Why Viagra Was Fast-Tracked And Women’s Hormones Were Left Behind
The story of Addyi, hormone health, and how misframing women’s biology created a billion-dollar blind spot in longevity innovation.
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In 1998, the FDA approved Viagra in just six months1.
It was a pharmaceutical milestone. A billion-dollar market. A cultural phenomenon. It reshaped the way we thought about male sexual health not as shameful, but as essential.
That same year, women reporting low libido or painful sex were told it was “all in their head.” That they were tired. Stressed. Depressed.
No fast track. No cultural celebration. No rush to understand what their symptoms meant.
And in that discrepancy, a generation of innovation stalled.
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The Six-Month Drug That Changed Everything
Viagra was a triumph of framing. A drug originally developed for heart disease happened to increase blood flow to a certain part of the body and suddenly, an entire medical category was born2.
Not only was the drug approved in record time, it was treated with respect. Urgency. Scientific legitimacy.
Doctors didn’t question whether men really wanted better sex.
Regulators didn’t suggest it was “just a lifestyle drug.”
Investors didn’t hesitate to pour in capital.
And it worked. Viagra became the fastest-selling prescription drug in history3. Its success opened the door to an entire class of treatments and an entirely new narrative about aging male bodies: they are worth fixing.
The Addyi Fight and the Message It Sent
Sprout Pharmaceuticals tried to do the same for women.
Their drug, flibanserin later marketed as Addyi was intended to treat hypoactive sexual desire disorder (HSDD) in premenopausal women. But instead of celebration, they faced skepticism, mockery, and repeated rejection4.
The FDA pushed back... hard. They questioned the validity of sexual desire as a medical concern. They demanded proof of “satisfying sexual events,” a subjective outcome measure that no male drug had ever been held to5. Media headlines dubbed it the “pink Viagra,” often with a wink or a smirk6.
Even after the drug was finally approved in 2015, 17 years after Viagra, the damage was done. The takeaway for many biotech founders was simple: female desire is controversial, not commercial.
But the cost went far beyond sexual health.
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Libido Is a Biomarker
Because estrogen isn’t just linked to libido. It’s linked to bone density. Cardiovascular health. Brain function. Mood. Pelvic integrity.7
When a woman in her 40s starts losing desire, it’s often the first sign that her hormonal environment is shifting. And that shift is a predictive marker of disease risk, cognitive decline, and metabolic instability.
In other words: libido is a signal. Not just of pleasure, but of aging.
But because we framed it as emotional, optional, or even indulgent, we missed the deeper implications. And we failed to build the infrastructure to treat what it was pointing to.
How Misframing Becomes Mispricing
Viagra was framed as functional. Addyi was framed as emotional.
Viagra was performance-enhancing. Addyi was a lifestyle luxury.
That framing shaped public perception. It shaped regulatory burden. It shaped reimbursement codes8. And ultimately, it shaped who got funded.
I’ve spent 20 years inside the system advising investors, managing billion of dollars in wealth, and seeing how capital decisions get made. And I can tell you this: when women’s health is framed as subjective, the funding dries up before the science gets a chance. If you care about changing the future of care at the source join me in the Women’s Health Investing Masterclass. Because awareness drives intention. And intention changes everything.
The Collateral Damage of Disbelief
Once hormone health was painted as soft science, the consequences rippled out9:
Insurance companies refused to cover menopause care unless symptoms were “severe”.
The 2002 WHI study overstated hormone therapy risks and led to widespread clinical retreat.
Menopause research flatlined in the aftermath.
The term “female sexual dysfunction” became culturally taboo.
Women themselves stopped seeking help thinking what they were feeling was either inevitable or unfixable.
And so we created an unspoken truth in the capital markets: Men’s performance is worth solving. Women’s decline is just nature.
The Longevity Market Forgot the Hormonal Engine Room
We are now in a longevity gold rush; aging clocks, personalized wearables, cellular reprogramming, bio-optimization. But most of this innovation is built on male-coded markers of health:
VO₂ max
Muscle mass
Testosterone levels
Glucose control
Almost none of it is designed to detect or respond to the most dramatic physiological shift in the human body: female menopause10. And this is not just a health gap. It’s a market distortion.
We are building the next wave of aging innovation on a faulty baseline. And that baseline is missing estrogen.
