26th October 2019

PTG2019: Flaws in the IAAF’s response to Semenya presentations

One of the most powerful sessions at Play The Game 2019 involved Russian whistleblower Vitaly Stepanov alleging that film maker Bryan Fogel was ‘stretching the truth’ regarding the credibility of Dr. Grigory Rodchenkov, former Director of the Moscow Laboratory, as a ‘whistleblower’ due to his involvement in doping Russian athletes. I was involved in another powerful session discussing Caster Semenya’s challenge to the International Association of Athletics Federations’ (IAAF) Differences of Sex Development (DSD) Regulations at the Court of Arbitration for Sport (CAS).

During questions, I was amazed to hear an IAAF lawyer level accusations against the Conference organisers, myself, Roger Pielke Jr., and Madeleine Pape. These accusations were that the IAAF was not invited to present its view at the Conference; and that we had said that the IAAF performed surgery on young athletes under its Hyperandrogenism Regulations, which preceded the DSD Regulations. Neither claim is correct.

The IAAF was invited on more than one occasion to take part in the Panel Session, entitled ‘The Semenya case: what it means to athletes’. I didn’t say that the IAAF had performed surgery on athletes. Pielke Jr. only said that the French authorities were investigating allegations that the IAAF performed surgery on athletes. Pape didn’t say that the IAAF had performed surgery on athletes.

As such, I approached the IAAF lawyer, who had presumably been flown to Colorado Springs not to take part in the debate, but to watch and criticise. They apologised for suggesting I had said that the IAAF performed surgery on athletes, adding that they had only been following the case for eight months. 

There are historic reasons why I would never suggest that the IAAF performed the surgery. But the fact is that four young athletes were offered surgery by physicians who were implementing the Hyperandrogenism Regulations, and were told that surgery would help them lower their testosterone and allow them to continue competing in the IAAF’s female category, ahead of the London 2012 Olympics. 

The IAAF may not have wielded the surgeons knife, but the doctors who operated on them were implementing IAAF Regulations. More on this later.

I was even more shocked to see a four page Response from the IAAF to our presentations being distributed to delegates the next day. In my opinion, the IAAF’s Response is also guilty of stretching the truth. I will explain why I have come to this conclusion below.

Speakers claimed that the CAS was ‘somehow incompetent’ to rule on Semenya’s challenge

This would be a ridiculous argument to make. The IAAF’s Response said that the panelists had argued such a point. We didn’t.

There is no question that most of those involved in Semenya’s case were more than competent to take a decision on her challenge to the DSD Regulations. What I said, in my presentation (see the References at the foot of this article for a video and link), was that the CAS allowed the IAAF to change the DSD Regulations both before and after the hearing, which illustrates why athletes should not take human rights grievances to the CAS. Pielke Jr. argued that most courts of law would throw the case out because of such amendments.

In support of its strange argument that the CAS was indeed competent to rule on Semenya’s challenge, the IAAF points out that at the end of the hearing, Semenya’s team acknowledged that they had been given a fair hearing. That wasn’t ever in dispute. But Semenya’s team did dispute what the CAS had been instructed to rule on. Semenya’s team contested the IAAF’s amendments to the DSD Regulations both before, during and after the hearing, as well as its view that the focus of its argument had changed.

The IAAF Response acknowledges that it amended the DSD Regulations five weeks before the hearing, whilst contesting Pielke Jr.’s claim that it rewrote the Regulations on the eve of the hearing. It argues that the only change made to them was the removal of Congenital Adrenal Hyperplasia (CAH) from their scope (note: this is important later on). Its statement doesn’t mention the post hearing amendments, nor what was viewed by Semenya’s team as a change in focus to exclude ‘biologically male’ athletes from its female category.

The IAAF may argue that the focus of the DSD Regulations has always been to exclude ‘biologically male’ athletes from its female category. But this doesn’t alter the fact that it was viewed as another change by Semenya’s team. During the hearing (para. 67), Semenya’s team argued that the IAAF has ‘completely departed’ from its position that high testosterone levels confer an unfair performance advantage, and by converting the DSD Regulations to apply to ‘biologically male’ athletes, the IAAF is attempted to convert them into a ‘shadow transgender rule’. 

So, in conclusion, although Semenya’s team accepted that the CAS Panel was competent and had given it a fair hearing, it wasn’t happy about what it viewed as changes in the focus of the DSD Regulations. And the CAS’s acceptance of the IAAF’s ability to make those changes is a valid concern for any athlete who wishes to launch a legal challenge to sport’s rules based on human rights grievances. As I said in my presentation.

