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The acquisition is being covered as a story about the race to own “immune system reset” technology. That read is correct. But the most important commercial logic embedded in this deal has not appeared in any coverage published so far.

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What happened

On May 3, 2026, UCB, the Belgian biopharmaceutical company, announced an agreement to acquire Candid Therapeutics for $2 billion upfront, with up to $200 million in additional milestone payments. Total deal consideration: up to $2.2 billion. The transaction is expected to close by end of Q2 to early Q3 2026.

Candid Therapeutics is a US-based clinical-stage company developing a new class of autoimmune drugs. Its lead asset, cizutamig, works by directing the body’s own immune cells to identify and destroy the specific cells responsible for producing the antibodies that drive autoimmune disease and effectively clearing the source of the problem rather than suppressing the immune system broadly.

As of the acquisition announcement, more than 100 patients had received cizutamig, including 68 with autoimmune diseases. Global Phase 2 studies are planned in myasthenia gravis and interstitial lung disease. Earlier-stage evaluation is also underway across additional autoimmune indications including lupus, rheumatoid arthritis, systemic sclerosis-associated disease, and IgA nephropathy.

UCB describes the acquisition as part of a platform-driven strategy in next-generation immunology — a deliberate move to own multiple targeting approaches before the field matures.

Why it matters

The coverage this week is framing this as a story about platform immunology. Two billion dollars for a clinical-stage company with a novel mechanism, before pivotal proof. A high-conviction bet on the thesis that if you can eliminate the cells producing the antibodies that drive autoimmune disease, you may produce durable remission rather than managing symptoms indefinitely. That read is accurate. It is also incomplete.

The most important commercial logic embedded in this deal has not appeared in any coverage published this week. In this edition I will name it, explain why it changes how capital allocators should read the acquirer landscape in this space, and deliver six observations on where to be positioned before the next announcement; three on what the deal signals now, and three on what to track as the thesis develops.

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This week on Signal Not Noise - With two approved drugs in the bag, what is the menopause market actually telling investors?

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A woman takes a sleeping pill exactly as prescribed. Before bed, she swallows a standard dose of zolpidem, one of the most widely prescribed sleep medications in the world. By morning, enough of the drug remains in her bloodstream to impair reaction time, blur cognition, and increase the risk of car accidents on the drive to work.

For years, nobody fully understood why women were disproportionately affected. Then regulators discovered the problem was not the molecule itself. Women metabolized the drug more slowly. The dosage guidelines had been calibrated on a male biological model. Foundational pharmacokinetic studies had been conducted primarily in male animals.

It is the kind of story that sounds, in hindsight, impossible. How could something so basic have been missed?

For decades, biomedical research relied predominantly on male animals under the assumption that males were the “simpler” or “default” sex. Even after the NIH introduced its “Sex as a Biological Variable” policy a decade ago, neuroscience studies using only female animals remain extraordinarily rare, hovering at roughly 3%.

The future of medicine is being built on a biological model that was never fully representative to begin with.

The consequence is not merely academic. Our mechanistic understanding of disease pathways, stress responses, and drug metabolism is systematically more developed for male physiology than female physiology. That matters more than it sounds.

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Modern therapeutics are built on mechanistic understanding. If the underlying mechanism is mapped primarily in males, the therapeutic itself is often implicitly optimized around male biology long before it reaches a human clinical trial.

Sometimes, in the real world, the drug fails because the biology behaves differently in women. Sometimes the drug works but produces adverse effects that were not detected during preclinical development. Both outcomes increase development costs, complicate regulatory review, and compress returns. The examples are already well documented.

And now, just as policymakers in Europe and the United States accelerate the transition away from animal research toward organoids, organ-on-chip systems, and AI-driven computational models, a more complicated problem is beginning to emerge.

The movement (the transition away from animal research) is framed, understandably, as ethical progress. New technologies — organoids, organ-on-chip systems, computational biology, predictive AI models — promise a future where medicine can advance with less animal suffering. It is an appealing vision, one which is sleek, humane and technologically elegant. But a recent commentary in Nature Neuroscience introduces a more uncomfortable possibility.

Kovlyagina and Jaric argue in the piece published in Nature Neuroscience that if animal research is phased out before female biology is adequately studied in vivo, the historical male bias embedded in biomedical research risks becoming structurally locked into the next generation of medicine itself.

