All athletes have their T levels tested as part of doping control. If a female's drug tests come back with high T levels, an investigation will be started as to why... is it doping? A tumor? PCOS? A DSD?
If a DSD is suspected, there is a detailed protocol the athletes go through, you can download the documentation from the World Athletics website.
In order to qualify to be a restricted athlete they have to...
- Have T levels above 7.7 nmol/L
- Have one of five specific DSD conditions. According to WA these conditions all involve XY chromosomes and internal testes.
- In World Athletics' opinion, have a "material androgenising effect," showing that their body can use at least some of the high levels of T they have.
So a woman could have a DSD and not be restricted for a variety of reasons:
- They are not competing in a restricted event
- Their natural T levels are not high enough or they are quietly lowering their levels
- They have a condition not on the restricted list
- Dr Bermon thinks their body looks feminine enough based on the criteria he selected.
Dr Bermon has stated before that he thinks the length of the clitoris is the primary indicator as to whether or not a woman with a DSD is gaining an unfair advantage in sports.
The "standard of care" in the western world is that babies with a large clitoris have them chopped off at birth, with no regard for how that will impact their ability to experience sexual pleasure in the future.
So it is possible that one reason we only seem to see athletes from the global south impacted by these regulations is that western women with DSDs have had their bodies altered in ways that make them more likely to pass Bermon's tests for "material androgenising effect."