Similar moves have been made before. The CAS allowed the IAAF to terminate Dutee Chand’s challenge to the Hyperandrogenism Regulations by promulgating the DSD Regulations. Chand’s events (sprints) were not included in the DSD Regulations. This is important because young athletes were harmed by surgeons operating under the DSD Regulations. But more on that later.

‘The IAAF does not say that [DSD athletes] are “not female enough”’

Nobody said that it did. What I pointed out was that in 2009, Pierre Weiss, Secretary General of the IAAF, said that tests conducted on an 18 year old Semenya had revealed that she “is a woman, but maybe not 100%”. 

The IAAF Response also points out that the CAS accepted that DSD athletes ‘derive materially the same physiological benefits from [elevated] testosterone levels as XY athletes without DSDs’. I did not argue against this. The IAAF’s argument is based on the idea that from puberty onwards, elevated testosterone has the same effect on the physiology of DSD athletes as it does on XY athletes. 

There is no reason why it shouldn’t have the same effect. We are talking about the effect of the same hormone on the same 46 XY karyotype.

My point is that such a ‘legacy advantage’, as I have termed it, cannot be measured as it depends on many other variables, such as diet and frequency of exercise, over time. There is a disconnect in the Regulations, because in order to compensate for this developmental ‘legacy advantage’, the IAAF is medicating DSD athletes by adjusting their natural hormonal balance (requiring them to reduce their testosterone to below 5nmol/L) in the present. And there is evidence that artificially adjusting a 46 XY athlete’s natural hormonal balance can have adverse consequences (detailed here and here).

In its Response, the IAAF confirms that my assessment of what it is regulating is correct. ‘Many argue that the physiological advantages derived from going through male puberty cannot be effectively addressed’, it reads. Nor can such physiological advantages be effectively measured, although its Response doesn’t mention that.

It does assert that the CAS accepts its scientific evidence that DSD athletes have a significant performance advantage due to exposure to elevated testosterone. Again, that isn’t at issue – it is a fact. The CAS accepted the IAAF’s evidence. What Pielke Jr. argued is that the scientific evidence was so flawed that the CAS shouldn’t have accepted it. You can follow his reasons as to why in the Twitter thread below.

Scientific evidence

We have been here before. The scientific evidence the IAAF relied upon is contained in two Papers. The first is a 2017 Paper entitled ‘Serum androgen levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female athletes’. The second Paper is ‘Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance’, published in October last year.

Aside from the scientific inaccuracies alleged by Pielke Jr., Paper One has a number of significant issues, discussed in this article under ‘Scientific evidence on performance advantage’. In short, the Paper (PDF below) found a correlation between females with elevated free testosterone and performance at the Daegu 2011 and Moscow 2013 IAAF World Championships, events which were marred by doping. Among the 1,332 female observations in the study, just nine had a DSD.

Aside from the scientific inaccuracies alleged by Pielke Jr., Paper Two (below) has a number of significant issues, detailed under ‘The 2018 Study’ in this article. In short, evidence for increases in muscle mass and strength appear to come from a 2014 Study performed on 62 post-menopausal women (mean age, 53) who had undergone a hysterectomy; it references several other studies in order to support the proposition that DSD athletes benefit from increases in circulating testosterone that increases circulating haemoglobin, which in turn translates to an increase in oxygen transfer; and compares endogenous testosterone levels with increases in muscle mass and strength.

Amazingly, one of the studies it relies on is a 2017 Study examining women with Congenital Adrenal Hyperplasia (CAH), a condition in which the adrenal gland can produce more testosterone. The Study found that in women with CAH, erythropoiesis may be driven by androgens. The proposition is that as DSD athletes have higher levels of testosterone (an androgen), they benefit from increased erythropoiesis (production of oxygen-carrying red blood cells). But remember, as stated earlier, the IAAF’s amendments carved CAH out of the DSD Regulations! By amending the DSD Regulations, the IAAF has negated part of its own evidential support.

‘Although these experiments cannot be replicated in humans, their key insight is that the higher circulating testosterone in males is the determinant of the male’s greater muscle mass and function compared with females’, reads Paper Two. ‘Studies of elite female athletes further corroborate these findings’, it mentions, referencing two Studies. 