Look deeper and you’ll see that this is not really a story about mice. This is a story about inheritance. Because systems rarely erase bias when they modernize. More often, they automate whatever assumptions already exist underneath them.

Artificial intelligence is perhaps the clearest example. Machine learning systems do not independently “discover” reality. They absorb patterns from historical data. If the underlying data reflects unequal representation, the outputs often reproduce those distortions with mathematical efficiency.

One example cited in the paper involved a deployed AI symptom-checking system that assigned lower urgency to some women’s reported symptoms because the clinical datasets used for training were themselves male-skewed. The machine was not intentionally discriminatory. The system inherited the structure of the data underneath it.

That distinction matters because modern healthcare is rapidly becoming data-driven. Diagnostic systems, drug development pipelines, predictive models, reimbursement frameworks, and AI-enabled clinical decision tools are increasingly dependent on historical datasets.

The risk is not merely that women were excluded from parts of twentieth-century biomedical research. The risk is that those exclusions become embedded into the operating system of twenty-first-century medicine. And this is where the essay in Nature Neuroscience becomes far more philosophically interesting than a standard debate about animal testing.

The authors are not arguing against technological progress. Nor are they dismissing the moral urgency of reducing animal suffering. Their argument is subtler and more unsettling.

From a capital allocation perspective, this creates a more stratified investment landscape than most investors currently appreciate.

Companies developing therapeutics in areas where female biology remains mechanistically undercharacterized face a different regulatory and scientific risk profile than companies operating in disease categories with more mature sex-inclusive evidence bases. Clinical endpoints become harder to define. Safety signals become less predictable. Regulatory pathways become more uncertain.

At the same time, companies prioritizing sex-inclusive preclinical work today may be building a form of long-duration advantage that the market is underestimating.

If in vivo research capacity contracts over the coming decade before these mechanistic gaps are adequately closed, the firms generating robust female-specific biological data now may ultimately control datasets, regulatory positioning, and intellectual property that competitors cannot easily recreate later using AI models alone.

That possibility changes the due diligence framework for allocators evaluating AI-enabled healthcare platforms or women’s health therapeutics. We cover this in greater depth in paid publication, Signal Not Noise.

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Modern societies often assume innovation naturally produces fairness. But history suggests otherwise. Railroads expanded prosperity unevenly. Early clinical trials excluded women. Credit scoring systems inherited racial disparities. Facial recognition technologies repeatedly struggled with darker skin tones because the datasets underneath them lacked sufficient diversity.

Technology does not transcend human assumptions. It scales them. Which raises a larger question for medicine now. If the biological models underneath our healthcare systems were historically incomplete, what exactly are we scaling?

Perhaps the most striking aspect of this debate is how invisible this issue remains to most people. The phrase “women’s health” still evokes, in many institutional settings, a specialized or socially driven category rather than a foundational systems issue.

Yet the underlying challenge touches nearly every major frontier in medicine: neuroscience, longevity, metabolism, AI diagnostics, immunology, pharmacology, and preventive health.

The blind spot was never confined to one vertical. It was embedded in the baseline assumptions themselves, and baselines are extraordinarily difficult to notice while living inside them.

In the future now being imagined for medicine, the mouse may disappear soon. But the real question we should be asking is whether the blind spots disappear with the mouse.

On 28 May, I’m hosting a private conversation with some of the people who have lived this arc; operators who have built and exited in women’s health, and an investor who has backed multiple companies in the space. We will be talking about what it actually takes to build in this category, what the reimbursement and adoption curve looks like from the inside, and where the capital opportunity sits right now.

It is not a panel. It is a practitioner conversation and the kind that usually happens behind closed doors. If you want to be in the room, you can request an invitation below.

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References

• Kovlyagina, I. & Jaric, I. “Phasing out animal research prematurely will maintain gender inequities in medicine.” *Nature Neuroscience* (4 May 2026). DOI: [10.1038/s41593-026-02309-w](https://doi.org/10.1038/s41593-026-02309-w). Irina Kovlyagina, Institute of Physiological Chemistry, University Medical Center, Johannes Gutenberg University Mainz. Ivana Jaric, Institute of Laboratory Animal Sciences, University of Zurich.

• Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist) | FDA

• Kovlyagina, I., & Jaric, I. “Phasing out animal research prematurely will maintain gender inequities in medicine.” Nature Neuroscience (2026).

• NIH Office of Research on Women’s Health — “Sex as a Biological Variable (SABV)”

• Arnegard ME et al. “Sex as a Biological Variable: A 5-Year Progress Report and Call to Action.” Journal of Women’s Health (2020).

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.

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Veozah launched in 2023 as the first non-hormonal oral treatment for menopause symptoms. Two and a half years later, the commercial revolution the category promised has not arrived. Bayer launched its competitor anyway. Here is what that tells capital allocators.

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What happened

In May 2023, Astellas’ Veozah became the first FDA-approved non-hormonal oral treatment for the hot flashes and night sweats affecting approximately 75% of women during the menopause transition. Astellas projected US revenues of $375 million in the drug’s first year of commercialisation.

In FY2024, its second full year on market, Veozah generated approximately $220 million globally. In December 2024, the FDA added a black box warning for rare but serious liver injury; the most prominent safety flag the agency can attach to a prescription drug.

Fast forward to October 2025 and Bayer’s Lynkuet received FDA approval for the same indication. It targets both the NK1 and NK3 receptors, a dual mechanism that Veozah does not carry. Importantly, it has no black box warning. Bayer made it commercially available in November 2025 and estimates annual peak sales of approximately €1 billion.

In April 2026, BioPharma Dive published a survey of persistent structural barriers in women's health drug development, noting that despite two approved non-hormonal drugs and a large unaddressed patient population, Veozah has faced slower-than-expected sales and reimbursement complications.

Why it matters

The coverage this week is framing this as a competitive story. Two drugs, same indication, different mechanisms. One with a cleaner safety profile. The question most coverage is asking is which company wins the menopause hot flash market.

That is the wrong question for capital allocators and in this piece, I will cover the one development most coverage has missed entirely, and share three observations on what this category dynamic tells capital allocators in women’s health about where to be positioned before the next announcement.

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This week on Signal Not Noise - The $11.75B Sun Pharma / Organon deal is being read as good news for women's health. But is it really?

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Jane is 52. Her cholesterol is slightly elevated. Her blood pressure has crept up. Her sleep is fragmented, her energy inconsistent, her body unfamiliar in quiet, disorienting ways. Sitting across from her physician, she hears a version of a sentence that has been repeated, in slightly different forms, to millions of women before her. Nothing is acutely wrong. Nothing demands urgency. It is, she is told, part of the transition.

Menopause.

The framing is clinical, almost reassuring. Her hormones are declining, her risk is increasing, and this is expected. Manage your numbers, adjust your lifestyle, monitor over time. It sounds contained, even understood. And for decades, that is precisely how medicine, and by extension capital, has treated it: as a hormonal shift, a loss of protection, a gradual and predictable increase in risk.

But what if that framing was never the full story? What if what we have been calling “risk” is not simply the absence of something, but the beginning of something else entirely?

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For most of modern medicine, estrogen has been cast as the central actor in women’s cardiovascular health. It was a model built for clarity. Estrogen conferred protection; menopause removed it. The downstream effects; rising rates of heart disease, metabolic dysfunction, vascular changes were interpreted as consequences of that loss.

From a systems perspective, it made sense. From a funding perspective, it was efficient. It enabled interventions that were measurable, testable, and scalable. Hormone replacement therapies, lipid-lowering drugs, glucose management, lifestyle interventions. Each mapped neatly onto existing clinical pathways and, critically, into established investment categories.

The issue is not that this model is wrong. The issue is that it is incomplete. And in both science and markets, incomplete models do more than leave gaps in understanding. They define what gets measured, what gets funded, and what remains invisible.

A recent line of research emerging from the Fralin Biomedical Research Institute begins to complicate this picture. Led by Sumita Mishra and published in the journal Cells, the work does not claim to have identified a single new mechanism behind the rise in cardiovascular risk after menopause. Instead, it reframes the question itself. Rather than asking only what happens when estrogen declines, it asks what that decline does to the systems that regulate the body over time.

The answer points toward epigenetics; the layer of biological control that determines when genes turn on or off without altering the underlying DNA sequence. In this view, menopause is not just a hormonal event. It is a regulatory event. A shift that may alter how genes governing cardiovascular function, metabolism, and inflammation are expressed across interconnected systems and over extended periods of time.

