Caster Semenya finally lost her long legal battle Tuesday against track and field’s rules to limit female runners’ naturally high testosterone levels.

Switzerland’s supreme court said its judges dismissed Semenya’s appeal against a Court of Arbitration for Sport ruling last year that upheld the rules drafted by track’s governing body affecting female runners with differences of sex development.

The Swiss Federal Tribunal said CAS “had the right to uphold the conditions of participation issued for female athletes with the genetic variant ‘46 XY DSD’ in order to guarantee fair competition for certain running disciplines in female athletics.”

The ruling means Semenya cannot defend her Olympic 800-meter title at the Tokyo Games next year, or compete at any top meets in distances from 400 meters to the mile, unless she agrees to lower her testosterone level through medication or surgery. She has repeatedly said she won’t do that.

The federal court said it was limited to examining “whether the CAS decision violates fundamental and widely recognized principles of public order. That is not the case.”

The federal judgment came more than a year after the two-time Olympic 800-meter champion lost a previous ruling from the same court.

That July 2019 verdict overturned a temporary ruling which had allowed Semenya briefly to compete in the 800 meters at international events without taking testosterone-suppressing drugs.