Silvia Camporesi, an assistant professor in bioethics and society at King’s College London, writing for Aeon: Who Is A Sportswoman?

Why seek out – or at least wilfully [sic] ignore – biological variations that confer advantage across a wide range of skills while penalising women for more testosterone? Why single out hyperandrogenism as the only variation that confers an unfair advantage in sport?

Silvia argues the fundamental unfairness of requiring women with high testosterone levels to have suppression therapy in order for them to compete as a female. She is right. She also acknowledges that while a woman with high testosterone levels is allowed to compete with the men, they are generally not competitive. Her proposed solution:

To move forward, we must err on the side of inclusivity, and consider an athlete a woman when she is legally recognised as such.

In most sports, there is a meaningful gap between the male world records and the women world records. If the International Olympic Committee adopted Sylvia's proposed approach, China would legally declare their second tier male athletes to be women, and they would win every medal in the women's events.

Therein lies the problem: everyone agrees the current method is unfair, and nobody can come up with a better method.