In a landmark ruling that touches upon complex issues of gender in sport, South African runner Caster Semenya has lost her appeal against track officials who may now proceed with a controversial rule that defines her and other female athletes by their body chemistry.

The international Court of Arbitration for Sport ruled against Semenya on Wednesday, declaring that the international track federation may regulate the participation of women with naturally high testosterone levels.

The IAAF will now present these women with a stark choice: Either take medication to alter their chemistry or race against men.

The CAS panel stated that “such discrimination is a necessary, reasonable and proportionate means of achieving the IAAF’s aim of preserving the integrity of female athletics.”

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