Testosterone gave me my life back

Lessons from a year of TRT

Illustration by Alexander Naughton

I’ve been going back and forth for a long time — like, months — on how to frame this piece, which concerns the fact that taking testosterone has massively, unmistakably improved my quality of life. I’ve been vacillating because I can see how easily it could be weaponized as evidence that women don’t belong in leadership roles or in male-dominated fields. Conceding that there may be a biological foundation for certain disparities feels like it risks excusing bias against women, and like a betrayal of some of my core beliefs.

When I played poker professionally, I was a staunch advocate for the position that there are few women at the top of the game for reasons that are primarily sociological: women aren’t encouraged to learn (96% of serious players are male); the environment is unwelcoming to them (see “The Royal Flush Girls”); and they aren’t invited to join the study groups that are critical for cracking into the elite tier. When I won the Female Player of the Year award at the 2016 American Poker Awards, my acceptance speech was about why it was silly to have a separate category for women, when they are equally capable.

It is almost physically painful to me to now conclude that maybe I had it wrong — maybe men really do have an innate advantage at poker. And yet. In the earliest weeks of testosterone therapy, when I really started to feel it kicking in, one of my first thoughts was: “I would have been so much better at poker if I’d had this.”

I.

I first got interested in testosterone because around the age of 40 my sex drive hit a brick wall. I had some health issues that seemed like an explanation at first, but when they resolved my libido didn’t return. I was recently married, totally in love, and sexually compatible with my husband — but, nothing. It felt terrible for both of us.

I investigated and tried a bunch of unhelpful treatments before running across a Reddit thread full of women who had experienced the same thing and been resurrected by testosterone. So I tracked down a doctor in Oakland who specializes in testosterone replacement therapy (TRT) for perimenopausal and menopausal women, and went to see her.

I remember sitting in the examination room, waiting to be seen. I pulled up some information on the signs of low testosterone and got ready to commit them to memory, so I could more efficiently steer the doctor to the result I wanted, regardless of how I really felt.

But what I saw stunned me: It was a list of difficulties I’d actually been experiencing over the previous 6-12 months, to such an extent they scared me. Low energy and muscle weakness: things most people probably experience at times, but I had to sit down after climbing the stairs to our bedroom. Sleep disturbances: Despite pulling all the levers I could find, I was still waking up at 3 or 4 a.m. most nights and staying awake. Difficulty concentrating, brain fog, memory problems: It’s hard to convey with such commonplace terms how clearly it felt like my mind was slipping away. It felt like I was slightly stoned all of the time, but without any of the fun. I’d hoped it was prediabetes or black mold, but was afraid I’d just cooked my brain via my prior drug addiction, or might be sliding into early dementia.

A blood test confirmed that my testosterone was low for my age, and very low relative to what it must have been 10 years earlier. I made another appointment with the doctor, who numbed my butt, made a small incision, and inserted a pellet the size of a Tic Tac.

A week later, in a single day, I felt the testosterone very palpably kick in (from what I understand, this is unusual). I felt a tingly rush of life restored to the world, of desire, of actually wanting things. Life quickened. My thoughts and speech sped up. My husband was being charming at a party, and the intensity of how I felt towards him was comical. I was like a teenager, sitting there blushing. “I have such a crush on my husband,” I tweeted.

There haven’t been any other single days as dramatic as that one. But the shift in my baseline has been profound, and the consequences extend far beyond my sex life.

II.

Without any embellishment, here are the changes I’ve experienced since starting TRT.

First and perhaps most importantly, testosterone made it possible for me to start and keep a regular exercise habit, which I’d failed to do for more than a decade. It’s important to acknowledge that a lot of the effects listed below may be downstream of this one — maybe if I’d come into it exercising regularly, the delta would have been a lot smaller. (It’s not all exercise, though — as I write this, I’m nearing the end of my 3-month cycle, and I can surely feel it.)

Regardless, for the last year I’ve gotten 3-5 hours of medium- to high-intensity exercise per week, versus zero and very little standing or walking before. In the first 9 months, I lost 6% of my body fat and replaced it with pure muscle. My heart health is much, much better, and I don’t hesitate to do physical things in front of other people for fear of embarrassment. This is all a miracle.

I sleep better than I ever have — though some of that’s due to me being a nighttime pot smoker for most of the years it should have been easy to get good sleep. I sleep 8 hours a night and either don’t wake up or immediately fall back to sleep. REM and deep sleep make up a higher percentage of that higher number of hours, too.

