"What Would Happen If Women Over 40 Got Their Testosterone Back?"

I’m 57 years old. I founded adoption.com in 1995, founded orphanages and international adoption programs in Ethiopia, Kenya, and Haiti, adopted seven kids, and I’m currently building multiple newsletters and AI systems simultaneously from a house that splits its time between Boulder, Colorado and Ajijic, Mexico.

I am not slowing down. But I have to be honest with you: I wasn’t always this person again.

There was a window — a long, foggy, maddening window — where the drive was just… gone. Not “tired” gone. Not “needs a vacation” gone. Gone like a pilot light that someone quietly turned off while I wasn’t looking. I had all the same ideas. I had the same values. I just couldn’t make myself want to execute on them with the ferocity I always had. And nobody — not one doctor in that window — told me why.

The reason was testosterone.

The number nobody tells you

By the time a woman turns 40, she has already lost approximately 50% of her peak testosterone. Not when menopause hits. Not when her periods stop. Before any of that. In her late twenties and thirties, quietly, while she’s raising children and building careers and holding everything together, half her testosterone is already gone.

The medical community has largely treated this as either irrelevant or acceptable. It is neither.

Testosterone is not a “male hormone” that women happen to have trace amounts of. It is a foundational hormone in women — present in higher concentrations than estrogen throughout most of a woman’s reproductive life, binding to receptors in the brain, muscle, bone, heart, and every organ system she owns. When it drops, things change. Not just libido (though yes, that too). What changes first, and most profoundly, is motivation.

Testosterone is the hormone most tightly coupled to the dopamine reward system — specifically the “wanting” circuitry, the drive to initiate, to pursue, to feel like action is worth taking. Researchers call this motivational salience. I call it the difference between seeing a goal and actually caring enough to move toward it.

When testosterone drops, women don’t stop having ideas. They stop feeling the pull toward them.

The economic argument nobody’s making

Let me put some numbers on this, because I think we’ve been having the wrong conversation entirely. This isn’t just a women’s health issue. It’s an economic issue. A civilizational one.

Women aged 50–74 in the United States represent roughly 37 million people — in the workforce, recently retired, actively entrepreneuring, caregiving, mentoring, writing, building. They hold more institutional knowledge than any other demographic. They are, per capita, among the most experienced humans alive. And a significant fraction of them are running on what amounts to a hormonal flat tire, undertreated or completely untreated, told this is “just aging.”

We talk about the “productivity crisis” and the “innovation slowdown” and “why aren’t more businesses being started” — and then we completely ignore the fact that we have tens of millions of highly-experienced women whose motivational engine has been quietly running on fumes for a decade or more.

Here’s the thought experiment I can’t shake: If even 10% of undertreated women over 40 got their testosterone back — what gets built?

What businesses launch? What nonprofits get funded? What books get written? What grandchildren get sat with, patiently, by a grandmother who has her full presence back? What caregiving capacity returns to families that are running on empty? What second careers emerge? What mentoring relationships form between a 58-year-old with thirty years of hard-won knowledge and a 28-year-old who desperately needs someone like her?

The economic value of that is not measurable in GDP alone. But if you forced me to try: a 2019 analysis estimated that women’s unpaid caregiving and household labor alone contributes the equivalent of $10.9 trillion annually to the global economy. Restore the motivational capacity of even a fraction of that workforce? The number is staggering.

The FDA has zero — zero — approved testosterone products for women

Here is the part that should make you genuinely angry.

The evidence for testosterone’s benefits in women — for energy, mood, libido, cognitive function, bone density, and body composition — has existed in peer-reviewed literature for decades. It is not fringe. It is not contested. The Endocrine Society, the International Society for the Study of Women’s Sexual Health, and menopause specialists around the world regularly recommend it. And yet: the FDA has not approved a single testosterone product for women.

Not because the evidence doesn’t exist. Because after the Women’s Health Initiative study scared the medical world into retreating from all hormones in 2002, the commercial and regulatory pipeline for women’s hormonal health essentially collapsed. The pharmaceutical companies looked at the post-WHI environment, decided the liability risk wasn’t worth it, and stopped pursuing FDA approval for testosterone products for women. The regulatory body never pushed back. And so we’re here: millions of women going undertreated, with doctors who either don’t know testosterone is appropriate to prescribe off-label, are afraid to, or have been trained to dismiss the conversation.

Meanwhile, I’m in Ajijic, Mexico, where testosterone is available at any pharmacy over the counter. No prescription. No insurance negotiation. No explaining myself to a doctor who looks at me like I’ve asked for something illicit. I pick it up alongside my groceries. My injectable — Despamen, testosterone enanthate, every two weeks — costs less than a nice lunch.

