Caster Semenya has lost a landmark case against athletics' governing body meaning it will be allowed to restrict testosterone levels in female runners.
The Court of Arbitration for Sport (Cas) rejected the South African's challenge against the IAAF's new rules.
But Cas said it had "serious concerns as to the future practical application" of the regulations.
Olympic 800m champion Semenya, 28, said in response to the ruling that the IAAF "have always targeted me specifically".
Now she - and other athletes with differences of sexual development (DSD) - must either take medication in order to compete in track events from 400m to the mile, or change to another distance.
"For a decade the IAAF has tried to slow me down, but this has actually made me stronger. The decision of Cas will not hold me back," said Semenya in a statement.
"I will once again rise above and continue to inspire young women and athletes in South Africa and around the world."
Previously, she had said that she wanted to "run naturally, the way I was born".
Cas found that the rules for athletes with DSD were discriminatory - but that the discrimination was "necessary, reasonable and proportionate" to protect "the integrity of female athletics".