We’ve been hearing a lot recently about transgender athletes competing as their preferred gender.

Democrats in the U.S. House of Representatives (along with eight Republicans) passed a bill on Friday that would allow biological male athletes who identify as trans women to compete against biological women in sports. In Connecticut, three female teenagers have submitted a complaint to the U.S. Department of Education’s Office for Civil Rights alleging sex discrimination in policies that allow men to compete as women.

Some athletic organizations have adopted hormone-level rules to deal with the issue, the idea being that having more testosterone — typically associated with being a biological male — gives athletes an advantage over biological females.

But what about the rare instances of an intersex athlete, who is not transgender and not identifying as the opposite sex?

Meet Caster Semenya, a 28-year-old from South Africa who has set world running records, won championships, and won gold at the 2012 Olympics (after the original gold-medal winner was disqualified for doping). Semenya was identified as a female when she was born and has never thought of herself as anything other than a woman. But after she won gold in the 800 meters at the World Championships in 2019 and improving her previous 800-meter score by four seconds in just a month, suspicions arose. She was subjected to a sex verification test, which the International Association of Athletics Federations (IAAF) said found her to have an intersex trait. Fox News reported the IAAF found Semenya was born “born with the typical male XY chromosome pattern,” which gives her “some male biological characteristics, male levels of the hormone testosterone after puberty, and an unfair athletic advantage over other female athletes.”

But again, Semenya did not identify as a male until some point in her life and then change her identity. She has always thought she was a woman. Should she not be allowed to compete because of a rare genetic condition that gives her an advantage?

Semenya has been in a legal battle with the IAAF over its hormone rule changes announced in 2018. The new rules stated that athletes with Differences of Sexual Development, such as those with hyperandrogenism, must take steps to lower their testosterone levels, according to The Telegraph. It was the third rule change since Semenya burst onto the scene in 2009. The limitations only applied to athletes competing in women’s track events between 400 meters and a mile — exactly where Semenya competed. Other events where high levels of testosterone could benefit an athlete — such as the pole vault and the hammer throw — were not included in the rule.

In order to continue competing, Semenya would have to find a way to lower her testosterone levels, either through a “daily contraceptive pill, a monthly hormone-blocking injection, or surgery,” Fox reported. Semenya said in court documents that she took testosterone-suppressing contraceptives between 2010 and 2015 to keep racing, which she said made her gain weight and feel sick with fevers and abdominal pain. She also said she was subjected to intrusive physical exams for her gender verification tests and wasn’t told the exact nature of the test when she was just 18 years old. She said she was not given a choice to comply with the second sex verification test ordered of her years later. She said in court documents, according to Fox, that the public speculation over her gender was “the most profound and humiliating experience of my life.”

Semenya has appealed a recent verdict in her case — which the IAAF won — on human rights grounds.

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