Annet Negesa and Maximila Imali, the elite athletes fighting for acceptance


Her Olympic goals have been crushed

Her profession was derailed by unproven science

Editors Note: This story is a part of As Equals, CNN’s ongoing collection on gender inequality. Read extra from As Equals right here and learn our FAQs for details about how the collection is funded and extra.

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As an formidable, decided teenager, Annet Negesa urged her physique to run quicker, and her physique, all the time loyal, obliged her.

Even earlier than the middle-distance runner had a coach, Negesa was qualifying for — and successful — main regional competitions. At 19, she would journey to Daegu in South Korea for the 2011 World Championships. After securing a top-three spot in the 800 meter and 1500 meter classes, in 4 worldwide competitions, the Ugandan athlete certified to characterize her nation at the 2012 London Olympics.

The following yr, the younger lady from Iganga, a small village in jap Uganda, was named ‘Athlete of the Year’ by the Uganda Athletics Federation and appeared set for a life in the athletics highlight.

That did occur — however not in the manner she had hoped. Much has been written throughout the world about Negesa. Not solely due to her victories on the monitor, but in addition due to what occurred to her off it.

‘I felt my life is over’: Negesa shares her harrowing story

In August 2011, whereas at the World Championships, Negesa submitted to blood exams. According to the International Association of Athletics Federations (IAAF, now generally known as World Athletics) this was a requirement for all athletes competing that yr.

But Negesa says she by no means obtained her check outcomes, and with out them, life continued as regular: With intense coaching for the London Games.

It was whereas in Europe, simply weeks earlier than the competitors, that Negesa would get a name from her supervisor, informing her that she might not compete at the Olympics.

She says he defined that the blood samples revealed ranges of the hormone, testosterone, in her blood that IAAF thought of too excessive and that at the advice of the athletics governing physique, she would want to get additional exams.

Negesa’s vibrant future shortly darkened from that time. She headed to a specialist hospital in the south of France, the identify of which was supplied by the IAAF. There, she underwent a medical evaluation that concerned an additional blood check and an MRI scan.

Again, Negesa says she didn’t perceive what was occurring, nor was she given any paperwork. “No one gave me advice … like: ‘If you do this, you’ll get this later.’ No one explained to me what the consequences are.”

World Athletics disputes this, saying in an electronic mail that “Ms. Negesa and her team were provided with the results of the tests undertaken.” The group additionally provides that it subsequently suggested Negesa by electronic mail “that it was important that a medical doctor in Uganda follows up with her, and explains to her what the different therapeutic options are.”

In November 2012, after being taken to the Women’s Hospital International and Fertility Centre in Kampala, Uganda, the then 20-year-old awoke from surgical procedure to be taught her inner testes had been eliminated.

“I woke up finding myself having cuts under my belly and really, I was asking myself, ‘What happened to me? What they did to me?’”

Negesa says she had understood that she was being handled for hyperandrogenism — the naturally excessive ranges of testosterone her physique produced — however the surgical procedure was not what she’d consented to. She says: “They gave me a suggestion of going for simple surgery or using an injection [to remove] the excessive testosterone in the body. My suggestion was using the injection.”

A medical report, seen by CNN, states that the docs in Uganda “restrained from starting her on estrogen therapy,” claiming that they have been “awaiting further discussions” with an IAAF physician.

Estrogen was important for Negesa’s restoration. Retired endocrinologist Peter Sonksen has not handled Negesa however famous the significance of estrogen in treating sufferers like her, saying: “Once the testes are removed, as in this case, the blood testosterone and estrogen levels fall to zero and the athlete is even more hormone deficient than a post-menopausal woman.” Sonksen provides: “It is essential therefore to give estrogen ‘replacement’ therapy. In [its] absence, [the athlete] will suffer multiple issues affecting most body systems.”

World Athletics informed CNN it “had no involvement in Ms. Negesa’s treatment” and that CNN would “have to ask [the doctor in Kampala] to explain the reference in this letter.”

In ache, and with out the after-care that she wanted, Negesa’s physique couldn’t carry out because it as soon as did. In an account of her story revealed by Human Rights Watch, Negesa shared that she misplaced her college scholarship, and then her supervisor dropped her.