The first is Paper One! The second is a Swedish Study published by the British Journal of Sports Medicine (BJSM) in 2017, involving 106 Swedish women (i.e. XX athletes, not XY athletes). It found that female athletes have higher serum concentrations of dehydroepiandrosterone, 5-androstene-3β, 17β-diol and etiocholanolone glucuronide and lower estrone levels compared to controls; and in female athletes, precursor androgens and metabolites positively correlate to lean mass and muscle performance. 

‘We found no correlation between serum T [testosterone] and physical performance’, reads the Study. ‘We suggest that endogenous androgens are associated with a more anabolic body composition and enhanced physical performance in women athletes’.

Professor Handelsman, the main author of Paper Two, admits in an email exchange (see tweet below) that the IAAF accepts that any attempt to prove an on-field advantage for DSD athletes will fail. ‘Any arguments they tried with evidence to actually quantify the advantage would collapse instantly’, writes Ross Tucker, an Expert Witness at the CAS in the Semenya case. ‘In fact, their evidence was so ridiculous that they actually show that in 17 out of 22 events, testosterone makes no difference to performance. They prove their own model wrong – I called this “the testosterone paradox” at the trial. Testosterone does not discriminate – in practice, or in theory. In their own model. Yet the policy does, to certain events only, which creates this weird internal inconsistency that should have undermined this policy, if not the theory.’

In an attempt to support its scientific evidence, the IAAF references ‘recent research  involving the administration of 10mg of testosterone cream daily to athletes. The research found that athletes who administered the cream performed better. Of course they did. This is doping.

A person doped with testosterone is getting something extra. Testosterone doesn’t discriminate. If you administer testosterone, an athlete’s physiology has something that it didn’t have before. The same is not true for DSD athletes. Elevated testosterone is their hormonal normal. 

Everyone knows this. It is the reason why the application of exogenous (external) testosterone is prohibited in sport. After all this time, what sill remains less certain is the effect that elevated endogenous (internal) testosterone has on performance. You cannot compare one with the other. 

The IAAF knows that this Study doesn’t support its arguments. Yet articles have appeared in the media (here, here and here) suggesting that this new Study supports both the DSD Regulations and the IAAF’s new Eligibility Regulations for Transgender Athletes. Given its knowledge of the historic role of exogenous testosterone in doping athletes, the IAAF’s promotion of this ‘evidence’ appears a little desperate. 

“You can’t dose young athletes with testosterone, unless you’re an East German doctor in the 1980s”, said Jonathan Taylor, one of the drafters of the DSD Regulations, last year. Yet this is exactly what this new Study appears to have done.

So as mentioned, the issue is whether the CAS should have accepted the IAAF’s supporting evidence, especially since some of it was based on conditions (CAH) that had been carved out of the DSD Regulations. But in its Response, after asserting that athletes who have been doped do indeed perform better, the IAAF changes tack, and mentions the ‘evidence from the field’. This is where things get very interesting.

That which must not be seen

I cannot comment on the accuracy of the IAAF’s ‘evidence from the field’, as it is ‘for confidentiality reasons, not publicly available’, as the IAAF’s Response points out. What we know from the CAS decision is that the Panel accepted that the ‘over-representation’ of female athletes with 5-ARD in the Restricted Events suggest that they hold a performance advantage over other female athletes. It appears to be observational data.

It may be true that such an advantage exists. But the IAAF’s contention is that the advantage is so unfair as to be ‘category defeating’, to borrow its grandstand term. As I said in my presentation, I would have liked to see the CAS compare the advantage that DSD athletes apparently hold with other physiological advantages, in order to determine whether it was indeed ‘unfair’. The CAS didn’t do this. It appears that it looked at a percentage of advantage, which it determined was due to elevated testosterone, and concluded it was unfair.

What we do know is that the IAAF used decreases in the performance of athletes medically harmed because of its Regulations on gender to support its DSD Regulations. Four young athletes, who were 18, 20, 20 and 21, were told that they needed to lower their testosterone levels in order to compete at the London 2012 Olympics, and a gonadectomy (removal of internal testicles) would help them do that. You can read about the horrible experience of two of them here.

30 cases were processed under the IAAF’s Hyperandrogenism Regulations…

The surgery was carried out on the athletes under the IAAF’s Hyperandrogenism Regulations, the forerunner to the Eligibility Regulations for the Female Classification (Athletes with differences of sex development (DSD)) Regulations – to give the DSD Regulations their official name. The Hyperandrogenism Regulations were in force from 2011 until July 2015. Para. 248(d) of the CAS judgment on Dutee Chand’s challenge to them revealed that there had been 30 cases dealt with under the Hyperandrogenism Regulations.