This is a subtle but consequential shift in perspective. It is the difference between removing a protective shield and rewiring the system beneath it. It suggests that what we are observing after menopause is not simply deterioration, but a form of reprogramming, one that unfolds across multiple biological domains at once.

At this stage, the science remains early. Much of the mechanistic evidence comes from laboratory and preclinical studies. Longitudinal human data is still limited. The causal pathways are not yet fully mapped, and the magnitude of these effects is not precisely quantified. This is not a finished story, nor a definitive explanation. But even in its current form, it begins to expose something more structural: not just a gap in biological understanding, but a gap in how that understanding has been organized.

Epigenetics itself is not new. It has been studied extensively, particularly in oncology, where gene regulation is central to disease progression and treatment. But its application to cardiometabolic health—especially in the context of women’s biology—has been comparatively limited because they sat outside the primary focus of inquiry.

And inquiry follows structure. It follows funding priorities, institutional incentives, and the categories through which we define disease. Breast cancer has a defined category, established funding streams, and a clear research mandate. Cardiovascular disease, too, is one of the most heavily funded and studied areas in medicine.

There is a broader pattern here. When biological systems become more complex than the frameworks we have built to study them, we do not immediately expand the framework. We simplify the biology. We isolate variables, prioritize what can be measured, and construct models that are tractable, even if they are partial. Those models then become the foundation not only for clinical practice, but for entire investment landscapes.

The estrogen model was one such construct. It enabled decades of progress, but it also constrained the scope of inquiry. It made certain questions easier to ask, and others easier to ignore.

The emerging epigenetic perspective does not replace that model, but it stretches it. It introduces a layer of complexity that does not fit neatly into existing categories. If menopause-related cardiovascular risk is mediated not only by hormone levels but by changes in gene regulation across metabolic and inflammatory systems, then the way we think about intervention begins to shift. It is no longer sufficient to replace or supplement what has been lost. We may need to understand and eventually target the regulatory pathways that have been altered.

This is where the implications extend beyond medicine into capital allocation. When a problem spans multiple domains, it often falls between mandates. It can appear too niche for generalist funds, too complex for single-vertical specialists, and too early for large-scale pharmaceutical investment. The result is not a lack of interest, but a lack of alignment. Capital flows most efficiently to what it can categorize. What it cannot easily classify is often treated as peripheral even when it is central.

We have seen this pattern in other areas of women’s health. Alzheimer’s disease, where women represent a disproportionate share of cases, has long been studied through frameworks that did not fully integrate hormonal and metabolic transitions.

Osteoporosis has often been reduced to a question of bone density rather than understood as part of a broader system of aging and hormonal regulation. Autoimmune diseases, many of which disproportionately affect women, continue to challenge models built around more linear cause-and-effect relationships.

In each case, the biology is complex, interconnected, and resistant to simplification. And in each case, funding has struggled to keep pace with that complexity.

What this new line of research begins to expose is not just a biological insight, but a structural one. We have built disease categories that make certain patterns visible and others peripheral. We have trained both clinicians and investors to recognize opportunity within those categories. And we have, often unintentionally, treated anything that does not fit as an exception. But women’s biology is not the exception. It is the system.

Heart disease remains the leading cause of death for women. This is not new. What is less well understood is why the risk accelerates so sharply during and after menopause, and why our existing frameworks have only partially explained it. The hormonal model gave us part of the answer. Epigenetics may be pointing toward another layer. There will likely be more.

The question, then, is not whether this research provides a definitive explanation. The question is what it reveals about the way we have been asking the question in the first place. Because when the underlying model is incomplete, the opportunity it obscures is not marginal. It is systemic. And the most valuable opportunities in markets are rarely the ones no one has seen. They are the ones everyone has seen, but just through the wrong lens.

On 28 May, I’m hosting a private conversation with some of the people who have lived this arc; operators who have built and exited in women’s health, and an investor who has backed multiple companies in the space. We will be talking about what it actually takes to build in this category, what the reimbursement and adoption curve looks like from the inside, and where the capital opportunity sits right now.

It is not a panel. It is a practitioner conversation and the kind that usually happens behind closed doors. If you want to be in the room, you can request an invitation below.

Request an Invitation

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.