Also dealing with public scrutiny for her intercourse, Negesa quickly fell into melancholy, explaining that in Uganda, it was “very hard for a person like me… an intersex person.” In 2019, she was granted asylum by the German authorities.



At a monitor in Berlin, in the shadow of the 1936 Olympic stadium, Negesa remains to be visibly stung by her expertise. She tells CNN about feeling confused at the discovery that her physique was totally different from what she understood it to be, and feeling powerless and fully unsupported as her life unraveled. “I was still a teenager, had no choice because I had a love of the sport … and they knew all the consequences which would come out from them.”

Referring to the IAAF, she provides: “They violated my rights as a human being. They treated me like a guinea pig.”

The hospital declined to remark, citing confidentiality. In an electronic mail to CNN, World Athletics says: “The IAAF hyperandrogenism regulations state that the treatment must be prescribed by a physician who is independent from the IAAF, and that the IAAF is in no way involved in the process. Under no circumstances may the athlete be forced to undergo any specific treatment.”

In 2013, as Negesa struggled to come back to phrases with what had occurred to her, in neighboring Kenya, Maximila (Max) Imali was studying that athletic success might carry her and her household out of a lifetime of poverty.

She remembers her highschool coach inspired her to coach for the 800m race, slightly than the sprints, telling her: “You see that you can make your family be on another level of living.”

“I just wanted to run good so that I can feed them,” Imali says of her household: Her mom, two siblings, and two orphans she additionally supplies care for. “I was so motivated.”

In July 2014, Imali obtained an opportunity to compete at the World Junior Championships in Oregon. “It was my first time to go to such a big race,” she remembers. “And after that, I realized that I can do good.”

She excelled in the heats however fell in the finals of the 800m occasion.

“After I came back home, [I] sat and discussed with the coach how I can improve and what is the best thing for me to do, so that I can do good in 800m and 1500m,” she says.

But Imali didn’t get that probability. The younger lady, who was shortly gaining nationwide and worldwide recognition, additionally obtained caught in the crosshairs of IAAF laws.

Once in Kenya, Imali says she obtained a name from an official with Athletics Kenya, telling her: “Maximila, they need you to be examined from the IAAF.”

So, Imali took a matatu minibus from Eldoret to a hospital in an upscale Nairobi neighborhood for a blood check and a bodily examination.

Consistent with Negesa’s account, Imali says she was given little details about the procedures or their penalties. Referring to the hospital’s physicians, she says: “They didn’t inform me something regarding my physique. After we did each examination, they have been simply placing the leads to the envelope. Then they take that envelope to Athletics Kenya.”

It can be a number of months earlier than Imali would be taught from her supervisor, over a cellphone name, that she wouldn’t be allowed to compete in the 800m class.

She says she was informed: “Max, you cannot run because you have high testosterone in your blood.” He went on to record all the races she couldn’t compete in and shared a letter from IAAF explaining the laws.

Weighed down by the questions on her gender id that the assessments had thrown up, Imali went to talk to her mom. What she heard reassured her. “For me, I’ve been raising you like a girl from the start when you were born, and that is it. I know you are a girl,” she remembers her mom saying.

But Imali says that being rejected for how God made her, in addition to the questions on her sporting, future all took a toll on her mom’s well being, and in September 2016, Eunice Khaleha died.

“My mom was hospitalized because of me, because of the pressure,” Imali says, her voice crammed with sorrow and remorse. “She died because of me. It still affects me because I always feel that I’m the cause of her death.”

Many sporting occasions, from monitor and subject to gymnastics, swimming to basketball, are divided in accordance with a binary separation of genders. Modern medical consensus however, so far as a lot of the sports activities world is anxious, there are solely two acknowledged classes: Men and girls.

However, Negesa and Imali each have — or had — ranges of testosterone that their sports activities’ governing physique officers deemed too excessive for a few of the girls’s competitions.

World Athletics now has a algorithm for athletes with what it calls variations of intercourse growth (DSD), requiring them to decrease the naturally occurring ranges of testosterone of their blood to five nanomoles per liter of blood (5 nmol/L) by remedy or surgical procedure in the event that they need to compete in sure races.

