The study that got a Nobel Prize and got it wrong

What we actually know now

The modern picture looks very different.

• The saturation model. Morgentaler and Traish proposed in 2009 that prostate tissue is exquisitely sensitive to androgens at very low levels, but becomes indifferent once the androgen receptors are saturated. You can think of it like watering a plant. Going from bone dry to watered matters enormously. Going from watered to flooded does not make it grow faster. More than fifteen years later it has held up well enough that its authors argue it should be treated as a description of reality, not a hypothesis.
• The big safety trial finally happened. TRAVERSE, published in the New England Journal of Medicine in 2023, randomized 5,246 men aged 45 to 80 who had hypogonadism plus existing or high risk of cardiovascular disease. Major adverse cardiac events: 7.0 percent on testosterone, 7.3 percent on placebo. Noninferior.
• And I want to be honest about the rest of that trial, because this is where a lot of people stop reading. TRAVERSE also found a 22.5 percent reduction in new onset diabetes, but small increases in atrial fibrillation, pulmonary embolism, and fractures. That is not nothing. It means testosterone therapy is a medical decision with real tradeoffs that deserves monitoring, not a wellness accessory.

TRT is not what you saw in that documentary

This is the one I get asked about constantly, so let me put numbers on it.

• Replacement means restoring a physiologic level. Typically somewhere around 100 to 200mg weekly, landing serum levels roughly in the 400 to 800 ng/dL range, which is where a healthy young man already sits.
• Performance and doping doses are a different category of thing entirely. Often 300 to 1,000mg weekly, sometimes far beyond that, frequently stacked with other compounds, producing levels that can run several thousand ng/dL.

The cardiac remodeling, the liver toxicity, the psychiatric effects people associate with "steroids" are overwhelmingly a function of supraphysiologic dosing, not of having a normal testosterone level. Restoring a hormone to the range your body ran on at thirty is not the same intervention as pushing it to five times that.

Conflating the two is how we ended up with a generation of men afraid to get their levels checked.

Now here's the part that actually made me write this

If the testosterone conversation has been distorted for men, it has barely been allowed to happen at all for women.

• There is not one FDA approved testosterone product for women in the United States. Zero.
• AndroFeme 1, a testosterone cream made by a small company in Perth, is licensed in Australia, New Zealand, South Africa, and the United Kingdom, where the MHRA approved it in July 2025. It is the only product in the world licensed specifically for women.
• So here, if your physician thinks testosterone would help you, the options are a men's product with instructions to use a fraction of it, or a compounding pharmacy. In 2026.
• The 2019 Global Consensus Position Statement, issued by the Endocrine Society and ten other international societies and the document nearly every guideline leans on, concluded that the only evidence based indication for testosterone in women is hypoactive sexual desire disorder in postmenopausal women. Everything else, in their words, has insufficient data.

I want to be careful here, because "insufficient data" is a precise statement and it is accurate. That statement is about the state of the literature.

But insufficient data is not the same thing as evidence against. And the reason the data is thin is not mysterious. The trials were never funded. Women's health research has been chronically underfunded for decades, so we arrive at a circular trap: we can't recommend it because there's no evidence, and there's no evidence because nobody paid to generate it.

A study published in the Journal of Sexual Medicine in August of this year gives you a sense of what's being missed. Researchers followed 279 women, average age 56, all already on transdermal estrogen for at least three months. Their hot flashes were controlled. They were still symptomatic: 92.9 percent reported fatigue, 89.6 percent low libido, 88.9 percent memory problems, 86.4 percent concentration problems, 82.1 percent irritability.

Those women were not treatment failures. They were being treated for one part of a larger problem.

What you can do this week

The FDA workshop is happening today, September 17, and here is the part most people miss: the public comment docket stays open until October 19.

1. Leave a comment. Docket FDA-2026-N-5479 at regulations.gov. Everything submitted becomes part of the official public record the agency has to review. It takes two minutes and a few sentences is plenty. Personal experience carries real weight in these dockets.
2. If you're a woman who has been told your labs are normal while you feel terrible, bring this up specifically at your next visit. Ask about a full hormone panel including free testosterone, not just a TSH and a CBC.
3. If you're a man who has avoided checking your levels because of the prostate cancer fear, that fear traces back to one patient in 1941. Get the labs.
4. Send this to someone who needs it. That is genuinely how this changes.

None of this is medical advice, and testosterone therapy is a real medical decision with real tradeoffs that belongs in a conversation with your physician. But you deserve to make that decision based on what we know in 2026, not on what one paper concluded in 1941.

Stay healthy, Clay Moss, MD

P.S. This issue is really about what happens when medicine inherits an answer instead of checking it, which is most of why I'm not going the traditional route after residency. I made a video about that decision last week and it struck a nerve, it's the most watched thing I've put on YouTube. Why I'm Not Taking a Hospital Job After Residency.

I'm posting there weekly now, longer and less filtered than anything that fits in a Reel. Subscribe here if that's your thing.