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The largest overseas acquisition in Indian pharmaceutical history transferred the world's biggest dedicated women's health portfolio to a biosimilar manufacturer. Here is what that means for where the exits go from here.

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What happened

On 26 April 2026, Sun Pharmaceutical Industries signed a definitive agreement to acquire Organon & Co. in an all-cash transaction valued at $11.75 billion. The offer price of $14 per share represents a 24% premium to Organon’s closing price the previous Friday. The deal is the largest overseas acquisition in Indian pharmaceutical history.

The transaction transfers Organon’s full portfolio to Sun: Nexplanon, the world’s leading contraceptive implant; NuvaRing; Follistim for fertility; and a biosimilar portfolio including Hadlima and Renflexis. It also transfers Organon’s commercial infrastructure in China, where the company generates more than $800 million in annual revenue.

Combined, the two entities are projected to generate approximately $12.4 billion in revenue, placing the merged group among the 25 largest pharmaceutical companies globally.

Sun Pharma anticipates becoming a top-three global player in women’s health and the seventh-largest biosimilar company worldwide. The deal is expected to close in early 2027, pending regulatory approvals and shareholder consent.

Why it matters

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In a recent episode of Blindspot Capital, I sat down with to explore what happens when a market begins not with products or funding but with missing information.

When Ann-Marie launched her newsletter in 2020, she wasn’t trying to build a company. She was trying to make sense of her own body. What she found instead was something far bigger: a fragmented, contradictory, and often commercialized information landscape where women were left to navigate perimenopause largely on their own. So she started writing.

What began as a weekly research letter has since grown into a global community spanning more than 20,000 women across 40 countries—an ecosystem built not on products, but on trust, nuance, and lived experience.

But this conversation is not about content creation. It’s about what has to exist before markets can function at all.

We talk about:

• Information as infrastructure: why women’s health markets are being built on community-led knowledge systems and what happens when reliable information doesn’t exist

• Trust vs. scale: why credibility in women’s health is earned through lived experience and nuance not reach, virality, or clinical authority alone

• The danger of certainty: how overly simplified narratives (especially around hormone therapy) can signal bias rather than truth

• The education burden on women: why midlife women are forced to become their own researchers, clinicians, and decision-makers in the absence of clear guidance

• Fear as a business model: who benefits when women are confused, overwhelmed, or anxious and how that shapes the entire category

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Gilead just paid $5 billion for a Munich biotech company. The deal was announced on Monday. The people who benefited from it were positioned years ago and in this article, I'm breaking down the signals they were watching so you know how to find the next one before the announcement.

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What happened

Gilead first partnered with Tubulis in December 2024 under an option and license agreement worth up to $465 million. Sixteen months later it didn’t just exercise the option. It bought the company.

What happened in between matters. Tubulis reported a 59% overall response rate in platinum-resistant ovarian cancer — an indication with no adequate standard of care and a patient population chronically underserved by both clinical investment and capital attention. The data moved Gilead from partner to acquirer.

And Gilead wasn’t the first major US strategic to take notice. BMS had also licensed Tubulis technology in 2023 for over $1 billion in milestones. Two of the world’s largest pharmaceutical companies had independently validated the same European platform.

Why it matters

US public R&D funding is under sustained structural pressure. Large pharma cannot rebuild deep-tech platform capability internally at the pace the competitive landscape demands. The efficient path (and Gilead has taken it three times this year alone) is acquisition of platform assets that have absorbed early-stage risk, demonstrated clinical signal, and retained scientific talent onshore. Tubulis is the European chapter of that strategy.

But here is the read that most coverage is missing this week.

When BMS licensed Tubulis technology in 2023, they validate the platform with that signal. When Gilead partnered sixteen months later, the auction had effectively started; it just hadn’t been announced yet.

That pattern — strategic partnership as a structured private option, clinical data as the conversion trigger, acquisition as the public confirmation — is not unique to Tubulis. It is how large pharma has been systematically acquiring European deep-tech biotech for the better part of a decade.

It just rarely happens at this scale, with this speed, and with a women’s health indication (ovarian cancer) anchoring the lead program.

That last fact is the one worth sitting with. The women’s health indication didn’t discount this exit. It justified it and that distinction is about to matter for every European platform asset currently sitting at Series B or C with a gynecologic oncology program in the lead position.