Non-compliance implies that athletes with DSD can’t compete in occasions akin to the 400m or 800m races placed on by World Athletics.

Most high-profile amongst the athletes affected by the DSD laws is South African runner and Olympic champion Caster Semenya, whose long-fought authorized battle to have the ability to compete in the 800m occasion is at the moment earlier than the European Court of Human Rights.

After her attorneys filed their lawsuit to the court docket on February 25, Semenya tweeted: “This fight is not just about me, it’s about taking a stand and fighting for dignity, equality and the human rights of women in sport.”

While Semenya’s dispute with World Athletics is over a decade outdated, the struggle to compete on equal phrases goes again virtually a century.

After a lot opposition (the founding father of the fashionable Olympics motion, Baron Pierre de Coubertin, was in opposition to the inclusion of girls in the Games), girls’s participation in sport started to develop early in the twentieth century. As competitors in the girls’s class intensified, the our bodies of athletes — and particularly, profitable ones — have been scrutinized.

      • Scrutiny of girls’s our bodies has performed out in the public eye at the very least since the Thirties, as girls’s athletics gained better visibility. Ahead of the 1936 Berlin Olympics, former International Olympic Committee (IOC) President Avery Brundage advocated for systematic medical examinations of athletes competing in girls’s occasions.

        At the 1936 Games, 100m gold medalist Helen Stephens was accused of being a person. The American runner underwent — and handed — the first intercourse check administered at an occasion. She is pictured right here (left) with Poland’s Stella Walsh, the 100m silver medalist.

      • The first systematic intercourse exams befell at the 1966 European Athletics Championships in Budapest, the place girls underwent a visible examination of the genitals and secondary sexual options, carried out by a panel of three girls docs. The exams have been known as “nude parades.”

        “You had to go in and pull up your shirt and push down your pants,” mentioned Maren Sidler, an American shotputter at the 1967 Pan-American Games in Winnipeg. “I bear in mind one in every of the sprinters — a tiny, skinny lady — got here out shaking her head again and forth saying, ‘Well, I failed. I didn’t have sufficient up high.’”

      • Polish sprinter Ewa Klobukowska, an Olympic gold medalist, failed a intercourse check at the 1967 European Cup in Kiev. It included a chromosomal check after a visible examination was decided to be ambiguous.

      • The IOC launched Barr physique testing at the Mexico City Olympics, calling it “simpler, objective and more dignified.” The check was based mostly on cells collected from the inside athletes’ cheeks and was thought to point an athlete’s chromosomal make-up.

        Medical consultants now criticize the Barr physique check as inaccurate and dangerous; failing to acknowledge the complexity of things that decide intercourse.

      • Spanish hurdler María José Martínez-Patiño was banned from competitors in 1985 after a check revealed a Y chromosome. She was reinstated three years later, after proving she had full androgen insensitivity, that means her physique doesn’t reply to testosterone.

      • The International Association of Athletics Federations (IAAF) ended necessary intercourse testing in 1992 and the IOC dropped blanket testing in 1999 — however they continued to conduct medical evaluations on a case-by-case foundation.

      • South Africa’s Semenya received the 800m at the World Championships in Berlin in 1:55.45. Afterwards, the IAAF required Semenya to endure a gender verification” course of. The ANC — South Africa’s ruling social gathering — known as the exams “sexist and racist.”

      • The IAAF launched new laws declaring that an athlete might solely compete in girls’s occasions if her testosterone ranges have been beneath 10 nmol/L, except she had “androgen resistance.”

      • The guidelines have been suspended for two years by CAS after a authorized problem by Indian sprinter Dutee Chand, who had been banned from competitors due to her naturally excessive testosterone ranges. CAS cited an absence of proof on the relationship between testosterone ranges and improved athletic efficiency in girls.

      • Free to compete after the 2015 CAS choice, Semenya received gold in the 800m at the Rio Games in 1:55.28. Burundi’s Francine Niyonsaba and Kenya’s Margaret Wambui — who would even be affected by later guidelines on pure testosterone ranges — take dwelling the silver and bronze.

