"She's 57, on testosterone, and building companies with AI."

There’s a number I want to tell you. Not because it’s shocking, though it is, but because once you hear it, you’ll never hear “I guess I’m just less motivated than I used to be” the same way again.

By around age 40, a woman’s testosterone is roughly half what it was in her early twenties.

Not by menopause. Not by 50. By 40. And it keeps falling from there, another quarter or so through her late fifties, before it levels off.

Before the hot flashes. Before the missed periods. Before anyone hands you a pamphlet or sends you to an endocrinologist. The hormone that runs ambition, creative fire, goal-directed behavior, and the deep animal desire to build things is already at half capacity, and almost no one will tell you it’s happening.

I know. Because nobody told me.

What we call “aging” might be a deficiency

You know the feeling I’m talking about. Not depression, exactly. Not burnout in the way that word gets used at work. Something subtler and harder to name. The flatness. The sense that you’re operating at 80% of yourself. The project you used to be excited about that now feels like it has a ceiling. The business idea you had in your 30s that you just… didn’t pursue, and when you try to remember why, all you can find is something like “I didn’t have the energy.”

I’ve watched brilliant women in their 40s and 50s describe this to me as if it’s an obvious truth about getting older:

“I’m just less driven than I used to be.” “I don’t start things the way I once did.” “I think I’ve become more of a settler.”

And I want to reach through time and ask them: what if you haven’t changed? What if a measurable, correctable hormone deficiency quietly changed the chemistry of your ambition, and medicine decided it wasn’t worth addressing because there’s no FDA-approved product to sell you for it?

Here’s the mechanism, briefly. Testosterone acts on the dopamine systems in the brain. Dopamine is the neurotransmitter of wanting, not of pleasure exactly, but of the motivated pursuit of it. The drive to initiate. The reward signal for doing hard things. When testosterone declines, that signal weakens, and what you feel isn’t sadness so much as flatness. A quieter, more manageable version of yourself that’s easy to mistake for maturity.

In a lot of cases it isn’t maturity. It’s a deficiency. And here’s the part medicine almost never explains: you can be on an antidepressant, I’ve been on one for 30 years, and still have textbook testosterone-deficiency flatness, because antidepressants work on serotonin and this runs through dopamine. Those are different systems. I’ve written about that gap in more detail in My antidepressant couldn’t fix this. Testosterone did. The short version: an antidepressant that’s doing its job on depression won’t touch the motivationless quality that comes from low testosterone, because it was never built to.

What came back

I’m 57. I founded adoption.com in 1995, built it from scratch, ran orphanages in Ethiopia, Kenya, and Haiti, adopted seven kids, and pioneered internet communities for families before most people had email. I know what it feels like to have the vroom vroom. I also know what it feels like when it goes quiet.

For a long time I thought the quieter version was just who I’d become. Older. More realistic. Less likely to bet on something crazy. I told myself that was wisdom.

Then I started testosterone, injectable testosterone enanthate, dosed for women rather than the men’s protocol, and I got 20 years back.

I don’t say that lightly. I mean it specifically. The drive to finish things came back, not just to start them, to follow a thread all the way to the end without losing it. The physical pull toward the work I’d laid out the night before. The appetite to bet on myself, the “what if I just tried this” I thought I’d outgrown. The willingness to do hard things because the fear had become interesting again instead of paralyzing.

The gym surprised me most. I used to white-knuckle my way through workouts. Now I want them. That’s not discipline. That’s dopamine.

My injection is every two weeks, and I can tell when it’s been too long, because the flatness starts creeping back at the edges. Not dramatically. I don’t crash. There’s just a warmth that dims, a hum that goes quieter. Then I get the injection and it comes back within about 48 hours, like a tide coming in. I’m not dressing that up to make a point. That’s what it actually feels like.

