Converse effects of reduced athletic performance in athletes who undergo suppression of circulating testosterone concentrations from those in the male into the female range have been reported. A minimal estimate of the impact of adult male testosterone concentrations on muscle size and strength in females is provided by the Huang et al. (112) study of postmenopausal women. Alternative explanations for the sex difference in athletic performance, other than it being due to the sex difference in postpubertal circulating testosterone, have been proposed, including (1) sex differences in height because height is a predictor of muscle mass (116), (2) genetic sex differences due to the influence of unspecified Y chromosome genes (154), and (3) sex differences in GH secretion (116). Extensive twin studies show that adult height is highly heritable with predominantly additive genetic effects (140) that diverge in a sex-specific manner from the age of puberty onwards (141, 142), the effects of which are likely to be due to sex differences in adult circulating testosterone concentrations. Alternatively, stress fractures in athletes, mostly involving the legs, are more frequent in females with the male protection attributable to their larger and thicker bones (146).Many if not most other aspects of physiology exhibit sex differences and may therefore enhance the impact of the male advantage in sports performance of the dominant determinants (muscle and hemoglobin). As with muscle, sex differences in bone are absent prior to puberty but then accrue progressively from the onset of male puberty due to the sex difference in exposure to adult male circulating testosterone concentrations reviewed in (135). The key findings providing conclusive evidence that testosterone has prominent dose-response effects in men are reported in studies by Bhasin and colleagues that proved a monotonic dose response, extending from subphysiological to supraphysiological range for men for testosterone effects on muscle mass, size, and strength in healthy young men, findings that have been replicated and confirmed by an independent group (65). Whereas numerous genes and environmental factors (including genetics, physical activity, and diet) may contribute to muscle mass, the major cause of the sex difference in muscle mass and strength is the sex difference in circulating testosterone. Conversely, among elite female athletes with circulating testosterone in the healthy premenopausal female range, circulating hemoglobin does not correlate with athletic performance (35). There is convincing evidence that the sex differences in muscle mass and strength are sufficient to account for the increased strength and aerobic performance of men compared with women and is in keeping with the differences in world records between the sexes (116). Anyone that was born female can compete as a male. Whatever it is, the top men do "good" surfing better than the top women. Any virgin can tell you that male and female bodies differ. Heavy alcohol consumption can lower your testosterone levels and impair your fertility. Your doctor can recommend the best treatment options for your low testosterone levels and your alcohol dependence. If you believe that your drinking is affecting your testosterone levels or reproductive health, it’s a good idea to see a doctor. Although the results of animal studies don’t always carry over to humans, the results of this study suggest that at least a partial recovery is possible. Gabeira, who learned to surf growing up in Rio de Janeiro, is among the world’s best female big-wave riders, along with Dupont, the Hawaiians Kennelly and Paige Alms, San Franciscan Bianca Valenti, and fellow Brazilian Andrea Moller. It was also the biggest wave surfed by anyone, male or female, for the season – the first time this feat has been achieved by a woman. Prolonged exposure to stress, for instance, can reduce testosterone levels, making recovery post-surfing more extended and less efficient. Alternatively, stress fractures in athletes, mostly involving the legs, are more frequent in females with the male protection attributable to their larger and thicker bones (146). An important difference between androgen effects on bone compared with effects on muscle or hemoglobin is that developmental bone effects of androgens are likely to be irreversible. These findings have strong implications for power-dependent sport performance and largely explain the potent efficacy of androgen doping in sports. Sex differences in performance (in percentage) according to age (in years) in running events, including 50 m to 2 miles (upper left panel), and in jumping events, including high jump, pole vault, triple jump, long jump, and standing long jump (upper right panel) for details, see Ref. (8). 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. For example, in a well-controlled prospective study of older men with prostate cancer (66), androgen deprivation achieving castrate levels of circulating testosterone sustained during 12 months markedly suppressed sexual desire and function, whereas those effects did not occur in age-matched men having nonhormonal treatment of prostate cancer or those without prostate cancer. There is a wide sex difference in circulating testosterone concentrations and a reproducible dose-response relationship between circulating testosterone and muscle mass and strength as well as circulating hemoglobin in both men and women. In both intersex/DSD and transgender individuals, the developmental effects of adult male circulating testosterone concentrations will have established the sex difference in muscle, hemoglobin, and bone, some of which is fixed and irreversible (bone size) and some of which is maintained by the male circulating testosterone concentrations (muscle, hemoglobin). The limited available prospective evidence from initiation of transgender cross-sex hormone treatment suggests that the advantageous increases in muscle and hemoglobin due to male circulating testosterone concentrations are induced or reversed during the first 12 months and the androgenic effects may plateau after time. An aesthetic preference for splitting categories is not a sound reason to require the virtually impossible standard of establishing fresh and comprehensive empirical evidence in women of testosterone dose-response effects ranging into male circulating testosterone concentrations. Overall, the unequivocal dose-response evidence in men together with the available overlap evidence in women appears sufficiently persuasive, so that it is doubtful that women would respond differently from men if their circulating testosterone levels were raised to the male range. The major limitations on scientific knowledge of the impact of adult male circulating testosterone concentrations on the sex difference in athletic performance is the lack of well-designed studies.