As such, a Friedman's test and Wilcoxon signed-rank tests were also applied to the performance data. Similarly to core body temperature, data were first assessed to establish whether they met the assumptions required for parametric statistical analysis. Where scoring differed in this study compared with Surfing Australia protocols is that scores were given on a scale of 0–10 with increments of 0.5, as opposed to scores being continuous in nature between 0 and 10; making the data somewhat categorical in nature. All participants were in the wave pool at the same time and took turns riding waves (i.e., only one person per wave; however, they were all presented with the same waves) (33, 34). The magnitude of change between the data points was also compared between days. "It’s the tale of a girl who surfs the biggest waves in the world." But the reality is that her record-breaking wave will give youngsters something to strive towards. Today’s teenagers have women athletes showing what’s possible. I think for women we’re going to see one crazy increase once we get the resources we need. "Hypothetically, because men have had the resources for so long, their level of performance won’t have as big a jump. They want access to more funding, better equipment, and male-only competitions. Meanwhile, the lowest testosterone dose (1.25 g of gel per day) produced a serum testosterone of 6.9 nmol/L, which is equivalent to that of a male in early to middle puberty. The placebo (0) dose produced a serum testosterone of 0.7 nmol/L (the typical mean for castrated men, childhood, and women of any age). The differences between cohorts (i.e., use of anastrozole) was not significant for muscle mass and strength and can be ignored with results of the two cohorts being pooled. In these studies, the lowest testosterone dose produced a mean serum testosterone of 253 ng/dL (8.8 nmol/L) in younger men and 176 ng/dL (6.1 nmol/L) in older men. In the Bhasin and colleagues studies, participants were then randomized to five groups and each received weekly injections of 25 mg, 50 mg, 125 mg, 300 mg, or 600 mg of testosterone enanthate for 20 weeks. Both sets of studies used a common design of fully suppressing all endogenous testosterone (to castrate levels) for the full duration of the experiment by administering a GnRH analog. Thus, three scores were subsequently given—performance in the first scoring block, performance in the second scoring block, and overall performance (which was the best two scores across both scoring blocks). Participants were scored in two "blocks" of three waves (waves 3–5 and waves 7–9). As such, the waves each participant surfed on each occasion were standardized as "advanced" level waves, with the wave face height always 1.6–2.0 m, the likely peel angle at approximately 30° (making it a fast wave), and the wave length at 12–16 s. They were thawed and assayed for cortisol and testosterone using commercial enzyme immunoassay kits (cortisol, catalog number ; testosterone, catalog number ; Salimetrics LLC, State College, PA, USA). Testosterone and cortisol were measured from saliva samples collected from participants immediately before the commencement of the active warm-up and 15 min after the completion of the active warm-up. An important finding from such studies is that androgen-resistant female mice have essentially the same muscle mass and function as wild-type androgen-sensitive females bearing normal AR, whereas androgen-resistant male mice have smaller and weaker muscle mass and function than do wild-type males and comparable instead with wild-type females (101). "Sex differences in height, where they exist, are largely dependent on postpubertal differences in circulating testosterone." In one study of hyperandrogenic female athletes, even mild nonclassic adrenal hyperplasia was ruled out by normal 17-hydroxyprogesterone (36) and, in another (47), reported serum androstenedione and cortisol did not differ from controls, ruling out significant congenital adrenal hyperplasia. A common clinical problem with management of CAH is that glucocorticoid/mineralocorticoid treatment is not always fully effective partly due to variable compliance, which may leave high circulating testosterone, including well into or even above the normal male range (92). Hence, individuals with PAIS may have adult male circulating testosterone concentrations but variable androgen sensitivity. Affected individuals have male internal genitalia (testes in the inguinal canal or abdomen with Wolffian ducts) and consequently adult male circulating testosterone concentrations after puberty. Thus, individuals with 5α reductase deficiency may have male chromosomal sex (46,XY), gonadal sex (testes), and hormonal sex (adult male testosterone concentrations), but such severely undervirilized genitalia that affected individuals may be raised from birth as females rather than as undervirilized males. The striking postpubertal increase in male circulating testosterone provides a major, ongoing, cumulative, and durable advantage in sporting contests by creating greater muscle mass and strength. Although these experiments cannot be replicated in humans, their key insight is that the higher circulating testosterone in males is the determinant of the male’s greater muscle mass and function compared with females. The defect leads to a bottleneck, creating a major backing up of precursor steroids that then overflow into other steroid pathways, leading to diagnostic high levels of 17-hydroxyprogesterone and, in female patients, excessive circulating testosterone or other adrenal-source androgen precursors (e.g., androstenedione, dehydroepiandrosterone) that may be converted to testosterone in tissues. Rare genetic intersex conditions known as DSDs can lead to markedly increased circulating testosterone in women. The most realistic view is that increasing circulating testosterone from the childhood or female range to the adult male range will have the same physiological effects whether the source of the additional testosterone is endogenous or exogenous. Although genetic males (46,XY) with 5α reductase deficiency will develop testes, they usually remain undescended and labial fusion to form a scrotum and phallic growth does not occur. This leads to a deficit of DHT during fetal life when DHT is required for converting the sex-undifferentiated embryonic and fetal tissue to form the sex-differentiated masculine form external genitalia. In this illustrative case the testis was exposed to nonphysiologically high testosterone concentrations (but without any gonadotropin stimulation) that induced sperm production and allowed for natural paternity (73). It is well established in rodents (70, 71) that spermatogenesis is induced by exogenous testosterone when the testosterone concentrations in the testis are high enough to replicate what occurs naturally via LH stimulation (72). Fortuitously, nine participants surfed on the right breaking wave and 10 participants surfed on the left breaking wave. The wave pool had both left and right breaking waves, and participants surfed on their preferred side for the entire session in every session. Saliva samples were collected from participants in sterilized cryovials and stored in a −20°C freezer until analysis to ensure the testosterone molecules crystalized and did not break down. For familiarization, participants surfed at the artificial wave pool in their own time before the commencement of the experiment. Hormones, core body temperature, and performance were compared between sessions, and the relationships between them were explored. We hypothesized that the warm-up and heat retention strategy would elevate core body temperature, and hence muscle temperature, enabling surfers to express more power early in the session and garnish higher judged scores.