Caster Semenya vs IAAF: Therapy life-long, has side-effects, says expert

Dr Ambrish Mittal, chairman Endocrinology at Medanta The Medicity, told The Indian Express what it will take, why there could be side-effects and how it will affect athletic ability.

4 min readNew DelhiUpdated: May 2, 2019 09:35 AM IST

Caster Semenya of South Africa at the IAAF track and field Continental Cup in Ostrava, Czech Republic. (Source: AP)

To participate in ‘restricted events’ – 400 metres to a mile – the IAAF eligibility rules for athletes with differences in sex development state that the athlete must reduce the blood testosterone level to below five (5) nanomoles per litre for a continuous period of at least six months using medication. Dr Ambrish Mittal, chairman Endocrinology at Medanta The Medicity, told The Indian Express what it will take, why there could be side-effects and how it will affect athletic ability.

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Testosterone and its effects

“The truth is that the level of testosterone they are talking about (IAAF states that female level is 0.12 to 1.79 nmol/L while the corresponding male range is 7.7 to 29.4 nmol/L, which is also the case with DSD athletes) won’t really happen unless you have a definite hormonal problem. The proportion of people with such levels is low and typically, they are girls who have had sexual differentiation problems at birth. But they have been brought up like girls but have high testosterone. Some may know about it from childhood and some may not. The straightforward thing is that high levels of testosterone correlates with muscular function. Otherwise why would you ban all exogenous testosterone? It is a performance-enhancing drug. But the issue is whether something made within the body will have the same impact? Well, it does because one of the main reasons men have bigger muscles and are stronger than women is testosterone. But it does not end there. If you have a disorder of sexual differentiation, whether the high testosterone levels correlate is unclear because you don’t have that many people with such condition where you can have an exhaustive study.”

Types of medication

“One method is surgical but that is hardly used these days and typically, we don’t do surgery for these patients. But there is no law banning surgery. Secondly, there are certain conditions which are steroid-dependent in these cases like Congenital Adrenal Hyperplasia. You give common steroids that we use and they can suppress testosterone. It depends on the reasons for elevated levels of testosterone. Then we can use female hormones, birth control pills essentially. Oral contraceptives like estrogen.”

Length of treatment

“To keep the testosterone levels to below 5 nmol/L, an athlete will have to take medication for the rest of her life. The moment the athlete stops taking the medication, the testosterone levels will rise again. Take it again and the level will go down again.”

Impact of suppression

“Athletic performance will dip. Going by pure science, I am certain it will be affected. How much, I can’t say. There will be an effect if you lower the testosterone in anybody. Long-term side effects can be there if you use regular steroids for suppressing testosterone in CAH cases. Steroids have their own side-effects and you have to balance the dose very carefully. If it is too high, it is a problem and if it goes down, it is a problem. When you use oral contraceptives, they have their own problems, they can cause mood changes, they can cause clotting too in rare cases. They are not common problems but can happen. They are not absolutely innocuous drugs. There is an issue.

Nihal Koshie

Nihal Koshie is an Associate Editor and sports writer at The Indian Express. He is best known for his in-depth reporting and investigative work that often explores the intersection of sports and social issues. He is also a key member of the sports desk, which is based out of The Indian Express' office in Noida. Professional Background Role: Associate Editor (Sports) at The Indian Express. Key Achievements: He is a two-time winner of the prestigious Ramnath Goenka Award for Excellence in Journalism. He won the RNG award for 'Sports Journalism' for 2019 for his exclusive interview and follow up stories with sprinter Dutee Chand, who became the first Indian athlete to say she was in a same-sex relationship. He won his second RNG award in the 'Investigative Reporting' for 2023 for a series of exclusive stories related to sexual harassment charges levelled against WFI president Brij Bhushan Sharan Singh by the country's top women wrestlers. Expertise: While he covers major sports, he is particularly recognized for his extensive reporting on Athletics, investigative stories and long-form news features. Recent Notable Topics & Articles (Late 2025) Nihal Koshie’s recent work reflects a focus on investigative and human-interest stories Recent investigative pieces: He recently wrote a profile of an Indian teenager serving a jail sentence in Kenya after being embroiled in a doping scandal while chasing "Olympic dreams." Wrestling: He continues to track the political and social fallout of the Indian wrestling protests, including the recent public appearances of Brij Bhushan Sharan Singh and the political career of wrestler Vinesh Phogat. Recent long-form features: The story of the rise of Kranti Gaud, the young fast bowler who was a key member of the ICC women's World Cup-winning team; The physics and science behind modern cricket bats Podcast Presence He is a guest and contributor to the "Game Time" podcast by The Indian Express, where he provides technical and social analysis of current sporting events. Experience: 24+ years Previous experience: Times of India (2001-2005), Daily News and Analysis (2005 to 2010) Nihal joined The Indian Express in May, 2010 Social Media X ( formerly Twitter) : @nkoshie You can follow his latest work and full archive on his official author profile. ... Read More

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