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---------- Forwarded message ----------
From: Hunter Williams <huntershealthhacks@mail.beehiiv.com>
Date: Apr 23, 2026 at 6:06 PM -0400
To: tjphuhs@gmail.com <tjphuhs@gmail.com>
Subject: Women and Testosterone
> Fascinating new study released
> April 23, 2026 | Read online
> Women and Testosterone
> Fascinating new study released
>
>
>
> Happy Thursday!
> FYI, in case you missed it, I launched a giveaway yesterday to celebrate 100,000 active newsletter readers. You can register to win here (apologies for the tech issues yesterday, the website crashed in the first 30 minutes).
> https://hunterwilliamshealth.com/giveaway
> Let me tell you about a conversation I have over and over again.
> A woman reaches out.
> She's tired. Her mood is flat. Her focus is gone. Libido is nonexistent. She's read enough to know hormones are involved.
> Then I ask what her testosterone levels are.
> Silence.
> Most women have never had them checked. A lot of providers never offer. And when they do get tested, the result gets waved off as "normal for your age" without a number ever being shared.
> Testosterone is the most abundant biologically active sex steroid in a woman's body. Not estrogen, testosterone.
> Circulating levels run roughly ten times higher than estradiol, even at peak reproductive years.
> And production starts dropping in your late 20s. By 45, most women have lost about half of what they had at 25.
> Why do I bring this up?
> Because a new study in the Journal of Personalized Medicine just put real numbers on what happens when you actually replace testosterone.
> Let’s look at what they found.
>
> The Myth
> Testosterone in women does heavy lifting across nearly every system that matters.
> It drives energy production at the mitochondrial level.
> It regulates mood by modulating dopamine and serotonin signaling.
> It maintains lean muscle.
> It supports hippocampal neurogenesis, which is a fancy way of saying your brain needs it to grow new memory-related neurons.
> It stimulates red blood cell production.
> It influences insulin sensitivity and lipid metabolism.
> Estrogen and progesterone matter. I'm not arguing against them. But they cannot do what testosterone does. They operate on different receptors and different pathways.
> Women who do BHRT with only estrogen and progesterone are running a hormone protocol with a missing pillar.
>
> The Study
> Researchers tracked 332 women on individualized testosterone replacement therapy.
> Ages ranged from 27 to 78, with an average of 45. A subset of 120 women also got paired blood work at baseline and 12 weeks.
> The protocol was simple.
> Start with a blood test, administer a low physiologic dose, retest, and then adjust.
> Then target the upper end of the premenopausal range, 25 to 50 ng/dL total testosterone (still too low in my opinion, but better than nothing).
> Delivery options were topical cream, oral troches, or subcutaneous injections.
> Women rated change across eight symptom domains.
> Energy, depression, irritability, anhedonia, sexual interest, relationship satisfaction, concentration, and memory.
> Every single domain improved.
> Interestingly, libido was one of eight things measured, and it wasn't even the star of the show.
> The real headline was what testosterone did to everything else.
>
> Energy
> 84.3% of women reported improvement in energy and fatigue. That was the highest number of any domain.
> When researchers asked women to pick their single biggest benefit, energy took the top spot again at 64.2%.
> Mood came in second at 49.7%. Sexual desire was third at 41.3%.
> Read that one more time. Energy and mood ranked above libido.
> The FDA has never approved a testosterone product for women in the US.
> The only sanctioned clinical use is postmenopausal low libido.
> That framing has shaped how doctors think, how insurance covers it, and what women even believe they're allowed to ask for.
> The data tells us that framing is way too narrow.
> The hormone that gets prescribed for sex drive is actually delivering its biggest value in energy and mood.
> The clinical guidelines haven't caught up.
> If you're exhausted and flat and your hormones are low, testosterone might matter more than any supplement, stack, or peptide you're currently chasing.
>
> Mood and Cognition
> Depression improved in 70.8% of women. Irritability in 69%. Anhedonia, which is the clinical term for loss of pleasure, improved in 67.5%.
> These are numbers that would get a psychiatric drug fast-tracked for emergency approval.
> Testosterone modulates dopamine and serotonin directly.
> When levels drop, mood regulation gets ugly. When levels are restored, everything cleans up.
> The cognitive piece was interesting.
> Memory and concentration started at the lowest scores of any domain at one month.
> They didn't show meaningful improvement until the 4 to 6-month mark.
> Why?
> Because brain tissue takes longer to remodel than energy metabolism does.
> Testosterone supports hippocampal neurogenesis and BDNF expression, but growing new neurons is not a 30-day process.
> This is the reason so many women try TRT for 12 weeks, don't feel a cognitive shift, and quit.
> They stopped three months before the brain benefits were going to kick in.
>
> Biomarker Data
> All five biomarkers moved in the right direction with massive effect sizes.
>
> • > Total testosterone: up 151.8% (16.8 to 42.3 ng/dL, which is still too low in my opinion, but better than nothing)
> • > Free testosterone: up 216.7% (1.2 to 3.8 pg/mL, again still too low in my opinion, but better than nothing)
> • > Hemoglobin: up 5.5%
> • > SHBG: down 13.3%
> • > Triglycerides: down 12.6%
>
> 100% of women saw their testosterone rise.
> 86.7% had meaningful hemoglobin increases.
> 77.5% had SHBG drop.
> 74.2% had triglycerides come down.
> Every post-treatment value stayed inside the normal physiologic range.
> Cardiovascular disease is the leading cause of death for women.
> Triglycerides rise through the menopausal transition. Testosterone therapy pushed them down by nearly 13% in three months.
> That's the opposite of what most people assume testosterone does to women's cardiovascular risk.
>
> Duration Matters More Than Dose
> At 1 month, only 5.4% of women reported significant improvement in quality of life.
> At greater than 12 months, 51.5% did. And not a single woman in the 12+ month group reported no change.
> The benefits compound.
> Most published trials on testosterone in women run 12 to 24 weeks. The study authors specifically called this out as a problem. These are trial windows that cut off just as the deeper benefits are starting to show.
> If you start TRT, plan on six to twelve months before you judge the results. The energy shift comes fast. The mood shift comes within a couple of months.
> The cognitive changes and full restoration of quality of life take longer.
> Real hormone optimization is a six-month conversation at minimum.
>
> Final Thoughts
> If you're on BHRT and still feel off, ask for a testosterone panel that INCLUDES free testosterone.
> Don't accept "normal for your age" as an answer without seeing a number.
> A woman at 50 with the testosterone of a 50-year-old is a woman running on half of what she had at 25. That's not normal!
> I favor injections, but in this study, the other delivery mechanisms worked too.
> Pick what fits your lifestyle best.
> Testosterone is foundational, and most women who need it have no idea they do.
> Best,
> Hunter Williams
>
> Further Reading
> Elggren CW, et al. Testosterone Replacement Therapy in Women Is Associated with Improved Symptom Burden and Favorable Biomarker Changes. Journal of Personalized Medicine. 2026. https://doi.org/10.3390/jpm16050231
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