The Opportunity We Are Still Undervaluing
The menopause market is projected to reach $24 billion by 203011. That sounds promising. But it dramatically understates the opportunity. Because menopause isn’t a single condition. It’s a hormonal event that affects every system it touches everything:
It raises the risk of heart disease
It accelerates bone loss
It influences sleep, metabolism, and neuroplasticity
It’s linked to Alzheimer’s onset, which disproportionately affects women12
Treating menopause isn’t about hot flushes. It’s about intercepting the aging process at one of its most crucial inflection points. And that should be the most investable thesis of all.
The Capital Lens We Need
The next billion-dollar drug in women’s health won’t be pink. It won’t be soft. And it won’t be marketed as a luxury.
It will be a systems drug; something that recognizes hormonal decline as a physiological domino, not just a symptom generator. It will bridge prevention and performance. It will be priced not for comfort, but for risk reduction.
And if the capital system is smart, it will get in early.
Because the companies that win in the next era won’t be the ones that chase “sexier” markets. They’ll be the ones that recognize that estrogen is infrastructure.
We Are Not Late But We Are Lagging
There are signs of change. Bio-identical hormones are becoming mainstream. Digital menopause platforms are gaining traction. Clinics focused on midlife care are expanding. Women are demanding better and they are backing startups to build it.
But we need more.
We need clinical trial pathways designed for women over 4513.
We need reimbursement models that treat hormone decline like the systemic risk it is.
We need FDA standards that don’t treat female biology as a niche edge case.
And we need capital that’s willing to fund the long game.
Because this isn’t about catching up to where men’s health is. It’s about building something more precise, more predictive, and more complete. We were told for years that women’s pain was too subjective. That libido was too complicated. That hormones were too messy.
But here’s the truth: We don’t need more clarity. We need more courage.
Because the data is already there. The science is advancing. And the demand is undeniable. Now we need to fund the future like women belong in it.
Preorder the upcoming book The Billion Dollar Blind Spot to learn why women’s health is the future of healthcare investing.
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Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
References
FDA Drug Approval History: Viagra approved March 27, 1998
Harvard Health, “Viagra’s History as a Heart Drug”
Pfizer Annual Reports 1998–2000
New York Times, “F.D.A. Approves a Drug for Low Libido in Women” (2015)
Lodise NM. Female sexual dysfunction: a focus on flibanserin. Int J Womens Health. 2017 Oct 11;9:757-767. doi: 10.2147/IJWH.S83747. PMID: 29066935; PMCID: PMC5644557.
Washington Post, “The Saga of the 'Pink Viagra”
Sources:
Mayo Clinic, “Osteoporosis After Menopause”
AHA, “Menopause and Cardiovascular Disease”
Nature Reviews Endocrinology, “Estrogen and Neuroplasticity”
JAMA Psychiatry, “Hormonal Influence on Mood Disorders in Midlife Women”
Journal of Pelvic Medicine, “Pelvic Floor Health Across Menopause”
CMS Guidelines on Reimbursement for Hormone Therapy (2022)
Sources:
Kaiser Family Foundation, “Gaps in Menopause Coverage” (2021)
WHI Study and NIH Reassessment Reports (2002, 2017)
Nature Medicine, “The 20-Year Freeze on Menopause Research”
Journal of Sex Research, “The Cultural Silencing of Female Sexual Dysfunction”
FemTech Analytics, “State of FemTech 2023”
Grand View Research, “Menopause Market Size Report”
Alzheimer’s Association, “Women and Alzheimer’s: Hormonal Risk Pathways”
FDA Snapshot Reports (2020–2023): “Inclusion of Women Over 45 in Clinical Trials”
Powerful piece, thank you for highlighting the massive discrepancy between genders. I do wonder however, about your comment of HRT becoming ‘mainstream’, currently only 10-15% of eligible women receive this in the UK and it’s less in the US. Given the significant benefits of this treatment to bone, brain, heart and generally feeling better during peri- and menopause, why is there not increased funding to educate and improve access to this basic medicine. The cost effectiveness of such an investment would surely be very positive.
What you've been describing in this article is basically gender affirming care, but for cisgender men and women of a certain age. It's with this lens that also transgender care is underfunded and understudied. And now being attacked by the federal government.