The pharmacokinetics explain it exactly. Testosterone enanthate has a half-life of roughly four and a half days, so on a two-week schedule you’re already below half your peak by day nine and close to bottom by day 14. The flatness at the edges isn’t in my head. It’s the predictable result of a dosing rhythm designed for men’s physiology, applied to a woman’s without adjustment. (I go into the full physiology, and my exact protocol, in My brain went from black and white to technicolor.)

My partner, Bob, will tell you he notices when it’s been too long between injections. The version of me on testosterone is the version he fell for.

Nobody told me this was available. I had to find it myself, which is its own indictment of how medicine handles women’s hormones. But that’s a separate story, and I’ve told it in She was never given the choice.

The economic case nobody’s making

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

Women in their 50s, 60s, and early 70s number in the tens of millions in the United States alone: in the workforce, recently retired, entrepreneuring, caregiving, mentoring, writing, building. They hold more institutional knowledge than any other demographic. Per capita, they’re among the most experienced humans alive. And a real fraction of them are running on what amounts to a hormonal flat tire, undertreated or untreated entirely, and told it’s “just aging.”

We talk about the productivity slump and the innovation slowdown and why more businesses aren’t being started, and then we ignore the fact that we have tens of millions of highly experienced women whose motivational engine has been running low 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 finally get written? What caregiving capacity returns to families running on empty? What mentoring happens between a 58-year-old with thirty years of hard-won knowledge and a 28-year-old who badly needs someone like her?

That value doesn’t show up cleanly in GDP. But consider the scale of what women already do for free: in 2020, Oxfam estimated that the unpaid care and domestic work performed by women and girls is worth at least $10.8 trillion a year to the global economy, more than three times the size of the global tech industry. Restore the drive behind even a slice of that labor and the number gets very large very fast.

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 past my own energy levels.

Testosterone may be neuroprotective, and that’s especially relevant for women who carry the APOE4 gene variant, which sharply raises Alzheimer’s risk. My mother has Alzheimer’s. I carry two copies of APOE4. Some research suggests testosterone, alongside estrogen, may help defend the aging brain against the changes that lead to dementia.

I want to be careful here, the way I try to be careful everywhere on this site. The evidence for testosterone and the brain is younger and thinner than the evidence for estrogen, and it’s nowhere near settled. But the timing is hard to ignore: women lose testosterone across exactly the window, their 40s and 50s, when Alzheimer’s risk begins to compound. We may be walking away from a possible layer of protection at the worst moment, not by choice, but because medicine looked at women’s hormones and decided the commercial math didn’t pencil out.

And this matters more for women than the culture has caught up to. Women are almost two-thirds of Americans living with Alzheimer’s, according to the Alzheimer’s Association. If we’re serious about that, testosterone can’t stay filed under “sexual wellness.” (I write about my own genetics, and what homozygous APOE4 actually means, in I carry two copies of the Alzheimer’s gene.)

Now add AI

Here’s where I want to go somewhere I don’t think many people are talking about yet.

We’re in the middle of the most dramatic individual-productivity shift in human history. AI tools are compressing work that used to take teams into work one motivated person can do. Voice interfaces are removing the keyboard barrier entirely: I dictated the concept for this very newsletter to my AI assistant, out loud, while doing something else.

But this shift rewards the energized, the curious, and the willing-to-try. The woman running on half her testosterone looks at a tool like Claude or Wispr Flow and doesn’t have the drive to pick it up. It feels like friction, one more thing to learn when she’s already tired. The “what if I tried this” signal is too quiet, and she closes the tab. The woman with her testosterone restored is the one who grabs the tool and runs.

I’m that woman right now, and I’ll tell you what it looks like from the inside. I split my time between Boulder and Ajijic, Mexico, which means testosterone is easy to get. I’m building several newsletters at once, running research pipelines that would normally take a team, dictating to my assistant with Wispr Flow so my thoughts become articles and briefs and plans, and waking up with ideas I actually want to act on and the energy to do it.