It is understood that French authorities are examining the IAAF’s role in the surgery performed on the four young athletes. What about the other 25 cases (discounting Chand’s case)? Were the athletes involved subject to similar treatment? 

‘No one outside the IAAF knows the identity, nationality or any personal information of any of those athletes’, reads the Chand judgment. I would hazard a guess that the IAAF is hoping it stays that way.

A study involving CAH was used to prop up the DSD Regulations. Yet in its Response, the the IAAF rationalises that it carved CAH out of the DSD Regulations because individuals ‘would suffer side effects that would make elite sports performance impossible’. If that is accurate, why was CAH included in the Regulations in the first place? In order to bolster the IAAF’s evidence base?

The IAAF also made sport impossible for at least two of the four young women on which surgery was performed, and used the decline in their performance to prop up the DSD Regulations. On the face of it, these two issues appear inconsistent and unethical.

‘Biologically male’

Pielke Jr.’s presentation states that the IAAF ‘used flawed theoretical science to reclassify certain females as “biological males’’. In its Response, the IAAF labels Pielke Jr.’s assessment as ‘false’, arguing that ‘the IAAF is not reclassifying any females as “biological males”’. The IAAF is correct that it doesn’t reclassify DSD athletes as ‘biological males’, and that it ‘does not question the assigned sex or gender identity of the DSD athletes’. 

It doesn’t ‘reclassify’ them into its male category, using the IAAF’s interpretation of these particular semantics, as DSD athletes are allowed to compete in its female category. But it does label DSD athletes as ‘biologically male’ with female identities. In other words, the IAAF considers DSD athletes as ‘biologically male’, but it allows them to compete in its female category. It is inclusive(!)

Here, again, the IAAF falls back on its scientific evidence by pointing out that Pielke Jr. didn’t argue against the IAAF’s assertion at CAS that 46 XY DSD athletes have higher endogenous testosterone than 46 XX females. Again, it falls back on its scientific evidence, this time quoting Paper Two as proving that increasing testosterone levels causes an increase in muscle size, strength, and haemoglobin. 

Of course it does. If you administer exogenous testosterone to people, you are doping them, as previously discussed. The IAAF should do better than this.

It also mentions ‘Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex-specific competition in sports, a narrative review’, a Paper by Richard V. Clark and others, published this year. The IAAF asserts that this Paper ‘entirely supports that 5nmol/L limit’.

The IAAF is correct to say that the Clark Paper doesn’t undermine the assertion that increasing testosterone causes an increase in muscle size, in strength and in haemoglobin. But the Paper is a comparative literature review on differences in endogenous testosterone levels between males and females. It is a bit of a stretch to suggest that it supports the IAAF’s assertion that DSD athletes should reduce their testosterone levels to below 5nmol/L to compensate for an advantage they may have developed from puberty onwards. Once again, it would appear that apples and oranges are being compared.

Medical Guidelines

The IAAF Response takes issue with Pielke Jr.’s assertion that the DSD Regulations ‘require that medical professionals violate widely held guidelines for medical and research ethics’, and ‘take perfectly healthy people and turn them into patients […] simply for the cosmetics of sport’. In my opinion, this particular argument is really about informed consent.

The IAAF’s Competition Medical Guidelines (click here to download) emphasise that they comply with the Helsinki Declaration, which places emphasis on informed consent. The DSD Regulations are clear that a doctor must obtain informed consent from an athlete on whether she wants treatment to reduce her testosterone levels. The IAAF points out that in the case of one athlete, a cancerous tumour was discovered and so treatment was necessary.

However, informed consent is a difficult concept when athletes are told that they will not be able to compete in the IAAF’s female category unless they undergo some sort of treatment. Remember, many of these athletes would not have been considered as ‘unwell’ until sport’s testosterone police stepped in. And many of them may be blinded by the bright lights of the podium.

Detail from the documentary…

The IAAF is correct to state that it does not pay for such treatment. But the word ‘anymore’ needs to be added to the end of that sentence. In a recent documentary, one athlete alleges that the IAAF wanted her to bear the costs of the surgery, but later agreed to share the costs. The IAAF Response correctly denies that it paid for the treatment of any DSD athletes, but doesn’t mention the shared cost of the surgery performed on the athlete under its previous Hyperandrogenism Regulations.