      • World Athletics, previously the IAAF, launched new laws for center distance races from 400m to a mile: girls with “sufficient androgen sensitivity” and testosterone ranges of 5 nmol/L and above should cut back their ranges by remedy or surgical procedure.

        Semenya appealed the laws to CAS — and misplaced the landmark case. In order to fulfill present World Athletics requirements, she must cut back her testosterone ranges if she needs to race the 800m once more.

Source: Historical newspaper clippings (Time journal, LA Times, Harrisburg Telegraph), Endeavour, JAMA, Journal of the Royal Society of Medicine, YaleNews, Lancet, World Athletics, South African Government,, Court of Arbitration for Sport (CAS)

The consideration didn’t come completely from the sporting our bodies. Media commentators over the a long time have helped peddle a slender imaginative and prescient of what it means to be — and to appear like — a girl.

Three days after the opening of the Rome Olympics in 1960, William Barry Furlong, reporting for The New York Times, wrote a chunk entitled “Venus Wasn’t a Shot-Putter,” during which he mirrored: “More and more of the fair sex are competing in sports, raising a profound question: Do men make passes at athletic lasses?”

As “gender-normalizing” surgical procedures turned extra frequent in the Global North, and extra athletes from the Global South have come to dominate in monitor and subject occasions, it’s Dutee Chand, Maximila Imali, Annet Negesa and Caster Semenya — amongst others — who’ve come into the media highlight and beneath World Athletics’ watchful gaze.

“World Athletics wants to recognize people however they identify,” World Athletics’ authorized counsel, Jonathan Taylor, tells CNN. “The problem with that is, on the sports field, we’ve already established that there has to be a distinction between male and female competition in order to promote fairness and equality.”

He continues: “Once you’ve decided that, once you’ve drawn a line, you have to classify people and that means deciding why the line is drawn.”

Maximila Imali competes in the girls’s 400m semifinals in the Gold Coast 2018 Commonwealth Games. Cameron Spencer/Getty Images

Taylor positions World Athletics as being in a bind: Needing to weigh in on a problem it will slightly not need to, however should, to be able to take away, as he places it, the “enormous, insuperable advantage that’s conferred by these higher testosterone levels” in events such as the 400m, 800m, 1500m and 400m hurdles races — all of which World Athletics classified as “restricted events” in 2019.

“If you have someone with a female gender identity, but XY testes and male levels of testosterone, you have to decide what to do. You could say: ‘You cannot compete in the female category’, which World Athletics does not want to do, because it wants to acknowledge and recognize the gender identity. So instead, they say you have to drop your testosterone down to the same levels as all the women and all the other women in the category,” he says.

Contrary to Taylor’s declare, “all girls” in the class do not need the similar testosterone degree.

Under World Athletics’ guidelines, an athlete with polycystic ovary syndrome, for instance, can compete regardless of having excessive testosterone as a result of they’ve XX chromosomes and no testes. Athletes with excessive testosterone ranges whose our bodies don’t reply to the hormone can even compete in the restricted classes.

And so World Athletics, in so doggedly guarding the line it has drawn, has positioned itself as an arbiter of what it means to be a girl in sport. Taylor says it is carried out “to advertise equity and equality.” But the guidelines are based mostly on scientific analysis that’s closely contested.

“There is good evidence to show muscle bulk increases with increasing dosage of testosterone,” Sonksen, who has beforehand spoken out in help of Semenya, mentioned in an electronic mail to CNN, however provides that the relationship between blood testosterone degree and efficiency stays “complex and controversial”.

“Measuring blood testosterone level gives some indication of the amount that is produced and testosterone does increase protein, thus muscle synthesis, but [the hormone’s] action is regulated also by other factors,” he explains.

“[World Athletics] are trying to refine further and further as the policies come under scrutiny. But the science is still very much contested,” says Katrina Karkazis, anthropologist and co-author of ‘Testosterone: An Unauthorized Biography’, a 2019 guide which units out to debunk a few of the myths round the hormone.

When it involves athletic efficiency, Karkazis and her co-author, Rebecca M. Jordan-Young, write about research which have linked excessive pure testosterone to hurry and energy, research that discovered no hyperlink, and but others which present the converse to be true: High testosterone resulting in worse efficiency.