What this signals for investors

The most important thing about the Tubulis exit isn’t the size.

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The most important acquirer in women’s health pharmaceuticals is subtly telling the market what it has become. Its not doing so through a press release but rather through a sequence of decisions made between October 2025 and March 2026 that, read together, paint a specific picture. Most investors in this space are reading them separately and that is the gap.

Organon, the MSD spin-out that holds Nexplanon, NuvaRing, and one of the largest women’s health commercial footprints in the world has spent the last five months selling assets, dropping R&D programs, licensing commercial-stage devices, running without a permanent CEO, and watching its share price sit roughly 63% below its three-year high. A non-binding acquisition approach from Sun Pharma surfaced in January, was publicly labelled speculative within days, and has since gone quiet.

What happened

Between October 2025 and March 2026, Organon:

• lost its founding CEO to a Nexplanon sales irregularity investigation

• reported full-year 2025 revenue of $6.2B against $8.64B in debt

• cut its quarterly dividend to $0.02

• discontinued its entire internal R&D pipeline for endometriosis and PCOS (both acquired via Forendo in 2021)

• divested its JADA postpartum hemorrhage system for $465M

• and licensed in MIUDELLA, the first new hormone-free copper IUD in the US in 40 years for $27.5M upfront.

In addition, guidance for FY 2026 is flat and the permanent CEO search is ongoing.

Why it matters

What Organon’s portfolio moves reveal is a deliberate strategic retreat: from originating science in women’s conditions toward distributing and commercialising proven products.

That is a rational response to $8.64B in debt and a governance crisis. It is also a structural shift in what Organon is and what it can offer the ecosystem that has been building toward it as an acquirer.

The endometriosis and PCOS pipeline drops are worth sitting with. These are two of the highest-unmet-need, highest-diagnostic-delay conditions in women’s health. Organon acquired rights to drug candidates in both, and has now walked away from both. At the same time, it licensed a commercial-stage contraceptive device.

That sequencing tells you something precise about what Organon is becoming. The more important question for anyone building or backing companies in this space is what that becoming means for where exits go from here.

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In a recent episode of Blindspot Capital, I sat down with Lindsay Davis, founder of FemTech Association Asia, to talk about what it actually takes to build women’s health markets in Southeast Asia.

When Lindsay moved to Singapore in 2020, she wasn’t planning to work in women’s health. But what she noticed was difficult to ignore: founders, policymakers, and investors were all present, but disconnected. There was no shared infrastructure, no unified ecosystem, and no clear pathway for innovation to scale. So she started building.

What began as a simple act of connecting people has evolved into one of the largest specialist networks for women’s health innovation across Asia spanning research, partnerships, founder support, and ecosystem development.

But this conversation is not about startup growth. It’s about what has to exist before growth is even possible.

We talk about:

• Ecosystem building before capital: why markets don’t emerge fully formed and why infrastructure matters long before funding arrives

• The education burden on founders: how stigma and low awareness shape how companies are built in Asia

• Regional complexity: why Southeast Asia is not a single market, but a matrix of cultures, systems, and behaviors

• The visibility gap: how lack of data and precedent keeps women’s health overlooked by investors

• Capital flows in Asia: where femtech funding is actually coming from and how that is beginning to shift

What emerges from this conversation is a different understanding of women’s health.

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Today, The Billion Dollar Blindspot is available for pre-order.

But this didn’t start as a book. It started in a gynecologist’s office; confused, dismissed, and aware that something wasn’t adding up, not just medically but structurally.

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In a recent episode of Blindspot Capital, I sat down with Cristina Ljungberg and Wendy Anderson, co-founders of The Case for Her, to talk about what it actually takes to create markets in women’s health that investors historically could not see.

For more than a decade, Cristina and Wendy have been working in the spaces that most traditional investors avoided: menstruation, sexual wellness, and access to reproductive health. When they started, these topics weren’t just underfunded. They were considered uninvestable.

Instead of waiting for venture capital to arrive, they took a different approach. They began using catalytic capital — philanthropy, early risk capital, grants, and unconventional financing — to fund research, build infrastructure, and support entrepreneurs long before a traditional venture ecosystem existed.

What followed was not a single breakthrough moment, but a slow process of market formation. The lesson is simple but uncomfortable: markets don’t fail because demand isn’t there. They fail because the system around them hasn’t been built yet.