Testosterone reversed the cognitive decline I’d been experiencing — not stopped, reversed. I feel sharper now than I did at 30; my memory is much better; the brain fog is gone. I can measure my clock speed pretty directly because I’ve timed myself on every New York Times crossword puzzle published in the last 10 years. In the two months after I started supplementing, I set new PRs for the Thursday (4:37) and Saturday (5:28) puzzles.

Testosterone has affected my life in ways both large and small. The best way I can describe it is that it uniformly lowered the activation energy required for pretty much every activity. When I get a message, I respond to it. When I need something from another room, I stand up and go get it. In fact, I have energy to burn; sometimes I find myself pacing in my office. I get 1-2 hours more peak productivity per day.

The benefits to my mood have also surprised me. All of my many varieties of anxiety are lower. I don’t dread events where I won’t know anyone; I’m not afraid of having attention on me. I feel more confident, though the shadow of that is the most significant side effect I’ve had to contend with — I can be headstrong and reactive, and I haven’t entirely learned to compensate for it yet.

III.

Testosterone was such a mindquake, it took me months to sort out my thoughts about it, other than “holy shit, this is good.” But there are a few lessons I’ve found myself returning to over the last year.

First, men play life on easy. The degree to which this is true embittered me for a while. How much better I could have been at poker, without working any harder. How much more clearly I could have spoken in meetings. How much more easily everything could have come to me, had testosterone lowered the bar of what life required.

Not only that: The game gets progressively easier for men relative to women with age. Both men and women lose testosterone starting in their 20s, but the male decline is much gentler. By 40, the average man has lost 15% of his testosterone, whereas the average woman has lost 50%. Meanwhile, outside of startup land, the vast majority of senior leadership roles are earned after 40. So, female testosterone plummets just as the ceiling gets raised. How big a role does testosterone decline play in women continuing to lag in mid- to late-career leadership roles, despite walloping men by most measures of achievement through their 20s?

Second, much better lives are not only possible, but astonishingly close at hand. At one point in my mom’s long journey with cancer, she told me she didn’t want to stop taking estrogen, even if it significantly increased her risk of recurrence. I found this hard to understand. From my perspective, surviving-with-estrogen and surviving-without-estrogen were two basically positive states, particularly in comparison to the misery of cancer or possibly death.

I think I get it now. I’ve thought carefully about it, and testosterone would need to be worse than smoking for me to give it up. I feel that much more alive.

The Bay Area, as a whole, is pretty high on the idea that experience can get much better. Serious meditators, like my husband, claim that long-term practice dramatically improves your day-to-day experience. Neurotech companies are betting on the ability to improve well-being via all manner of invasive and noninvasive devices. And pharmaceutical startups are developing next-generation psychedelics that could be useful for therapy or even daily use. Maybe we’ll fuse soon with AI, and maybe that will feel good.

My experience with testosterone doesn’t say anything about whether, individually, these ideas are credible. But it was shocking to me that a brain state this much better was available this readily. We’re talking about a tweak to a naturally occurring hormone, designed to bring its level back in line with when I was younger. What other radical quality-of-life improvements are just waiting to be unlocked?

Third, willpower is overrated; biochemistry is king. Lots of people spend their lives trying to cultivate a mysterious substance called “willpower” so they can behave the way they want to. They watch motivational videos, psych themselves up with affirmative slogans, and try to engineer their environments to reinforce their good habits. Practices like these can certainly be helpful. But my experience with testosterone showed me that all the motivational videos in the world can’t hold a candle to a pellet the size of a Tic Tac.

I could not will myself to exercise before, any more than I could will myself to sleep through the night, or to think clearly. But I was able to massively improve my life through an intervention that required no willpower at all — and thank god for that. Although my symptoms may have been unusually severe, the kinds of cognitive issues I experienced before starting TRT are routine with aging; about half of perimenopausal women report brain fog. I hope that someday this miraculous shortcut for flourishing becomes just as common.

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I promised to write this post months ago, but I nearly left it in my drafts. I still worry it will be screen-shotted and passed around as evidence that women aren’t built for high-stakes work. But I could so easily have missed that Reddit thread, never stumbled on TRT, and right now be much worse at the things I care about, in a less happy marriage, in the soup. I could so easily have decided that’s just what aging feels like. I’m so glad I know that it doesn’t need to.

Looking back, the whole time I was engaged in that noxious debate about whether biology or sociology accounted for women’s poor performance in poker, it was a proxy war for the question of whether a woman who wanted to win could do anything about it. Biology was destiny, I thought; sociology, mere circumstance. My experience with testosterone has decoupled those concepts for me — yes, biology is baked into the world, but we have some freedom to change it. Despite my reservations, I decided to publish this piece because when I look back at myself then, I know I would have wanted to know, and I know other women will want to know, too.

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