I am not recommending everyone self-prescribe. I work with a provider who monitors my levels. But the contrast is clarifying: the United States, the most medically advanced country in the world, has decided women don’t deserve a regulatory pathway for a hormone their bodies have been producing since puberty. Mexico put it on the pharmacy shelf. Make that make sense.

The brain protection argument you haven’t heard enough

There’s another dimension to this that I think about constantly, because it’s personal in a way that goes beyond my own energy levels.

Testosterone appears to be neuroprotective — particularly relevant for women who carry the APOE4 gene variant, which dramatically increases Alzheimer’s risk. My mother had Alzheimer’s. I carry APOE4. And the research suggests that testosterone, along with estrogen, may play a role in protecting the aging brain against the pathological changes that lead to dementia.

Women are losing testosterone at exactly the window — their 40s and 50s — when Alzheimer’s risk begins to compound. We are walking away from a potential layer of protection at the worst possible time, not because we chose to, but because medicine looked at women’s hormonal health and decided the commercial math didn’t pencil out.

If we’re serious about the Alzheimer’s epidemic — and we should be, because women represent two-thirds of all Alzheimer’s patients — then we cannot keep treating testosterone as a “sexual wellness” footnote. It belongs in the brain health conversation, now.

The force multiplier I didn’t expect

Here’s what I’ve discovered in the last year that I didn’t anticipate: testosterone doesn’t just restore your drive. It restores your leverage.

I use AI tools — Claude, Wispr Flow for voice dictation, others — as a force multiplier for my work. One person, with the right tools, can now do what used to require a team. I can draft, research, build systems, write code, iterate, and publish at a pace that would have been impossible ten years ago even with a staff.

But here is the truth I want to be precise about: the AI is the multiplier. The testosterone is the engine.

Without the engine, the multiplier is irrelevant. I had the AI tools before my testosterone was restored. They sat there, available, while I struggled to summon the initiative to open them. What changed wasn’t the tools. What changed was that I wanted to use them again. The wanting came back. The dopamine circuit reengaged. And suddenly I was building things at 57 that I couldn’t have imagined powering through at 52.

That is the story we are not telling. Not “AI will save productivity” — but “what happens when you give a woman with 35 years of expertise her motivational hardware back AND hand her the most powerful productivity tools in human history?”

The answer, at least in my case, is: she builds faster than she ever has.

This is not about chasing youth. It’s about claiming what’s yours.

I want to be clear about something, because I’ve watched this conversation get distorted in both directions.

Restoring testosterone is not about becoming something you’re not. It is not about denying age. It is not about vanity, or about chasing a twenty-five-year-old’s body, or about making women into men.

It is about restoring what every cell in a woman’s body was designed to have, for as long as biology cooperatively allows. Every organ system in a woman’s body has testosterone receptors. The heart. The brain. The bone. The muscle. The vaginal tissue. They are there because testosterone belongs there. Losing it in your thirties and forties is not a design feature. It’s a flaw in the plan — and one that medicine has the tools to address.

Women want to be productive their whole lives. Not productive in the narrow GDP sense. Productive in the full human sense: raising their grandchildren, mentoring the next generation, building the businesses they always wanted to build, writing the books they’ve been carrying for decades, sitting on nonprofit boards, teaching what they know, creating meaning for themselves and others.

“Productive retirement” is not a fantasy. It is what women have always wanted. We just keep handing them a body that makes it feel impossible, and then acting surprised when they opt out.

What needs to change

The policy list isn’t complicated. The will to execute it has been the missing ingredient.

The FDA needs a regulatory pathway for testosterone therapies in women that reflects the actual evidence base, not the post-WHI panic that has governed women’s hormonal care for the last twenty-three years. The medical education pipeline needs to train providers that testosterone deficiency in women is real, common, and treatable. Insurance needs to cover off-label testosterone for women the same way it covers off-label treatments for men. And the research funding that evaporated after 2002 needs to return — specifically for women’s hormonal health across the full lifespan.

None of this is radical. All of it is overdue.

I think about the women in their 40s reading this who are just now hearing, for the first time, that half their testosterone is already gone. I think about the doctors who were never trained to ask the question. I think about the economy — the caregiving capacity, the entrepreneurship, the mentoring, the sheer accumulated human wisdom — that we are leaving untapped because we decided this wasn’t worth treating.

It is worth treating. The evidence says so. The economics say so. And thirty-seven million women, many of them quietly wondering why the drive that used to come so naturally has gone somewhere they can’t find it —

They say so too.

Annette Thompson is 57, the founder of adoption.com, and a menopause advocate writing about evidence-based women’s health.