women’s events if her testosterone levels were beneath 10 nmol/L, unless she had "androgen resistance."

      • The rules were suspended for 2 years by CAS aft a ineligible situation by Indian sprinter Dutee Chand, who had been banned from contention due to the fact that of her people precocious testosterone levels. CAS cited a deficiency of grounds connected the narration betwixt testosterone levels and improved diversion show successful women.

      • Free to vie aft the 2015 CAS decision, Semenya won golden successful the 800m astatine the Rio Games successful 1:55.28. Burundi's Francine Niyonsaba and Kenya's Margaret Wambui -- who would besides beryllium affected by aboriginal rules connected earthy testosterone levels -- instrumentality location the metallic and bronze.

      • World Athletics, formerly the IAAF, introduced caller regulations for mediate region races from 400m to a mile: women with "sufficient androgen sensitivity" and testosterone levels of 5 nmol/L and supra indispensable trim their levels done medicine oregon surgery.

        Semenya appealed the regulations to CAS -- and mislaid the landmark case. In bid to conscionable existent World Athletics standards, she volition person to trim her testosterone levels if she wants to contention the 800m again.

Source: Historical paper clippings (Time magazine, LA Times, Harrisburg Telegraph), Endeavour, JAMA, Journal of the Royal Society of Medicine, YaleNews, Lancet, World Athletics, South African Government, Olympics.com, Court of Arbitration for Sport (CAS)

The attraction didn’t travel exclusively from the sporting bodies. Media commentators implicit the decades person helped peddle a constrictive imaginativeness of what it means to beryllium -- and to look similar -- a woman.

Three days aft the opening of the Rome Olympics successful 1960, William Barry Furlong, reporting for The New York Times, wrote a portion entitled “Venus Wasn't a Shot-Putter,” successful which helium reflected: “More and much of the just enactment are competing successful sports, raising a profound question: Do men marque passes astatine diversion lasses?”

As “gender-normalizing” surgeries became much common successful the Global North, and much athletes from the Global South person travel to predominate successful way and tract events, it is Dutee Chand, Maximila Imali, Annet Negesa and Caster Semenya -- among others -- who person travel into the media spotlight and nether World Athletics’ watchful gaze.

“World Athletics wants to admit radical nevertheless they identify,” World Athletics’ ineligible counsel, Jonathan Taylor, tells CNN. “The occupation with that is, connected the sports field, we've already established that determination has to beryllium a favoritism betwixt antheral and pistillate contention successful bid to beforehand fairness and equality.”

He continues: “Once you've decided that, erstwhile you've drawn a line, you person to classify radical and that means deciding wherefore the enactment is drawn.”

Maximila Maximila Imali competes successful the women's 400m semifinals successful the Gold Coast 2018 Commonwealth Games. Cameron Spencer/Getty Images

Taylor positions World Athletics arsenic being successful a bind: Needing to measurement successful connected an contented it would alternatively not person to, but must, successful bid to instrumentality away, arsenic helium puts it, the “enormous, insuperable vantage that's conferred by these higher testosterone levels'' successful events specified arsenic the 400m, 800m, 1500m and 400m hurdles races -- each of which World Athletics classified arsenic “restricted events” successful 2019.

“If you person idiosyncratic with a pistillate sex identity, but XY testes and antheral levels of testosterone, you person to determine what to do. You could say: ‘You cannot vie successful the pistillate category’, which World Athletics does not privation to do, due to the fact that it wants to admit and admit the sex identity. So instead, they accidental you person to driblet your testosterone down to the aforesaid levels arsenic each the women and each the different women successful the category,” helium says.

Contrary to Taylor’s claim, “all women'' successful the class bash not person the aforesaid testosterone level.

Under World Athletics’ rules, an jock with polycystic ovary syndrome, for example, tin vie contempt having precocious testosterone due to the fact that they person XX chromosomes and nary testes. Athletes with precocious testosterone levels whose bodies bash not respond to the hormone tin besides vie successful the restricted categories.

And truthful World Athletics, successful truthful doggedly guarding the enactment it has drawn, has positioned itself arsenic an arbiter of what it means to beryllium a pistillate successful sport. Taylor says it's done "to beforehand fairness and equality.” But the rules are based connected technological probe that is heavy contested.

“There is bully grounds to amusement musculus bulk increases with expanding dosage of testosterone,” Sonksen, who has previously spoken retired successful enactment of Semenya, said successful an email to CNN, but adds that the narration betwixt humor testosterone level and show remains “complex and controversial”.

“Measuring humor testosterone level gives immoderate denotation of the magnitude that is produced and testosterone does summation protein, frankincense musculus synthesis, but [the hormone’s] enactment is regulated besides by different factors,” helium explains.

