During embryonic development, several things happen to determine male and female as such.  While I should point out that I am an exercise physiologist and medical student (not an embryologist), I hope to paint a broad (nonexhaustive) picture of this differentiation process.  I think it is fair to say that biological “sex” is comprised of three major facets.  First, there is “genetic sex”; does one possess an X chromosome (female) or Y chromosome (male) to complete the 23^rd chromosome pair (XX or XY).  Second, there is “gonadal sex”; does one possess all the proper “machinery” to produce a male internal reproductive system (this involves the gene that produces testicular determining factor (SRY), which allows the gonads to develop into testicles).  And third, there is “external sex”; this involves whether male or female external genitals are developed (involving the formation of DHT via an enzyme called 5-alpha-reductase).  In typical situations, a female is formed because her 23^rd chromosome is XX and a male is formed because his 23^rd chromosome is XY, complete with the SRY gene and adequate 5-alpha-reductase to ensure external male genitalia.  But there are many deviations from this norm, not always producing a clear male or female. 

While we still do not know the exact details of the Semenya case, we can note that she has the muscular appearance and voice usually characteristic of males, and that reports have been “leaked” that she has no internal female reproductive system and high levels of testosterone.  However, none of these speculations have been officially confirmed.  While the IAAF should be very ashamed of the leak, they should not be ashamed of wishing to have testing done.  Their interest is in keeping the competition fair for women, since being male would confer certain advantages (e.g., high testosterone levels dramatically increasing muscle mass).  The IAAF has every right to question and to know if everyone in the female race is female (and should verify this to be fair to the other women).  The physiology of males and females is quite different, especially with regards to the hormonal milieu in the body, and these differences are part of what give males their athletic advantage over females in many sports.     

If the reports are true, it is possible that Semenya has a deficiency in the enzyme that converts testosterone to DHT (5-alpha-reductase).  As mentioned, this DHT is needed during gestation for the external male genitalia to develop.  In the case of a major deficiency of 5-alpha-reductase, she would retain internal testes that produce testosterone and give one the male secondary characteristics.  On the other hand, if she had androgen insensitivity (as some have speculated), she would be resistant to androgens through some receptor defect.  This would theoretically confer no athletic advantage, as the high testosterone would not produce the secondary male sex characteristics of larger muscles, deeper voice, etc.   

If results come back that she has a deficiency in 5-alpha-reductase and the internal male reproductive system, then what can be done?  I think gynecologists will suggest she remove the testes for health reasons.  But what about competition?  Well, extra androgens DO confer an advantage in a “non-female” way, and she should not be able to compete with an androgen level that exceeds the limit.  Some have suggested that this is ridiculous because all athletes have some genetic advantage (they are tall, naturally fast, etc.).  But for most advantages, we don’t split athletes into different groups to compete (tall vs. short); for others we do (male vs. female).  Being tall might give one an advantage in basketball, but there is not a different league for female players that are “females over 6 feet tall”; there IS a separate league for males and females because “being male” confers such significant advantages in many sports.  It should be determined what “male-like” advantages Semenya might have.  Remember, there is a reason men and women compete separately.   

In any case, Semenya should keep her medal.  If she lacks internal female genitalia, has internal testes, and has external female genitalia, one can hardly fault her for competing as a woman even if she was aware of these things!  Chances are the experts will know all these answers and still argue over exactly where or how she can compete.  It’s not as simple as “male” or “female” anymore.  The South African federation (Athletics South Africa) dropped the ball on this one; if they did indeed perform tests to investigate this issue, it is abominable that they would allow her to compete in the public eye without clearing up the issues.  As of now it sounds as if they covered it up in the interest of a gold medal for their country. If this is true, they should suffer a severe penalty (banned from 2012 Olympics?); Semenya should be protected. 

Whatever the outcome is, Semenya should be protected to the highest feasible extent.  We the public should give Semenya our respect and empathy.  Imagine her state right now: 18 years old, accomplishing the greatest thing she’s ever accomplished, and instead of celebrating she is being forced to defend her biological sex and possibly dealing with it not being what she once thought.  It is beyond comprehension what struggles she must now be enduring. 

If Semenya had an unfair “male-like” advantage, then Janeth Jepkosgei Busienei deserves a gold medal, Jennifer Meadows a silver, and Yuliya Krevsun a bronze.  But DO NOT take away Semenya’s gold.  Award a second gold medal.  It has  been done before.  It is the appropriate response. 

Finally, whatever comes of this, I hope that people begin to see that biological sex is not quite as simple as being “man and woman.”  In reality, mutations and deficiencies and variants happen; that’s nature.  It’s not perfect and it’s not black and white.  And above all, it’s not your fault when nature deals you a difficult hand.  If it turns out Semenya does have a deficiency of 5-alpha-reductase and lacks female internal genitalia (or some other variant), I hope she continues to stand up and say, “Yes, this is who I am and I’m proud of it. I didn’t ask for it, but it happened, just like it happens to many all over the world.”   

Semenya, whatever the tests say and whatever the results to your athletic career, take the opportunity to rally the world behind you.  Don’t let people convince you to fall back on simpleton answers about being a girl no matter what anyone says.  Step forward and be proud of how you are made, no matter how that is.  About 1/1000 births exhibit some disorder of sexual development (DSD) (Gynecol Endocrinol 25(2); 117-121, 2009).  That means that over 100,000 people come into the world each year with some DSD.  How great it would be for a young child with DSD to see a gold medalist, a black female, a South African, stand up and say “Hello world, this is who I am, and you know what, it’s ok.  I’m a person too.”  

As scientific knowledge continues to unveil how simple and incorrect our notions of what it means to be a person are (in this case the thinking that people are simply “male” or “female”), Semenya might just be the role model this generation needs.