‘In response to recent claims made in the media, the IAAF has never advised any DSD athlete that it prefers that they undergo gonadectomy’, reads the IAAF’s Response. True, but as a Study written by Dr. Stéphane Bermon confirms, it advised athletes that a gonadectomy would help them reduce their endogenous testosterone levels and allow them to return to female competition, ahead of the London 2012 Olympics. As the above documentary painfully points out, this was very far from the truth for two of the four athletes on whom surgery was carried out.

The IAAF denied that Dr. Bermon was involved in, or recommended the treatment of Annet Negesa, who features in the documentary. ‘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’, reads the Study (below) authored by Dr. Bermon, which documents the treatment performed on the four athletes, one of whom is understood to be Negesa.

Concerns have also been raised as to whether such consent to such treatment was fully informed. It is understood that many who have such surgery later regret it and that there can be side effects, as emphasised in the documentary. It could also be argued that by offering gender remodelling surgery to such young athletes, the doctors involved robbed them of a choice to make a decision about their own gender. Such a choice was also denied to former German Democratic Republic athletes who were doped with testosterone under State Plan 14.25, which can affect gender development. “My decision to discover my gender was taken from me”, says Andreas Krieger in the below documentary. It could be argued that the four young female athletes have suffered the same fate.

Responsibilities

“You have a responsibility to get this stuff right”, said Jonathan Taylor last year, when we spoke about the DSD Regulations at the Sport Resolutions Conference. He is, of course, correct. But the IAAF has an even greater responsibility to regulate this area fairly and correctly.

I have no problem with the IAAF protecting female sport from male dominance. I have no problem with the IAAF protecting female sport from those athletes who, by virtue of having undergone male puberty, enjoy an unfair advantage. But the IAAF needs to prove that such an advantage is more unfair than the other physiological variables that exist. Doping athletes with testosterone and finding that they run faster doesn’t do that.

For all of those that scream “level playing field!”, I would answer that this is an outdated concept that sport needs to stop promoting. When you take the starting line, everyone plays to their advantages – economic, social, educational, physiological and physiological – even if they are considered unfair. Not everyone can afford a Vaporfly or a Pinarello, just as not everyone has access to high altitude training.

It is also important to remember that we have come a long way. The DSD Regulations apply to a very narrow range of events and do allow DSD athletes to compete in the IAAF’s female category, if they reduce their testosterone levels. The IAAF’s argument is that it allows male bodied athletes to compete in its female category only if they medicate themselves to compensate for their ‘legacy advantage’. 

It is the medicating of athletes who are not unwell that is a cause for concern. Caster Semenya is not unwell. By allowing the DSD Regulations to stand, the CAS has given sport the green light to medicate the natural hormonal balance of athletes, which can make them ill. 

Testosterone is a naturally occurring androgenic hormone, produced by both males and females (in much smaller quantities). In the XY karyotype, androgens (such as testosterone) are understood to be the primary driver of protein synthesis. In the XX karyotype, the primary source for this function is understood to be human growth hormone. 

Protein synthesis is understood to help the body develop red blood cells, muscles and ligament tissue. In simple terms, it is understood that the XY karyotype requires between six and ten times the amount of testosterone than the XX karyotype to ensure that protein synthesis continues effectively – or in other words, to maintain health. It is understood that this is why 46 XY karyotype people have higher testosterone levels than 46 XX karyotype people. 

As such, if you reduce the testosterone levels of 46 XY karyotype athletes, you will reduce athletic performance, but you also risk damaging their health. Especially if a gonadectomy is performed, since you are reducing their testosterone levels to almost zero. These people have no source for protein synthesis to continue, meaning that the body’s creation of red blood cells, muscles and ligament tissue is affected.

The DSD Regulations recognise that there is likely to be an impact on athlete health. They explain that a physician conducting an initial clinical examination on an athlete under the DSD Regulations will explain ‘the potential consequences both for the athlete’s health and for her eligibility under the Regulations’. Nowhere in the DSD Regulations, or in the Explanatory Notes, is there any mention of measures taken to monitor an athlete’s health after her natural testosterone levels are reduced to below 5 nmol/L.

46 XY DSD athletes who have not undergone a gonadectomy would be required to take a contraceptive pill, similar to that taken by XX women for birth control reasons. In a September 2018 letter to IAAF President Sebastian Coe, the Human Rights Special Procedures body of the United Nations (UN) outlined that medical harm can be caused by forcing XX women to lower their endogenous testosterone levels in this way. ‘Hormonal treatment to lower testosterone levels has adverse side effects including: diuretic effects that cause excessive thirst, urination and electrolyte imbalances, disruption of carbohydrate metabolism (such as glucose intolerance or insulin resistance), headaches, fatigue, nausea, hot flashes and liver toxicity’ they wrote, citing scientific studies published in the British Medical Journal (BMJ).