“[World Athletics] are trying to refine further and further arsenic the policies travel nether scrutiny. But the subject is inactive precise overmuch contested,” says Katrina Karkazis, anthropologist and co-author of ‘Testosterone: An Unauthorized Biography’, a 2019 publication which sets retired to debunk immoderate of the myths astir the hormone.

When it comes to diversion performance, Karkazis and her co-author, Rebecca M. Jordan-Young, constitute astir studies that person linked precocious earthy testosterone to velocity and power, studies that recovered nary link, and yet others which amusement the converse to beryllium true: High testosterone starring to worse performance.

Karkazis told CNN that the deficiency of conclusive grounds hasn’t stopped World Athletics from forming its policies. She cites, by mode of example, a ruling by the Court of Arbitration for Sport (CAS) which states that successful the 1500m and 1 mile races, the grounds of existent important diversion vantage “could beryllium described arsenic sparse.” CAS recommended that “The IAAF whitethorn see deferring the exertion of the DSD regulations to these events until much grounds is available.”

“Even erstwhile the grounds wasn't there, [World Athletics] decided to see it and modulate it anyway,” says Karkazis.

Not lone are these regulations -- introduced and enforced without statement from crossed the technological assemblage -- being framed arsenic bully for the games, Taylor, speaking for World Athletics, besides suggests that they are bully for athletes with DSD.

“We're not stopping radical from competing,“ Taylor tells CNN. “We are trying to facilitate their competing” earlier adding: “One of the benefits of the regulations is that you place and diagnose and dainty DSD conditions arsenic well.”

But determination is progressively vocal pushback from parts of the medical community, parents and intersex radical themselves, saying that being intersex isn’t a aesculapian “problem” to beryllium “solved” immoderate much truthful than being calved antheral oregon pistillate is one.

At the past Olympics -- the 2016 Rio Games -- Caster Semenya, Burundi’s Francine Niyonsaba, and Kenya’s Margaret Wambui took the gold, metallic and bronze medals respectively successful the 800m race.

This year, successful Tokyo, nary of these women volition beryllium competing successful that class -- each 3 impacted, they say, by World Athletics’ rules regulating testosterone successful women.

In its pursuit of fairness, affected athletes and activists alike accidental that World Athletics has itself been profoundly unfair.

Speaking to CNN from London, world and athletes’ rights advocate, Payoshni Mitra, says: “Rules could beryllium indispensable successful sport, but those rules should besides guarantee information of athletes. No rules should pb to quality rights violations, and these rules are starring to quality rights violations of athletes.”

Burundi's Burundi's metallic medal victor Francine Niyonsaba, left, Kenya's bronze medal victor Margaret Wambui, right, and South Africa's golden medal victor Caster Semenya observe aft the women's 800m last during the 2016 Summer Olympics successful Rio de Janeiro, Brazil. Martin Meissner/AP

For Mitra, World Athletics’ rules aren’t conscionable sexist, they are besides racist. “It intelligibly seems to beryllium racist policy,” she says. “We person women's bodies from the Global South -- brownish women, Black women -- successful sport. Their bodies person been scrutinized much and more. It's a information which they cannot deny.”

Taylor denies this, countering: “What we're trying to bash is guarantee a level playing tract for each women -- of immoderate colour -- truthful that they tin each purpose to excel.”

The South African authorities didn’t spot it the aforesaid way, with the then-Minister of Sports, Tokozile Xasa, weighing successful to lend enactment to Semenya aft World Athletics projected caller regulations successful 2019: “Women’s bodies, their wellbeing, their quality to gain a livelihood, their precise identity, their privateness and consciousness of information and belonging successful the world, are being questioned.”

And so, from Mitra’s perspective, it is hard to recognize World Athletics’ “adamant” absorption connected DSD regulations erstwhile determination has already been truthful overmuch suffering, truthful overmuch astatine involvement for the idiosyncratic athletes, truthful overmuch to lose, and truthful overmuch other for the sporting satellite to address.

“Why they're truthful adamant astir these regulations is truly hard to understand, fixed that determination are truthful galore different problems successful the sport. Doping is specified a immense occupation successful athletics. If you look astatine issues concerning information of women, intersexual harassment and abuse, these are specified important issues successful athletics contiguous … [World Athletics’ leaders] conscionable privation these radical to go. They conscionable privation a purified conception of women's class without immoderate of these athletes … What World Athletics thin to hide is athletes are quality astatine the extremity of the day."

What those athletes accidental they privation much than thing is to bash what they love, without peculiar scrutiny oregon restriction. They privation to tally arsenic equals.

Imali, who is astatine location successful Kenya and continues to bid for the 100m and 200m sprints, is resolute: “God wanted maine to beryllium the mode I am.”

As for Negesa, she has returned to the way aft astir a decennary and is allowing herself to imagination erstwhile again of Olympic glory: “I conscionable commune to God that I proceed doing improvements each time truthful that I fulfil my dream. It was snatched from maine successful 2012 ... I don't privation to miss it again.”

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