Double Olympic champion Caster Semenya on Wednesday lost her appeal against the regulations imposed by the International Association of Athletics Federations (IAAF) that compel middle-distance female runners to reduce their testosterone by taking medication in order to compete as women.

The New York Times reported that the decision was a loss for the 28-year-old South African who has time and again challenged the limits women athletes with higher levels of testosterone face in world sports.

While some competitors have said women with higher levels of the hormone have an unfair advantage over the rest, several human rights activists, and people around the globe have magnified their voices in favor of Semenya by arguing that the consequences of using testosterone as a tool to determine athletes as male versus female defy constantly evolving gender politics, inclusion and identity. Many have also said that the ruling might not be trustworthy, as it does not provide any substantial scientific backing.

In its 165-page ruling, the IAAF’s Court of Arbitration for Sport Panel acknowledged the discriminatory nature of their decision, but were totally cool with it: “The Panel found that the DSD (testosterone) regulations are discriminatory, but the majority of the Panel found that, on the basis of the evidence submitted by the parties, such discrimination is a necessary, reasonable and proportionate means of achieving the IAAF’s aim of preserving the integrity of female athletics in the restricted events,” the Panel said in a statement.

Under the rules, female athletes who have high natural levels of testosterone will have to reduce their levels through medication to less than 5 nmol/L, which is double the ‘normal’ female range of less than 2 nmol/L.

Essentially, what the IAAF is saying is that testosterone will decide whether someone is female. There has been no similar policing of men’s hormone levels to dictate and define what is male.

(Perhaps, if Semenya had a more clichéd female appearance and were white, no one would have objected to her unreal athletic excellence.)

Semenya has said she does not want to take medication to change who she is and how she was born, and wants to compete naturally. “I know that the IAAF’s regulations have always targeted me specifically,” she said in a statement released via her lawyers. “For a decade the IAAF has tried to slow me down, but this has actually made me stronger. The decision will not hold me back. I will once again rise above and continue to inspire young women and athletes in South Africa and around the world.”

Semenya is not the only athlete likely to be affected. Indian sprinter Dutee Chand was barred by the IAAF from competing against other female runners and was twice dropped from her country’s team due to similar policing of her naturally high levels of testosterone. Even though Chand’s ban was lifted and she has returned to competing, she too has spoken about facing humiliation about trying to prove her gender.

Coming out in support of the athlete, the United Nations Human Rights Council adopted a resolution last month branding the IAAF rules “unnecessary, humiliating and harmful.” The resolution also brought the IAAF flak from the council’s 47 member states representing every continent.

But her most ardent support has come from her own country. “Naturally we are disappointed with the judgement. We will study the judgement‚ consider it and determine a way forward. As the South African government we have always maintained that these regulations trample on the human rights and dignity of Caster Semenya and other women athletes,” said South Africa’s Sports Minister Tokozile Xasa.