However, as explained, the DSD Regulations deal with the XY karyotype. As such, the impact of taking such a pill on that phenotype is not fully understood. This is a concern.

The UN also highlighted the medical harm that a gonadectomy can cause. ‘These surgeries can cause irreversible harms to women, including compromising bone and muscle strength and risking chronic weakness, depression, sleep disturbance, poor libido, and adverse effects on lipid profile, diabetes, and fatigue’, states the letter, again citing the BMJ.

The IAAF has mandated a similar 5nmol/L limit in its new Eligibility Regulations for Transgender Athletes. 46 XY transitioned athletes who have undergone a gonadectomy could also face health complications from reducing their testosterone to such a level. Some 46 XY transitioned athletes require prescribed exogenous (external) testosterone in order to maintain ordinary health. Kristen Worley was the first XY female athlete to receive a therapeutic use exemption (TUE) for testosterone, as she details on page 149 of her book, ‘Woman Enough’.

My concern is that medical intervention in the name of fair competition may end up harming people for no reason. As the experience of Annet Negesa and ‘Lara’ highlights, this has already happened. And 30 cases were dealt with under the Hypderandrogenism Regulations. I don’t want history to repeat itself.

I don’t have the answers. Nobody wants a return to the infamous ‘gender test’ that traumatised so many women before Semenya’s case led to the Hypderandrogenism Regulations. 

It may be that testosterone levels in serum can be used to determine whether somebody is eligible to compete in the Restricted Events within the IAAF’s female category. Paula Radcliffe is correct to point out that unless DSD athletes are regulated correctly, then there is a danger that unscrupulous coaches might seek them out in order to win. Perhaps a new category is needed, but this would stigmatise DSD athletes even further.

This is why Pielke Jr. and Pape are right to focus on the viability of the scientific evidence that the performance advantage enjoyed by DSD athletes is ‘unfair’. As explained in the presentations, in the IAAF Response and above, there are issues with it. Then there is the redacted ‘evidence from the field’. Doriane Coleman calls it “devastating”, and Jonathan Taylor “absolutely unbelievable”. 

I haven’t seen it, and so it is impossible to make a judgment on it. Many female athletes also appear convinced by the IAAF’s argument that DSD athletes do hold an unfair advantage.

If DSD athletes have historically dominated the Restricted Events, as the IAAF’s evidence apparently asserts, then it is crucial to determine what degree of advantage is considered ‘unfair’. Otherwise the IAAF risks accusations that it is stigmatising DSD athletes – who are recognised as female by the World Health Organisation (WHO) – as ‘biologically male’ in order to exclude them from female competition in the Restricted Events. If the degree of advantage isn’t considered ‘unfair’, then perhaps is is time to start celebrating naturally gifted athletes.


References:

1. Video coverage of our presentations in the Play The Game 2019 session entitled The Semenya case: what it means to athletes’ is split into two parts. To view Part One, click here. To view Part Two, which includes criticisms of our presentations by an IAAF lawyer at the Conference, click here.
2. ‘Four (Should Be) Fatal Flaws in the IAAF Semenya Regulations’, Roger Pielke Jr.’s presentation, is available here.
3. ‘Making Sense of a Divided Sport: A View from the Track and the Field’, Madeleine Pape’s presentation, is available here.
4. ‘How the IAAF framed the debate in order to defeat Caster Semenya’s challenge to the DSD Regulations’, Andy Brown’s presentation, is available here.
5. ‘The IAAF’s response to allegations made at the 2019 Play the Game conference regarding its DSD Regulations’, the IAAF’s Response to the above presentations, is available here.
6. ‘A skilful poker player never shows their hand’. An explanation of how the IAAF framed the debate at the CAS in order to defeat Caster Semenya’s challenge to the DSD Regulations, is available here.
7. ‘How the IAAF fails to ensure human rights’. A film by Annet Negesa.
8. ‘Androgens and athletic performance of elite female athletes’ by Dr. Stéphane Bermon. The Paper proving that the IAAF used performance data from three of four medically damaged athletes to support the DSD Regulations.
9. ‘Questions remain over IAAF Differences of Sex Development Regulations’, a 2018 article questioning the science underpinning the DSD Regulations.
10. ‘IAAF response to article on its Differences of Sex Development Regulations’. The IAAF’s response to the above article.

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