Karkazis informed CNN that the lack of conclusive proof hasn’t stopped World Athletics from forming its insurance policies. She cites, by means of instance, a ruling by the Court of Arbitration for Sport (CAS) which states that in the 1500m and 1 mile races, the proof of precise important athletic benefit “could be described as sparse.” CAS beneficial that “The IAAF may consider deferring the application of the DSD regulations to these events until more evidence is available.”

“Even when the evidence wasn’t there, [World Athletics] decided to include it and regulate it anyway,” says Karkazis.

Not solely are these laws — launched and enforced with out consensus from throughout the scientific neighborhood — being framed pretty much as good for the video games, Taylor, talking for World Athletics, additionally means that they’re good for athletes with DSD.

“We’re not stopping people from competing,“ Taylor tells CNN. “We are trying to facilitate their competing” earlier than including: “One of the benefits of the regulations is that you identify and diagnose and treat DSD conditions as well.”

But there’s more and more vocal pushback from components of the medical neighborhood, mother and father and intersex individuals themselves, saying that being intersex isn’t a medical “problem” to be “solved” any extra so than being born male or feminine is one.

At the final Olympics — the 2016 Rio Games — Caster Semenya, Burundi’s Francine Niyonsaba, and Kenya’s Margaret Wambui took the gold, silver and bronze medals respectively in the 800m race.

This yr, in Tokyo, none of those girls might be competing in that class — all three impacted, they are saying, by World Athletics’ guidelines regulating testosterone in girls.

In its pursuit of equity, affected athletes and activists alike say that World Athletics has itself been deeply unfair.

Speaking to CNN from London, tutorial and athletes’ rights advocate, Payoshni Mitra, says: “Rules could be necessary in sport, but those rules should also ensure safety of athletes. No rules should lead to human rights violations, and these rules are leading to human rights violations of athletes.”

Burundi’s silver medal winner Francine Niyonsaba, left, Kenya’s bronze medal winner Margaret Wambui, proper, and South Africa’s gold medal winner Caster Semenya rejoice after the girls’s 800m remaining throughout the 2016 Summer Olympics in Rio de Janeiro, Brazil. Martin Meissner/AP

For Mitra, World Athletics’ guidelines aren’t simply sexist, they’re additionally racist. “It clearly seems to be racist policy,” she says. “We have women’s bodies from the Global South — brown women, Black women — in sport. Their bodies have been scrutinized more and more. It’s a fact which they cannot deny.”

Taylor denies this, countering: “What we’re trying to do is ensure a level playing field for all women — of whatever color — so that they can all aim to excel.”

The South African authorities didn’t see it the similar manner, with the then-Minister of Sports, Tokozile Xasa, weighing in to lend help to Semenya after World Athletics proposed new laws in 2019: “Women’s bodies, their wellbeing, their ability to earn a livelihood, their very identity, their privacy and sense of safety and belonging in the world, are being questioned.”

And so, from Mitra’s perspective, it’s obscure World Athletics’ “adamant” deal with DSD laws when there has already been a lot struggling, a lot at stake for the particular person athletes, a lot to lose, and a lot else for the sporting world to handle.

“Why they’re so adamant about these laws is de facto obscure, on condition that there are such a lot of different issues in the sport. Doping is such an enormous downside in athletics. If you have a look at points regarding security of girls, sexual harassment and abuse, these are such vital points in sport as we speak … [World Athletics’ leaders] simply need these individuals to go. They simply desire a purified notion of girls’s class with none of those athletes … What World Athletics are inclined to neglect is athletes are human at the finish of the day.”

What these athletes say they need greater than something is to do what they love, with out particular scrutiny or restriction. They need to run as equals.

Imali, who’s at dwelling in Kenya and continues to coach for the 100m and 200m sprints, is resolute: “God wanted me to be the way I am.”

As for Negesa, she has returned to the monitor after almost a decade and is permitting herself to dream as soon as once more of Olympic glory: “I just pray to God that I continue doing improvements every day so that I fulfil my dream. It was snatched from me in 2012 … I don’t want to miss it again.”

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