The testosterone isn’t incidental to that. It’s the foundation. Think of the AI as a multiplier: multiply 50% and you still have 50%. Restore the baseline first, then apply the multiplier, and that’s when something extraordinary opens up. That’s the story we’re 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 tools in history at the same time?

In my case, she builds faster than she ever has.

Why this isn’t happening, and what you can do

Here’s the short, unflinching version of why you probably don’t know any of this.

There are zero FDA-approved testosterone products for women. Not because the evidence doesn’t exist, it does, but because the regulatory and commercial pipeline for women’s hormones has been broken since the Women’s Health Initiative frightened everyone away from hormone research in 2002. (That story is in She was never given the choice.) The pharmaceutical companies looked at the post-2002 liability climate and stopped pursuing approval. The regulators never pushed back. So women are left using off-label products, compounded formulations, and men’s products in micro-doses, all of which can work, but all of which require finding a provider who actually knows what they’re doing.

Meanwhile, in Ajijic, testosterone is on the pharmacy shelf, over the counter. My injectable, Despamen, costs less than a nice lunch, and I pick it up alongside my groceries. I’m not telling anyone to self-prescribe, I work with a provider who monitors my levels, but the contrast is clarifying. The most medically advanced country in the world decided women don’t need a regulatory pathway for a hormone their bodies have made since puberty. Mexico put it on the shelf. Make that make sense.

What you can do:

Find a menopause specialist. Not just an OB/GYN, a clinician with specific training in hormones and menopause. The Menopause Society keeps a provider finder at menopause.org.

Ask for the right labs. Total testosterone alone isn’t enough. Ask for:

Total testosterone
Free testosterone by equilibrium dialysis (the gold-standard method, not calculated free T or an analog assay)
SHBG, sex hormone-binding globulin, the protein that binds testosterone and makes it unavailable. High SHBG, common in women on oral contraceptives or oral estrogen, can tank your free testosterone even when your total looks fine.

Name it explicitly. Say: “I want to discuss testosterone restoration for motivation, energy, and cognitive drive, not just libido.” If you don’t say it, they’ll assume you’re there about sex and give you a libido-focused answer that undersells what’s actually available to you.

The vroom vroom was never supposed to leave

Here’s what I want you to hear, if you’re 45 or 52 or 57 and you’ve been quietly grieving a version of yourself you assumed was just youth.

The ambition you had in your 30s wasn’t youth. A lot of it was testosterone. The drive to start things, to bet on yourself, to do hard things voluntarily and enjoy the doing, that ran on a hormone. And hormones are testable, and in many cases correctable.

Think of the woman who had a business idea and let it go, not because the idea was bad, but because she couldn’t summon the fire and didn’t know the fire had a chemistry. She didn’t grow out of it. She didn’t mature past it. A measurable deficiency quieted her, and she can come back.

I know, because she came back for me. At 57 I’m building more, creating more, and honestly having more fun than I was at 47. The testosterone is most of why. The AI tools help, but without the engine, the tools just sit in the driveway.

None of this is radical, and none of it is a promise that hormones fix everything. It’s an argument for information and access: tell women the truth, give them the option, and get out of the way.

Go get your labs. Find a doctor who’ll actually run them. Have the conversation.

And then come back and tell me what you built.

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

This article is educational and is not medical advice. Talk to a qualified clinician before starting any hormone therapy.

Sources: Zumoff B, et al. “Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women.” J Clin Endocrinol Metab, 1995 (doi:10.1210/jcem.80.4.7714119) | Davison SL, et al. “Androgen levels in adult females: changes with age, menopause, and oophorectomy.” J Clin Endocrinol Metab, 2005 (doi:10.1210/jc.2005-0212) | Oxfam. “Time to Care: Unpaid and underpaid care work and the global inequality crisis.” January 2020 | Alzheimer’s Association. 2025 Alzheimer’s Disease Facts and Figures.

Keep reading

Get the research, not the reassurance.