NEW YORK — Caster Semenya’s running career, jarred by an adverse court ruling on Wednesday, is unique in virtually all its details. Yet the dilemmas she has posed for the track-and-field establishment reflect how vast segments of the sports world are now wrestling with issues related to intersex and transgender athletes.

The essence of the dilemma: How to minimize or eliminate discrimination while simultaneously ensuring that competitions are as fair as possible.

The challenges faced by Olympic champion Semenya — a South African woman who reportedly has some intersex traits — differ in key respects from those confronting transgender women. But there are parallels as well, as evidenced in the ruling by the Court of Arbitration for Sport, the sports world’s highest court,

The CAS ruled that Semenya and other female runners with unusually high testosterone must take medication to reduce their levels of the male sex hormone if they want to compete in certain events, notably the 400 and 800 metres. Comparable requirements apply to transgender women seeking to compete in the Olympics and in NCCA-governed collegiate sports in the U.S.; both organizations say male-to-female athletes should demonstrate that their testosterone level has been below a certain point for at least a year before their first competition.

In Semenya’s case, the CAS voted 2-1 to uphold proposed rules issued by international track’s governing body, the IAAF, saying that they are discriminatory but that “such discrimination is a necessary, reasonable and proportionate means” of “preserving the integrity of female athletics.”

Athlete Ally, a U.S.-based group advocating for grater transgender inclusion in sports, assailed the ruling against Semenya.

“Forcing athletes to undergo medically unnecessary interventions in order to participate in the sport they dedicate their lives to is cruel, and a violation of their human rights,” said the group’s executive director, Hudson Taylor.

Also angered was Kimberly Zieselman, executive director of InterACT, which advocates on behalf of intersex youth.

The CAS ruling against Semenya “is another example of the ignorance faced by women athletes who have differences in their sex traits,” Zieselman said in an email. “There is no one way to be a woman.”

“It is an inherently flawed conclusion that Caster’s natural testosterone level is the only thing giving her physical strength,” Zieselman added. She noted — while citing swimmer Michael Phelps’ long arms — that many athletes have unique physical advantages.

Powerful female stars such as Serena Williams in tennis, Katie Ledecky in swimming and 6-foot-9 (2.06-meter) Brittney Griner in basketball also have been cited as possessing a distinctive physical edge.

Aside from Semenya, there have been relatively few high-profile controversies involving intersex athletes, while there’s been an abundance of news stories about transgender athletes.

Overall, supporters of increased trans inclusion in sports are heartened by the pace of progress. In the United States, a growing number of state high school athletic associations in the U.S. enable them to play on teams based on their gender identity, and the NCAA has trans-inclusive guidelines for all its member schools.

But there have been numerous bitter controversies, even at the high school level. In Connecticut, for example, the dominance of transgender girl sprinters Terry Miller and Andraya Yearwood has stirred resentment among some competitors and their families.

At the adult level, USA Powerlifting incurred recent criticism for sticking by its policy of banning trans women from its competitions. The organization contends that regardless of testosterone levels, male-to-female competitors generally have significant advantages related to bone density and muscle mass.

Earlier this year, tennis great Martina Navratilova became entangled in the debate over trans women’s place in sports.

A lesbian and longtime gay-rights activist, Navratilova was accused of being “transphobic” after asserting that many transgender women — even if they’d undergone hormone treatment — have an unfair advantage over other female competitors. Among her critics was Athlete Ally, which ousted her from its advisory board.

Another critic was Rachel McKinnon, a transgender Canadian track cyclist who in October won a world championship sprint event for women of ages 35 to 44. She suggested that Navratilova’s argument reflected “an irrational fear of trans women.”

McKinnon encountered widespread resentment after she won her championship event.

Initially, she was elated, even though one of her top rivals pulled out of the final at the last minute. But then a photo spread across the internet showing her on the podium with the two smaller, skinnier runners-up, triggering extensive social-media attacks.

Joanna Harper, a medical physicist and transgender runner from Portland, Oregon, says the controversies raise complex questions, and she believes there needs to be a standard based on hormone levels.

“The gender identity doesn’t matter, it’s the testosterone levels,” Harper said. “Trans girls should have the right to compete in sports. But cisgender girls should have the right to compete and succeed, too. How do you balance that? That’s the question.”

The IAAF argued in Semenya’s case that high, naturally occurring levels of testosterone in athletes with intersex characteristics that don’t conform to standard definitions of male and female give them an unfair competitive advantage. It decreed a maximum level for females.

Semenya — whose muscular build and super-fast times have led some to question her accomplishments — declared she will not be deterred by the CAS ruling.

“For a decade the IAAF has tried to slow me down, but this has actually made me stronger,” she said in a statement. “I will once again rise above and continue to inspire young women and athletes in South Africa and around the world.”

David Crary, The Associated Press