We talk about:

• Catalytic capital: why philanthropy, impact capital, and early-stage risk capital are often required before venture capital can enter a market

• The hidden infrastructure problem: how missing standards, regulations, and research can quietly block entire industries from forming

• Taboo as a market barrier: why menstruation, sexual health, and reproductive care have historically struggled to attract capital

• The pattern recognition gap: why investors often avoid women’s health simply because they have never invested in it before

This conversation offers a rare look at the earliest stage of market creation; the phase that happens long before venture capital arrives and long before headlines start calling a sector “the next big opportunity.”

If you want to understand where the next wave of women’s health innovation will come from, this episode is a powerful reminder: Markets don’t appear fully formed. They are built.

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📄 Learn more about The Case for Her and catalytic capital in women’s health

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But in women’s health, progress rarely looks like that.

More often, there is a long stretch where the science works and yet nothing seems to move. Inside that stretch, entrepreneurs are judged, investors grow impatient, and real progress is often mistaken for failure.

In a recent episode of Blindspot Capital, I sat down with Skip Baldino, former CEO of Gynesonics, to talk about what it actually takes to move a women’s health medical technology through a system that was never designed to adopt change quickly.

Much of what looks like an “exit” from the outside is, in reality, the end of a very long middle.

Gynesonics, which developed a minimally invasive treatment for uterine fibroids as an alternative to hysterectomy, was acquired by Hologic for $350 million last year. Headlines called it a success story. But the journey was not a straight line. It included multiple leadership transitions, product iterations, clinical trials, reimbursement battles, investor fatigue, and even the collapse of Silicon Valley Bank during one of the most fragile moments in the company’s history.

At several points, the company could easily have disappeared. Instead, a small group of investors stayed in when others could not or would not. Importantly, the employees stayed in and the company continued building toward a future that was still invisible to the outside world.

We talk about:

• The hysterectomy default: why 600,000 procedures still happen annually in the U.S. and what it takes to shift the standard

• The real work of medtech commercialization: clinical outcomes, economic proof, reimbursement, and payer dynamics

• The do-or-die year at Gynesonics and why key opinion leaders matter

• The Blackstone signal: what major capital moving into women’s health could mean for founders and exits

This conversation offers a grounded view of how innovation actually moves through healthcare and why patience, conviction, and sustained capital matter more than headlines suggest.

If you care about women’s health innovation, this episode offers a rare look inside the part of the journey most people never see.

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📄 Learn more about the Learn more about uterine-sparing fibroid treatment and minimally invasive options.

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We keep calling it “low libido,” as if it’s one problem with one solution. But if you listen closely to how women actually talk about it, the category starts to fracture in your hands.

For many women, the issue isn’t desire at all. It’s sensation. The brain still lights up. The imagination still works. The relationship is still there. But arousal doesn’t arrive. Touch doesn’t land the way it used to. Orgasms require effort, precision, and tools and sometimes, the orgasms don’t show up at all. For some, sex doesn’t feel like a loss of appetite. It feels like the body has stopped speaking the same language as the mind.

That distinction matters, because it quietly explains why the hunt for a “female Viagra” has been so disappointing. Not because the science is impossible, but because the market has been misnamed.

The flawed search for a female Viagra

For nearly three decades, the search for a female equivalent to Viagra followed a familiar script. When sildenafil was approved for erectile dysfunction in men in 1998, the results were immediate and visible. A simple mechanism which improved blood flow produced a clear, measurable outcome. Within a few years, Viagra became one of the most recognisable pharmaceutical brands in the world. It didn’t just treat a condition; it reshaped the cultural conversation around aging, masculinity, and sexual function. Naturally, the industry went looking for symmetry for women.

But the analogy was flawed from the beginning.

Male erectile dysfunction is, in many cases, a mechanical problem. Blood flow in, erection follows. The physiology is relatively linear. Female sexual function is not. It is hormonal, neurological, psychological, relational, and contextual, often all at once. Desire and arousal are not the same thing. Neither are arousal and orgasm. And the pathways that govern each of them don’t sit in a single place in the body.

Still, the market wanted a mirror image.

The first wave of libido drugs targeted the brain. Addyi, approved in 2015, worked on neurotransmitters associated with desire. Vyleesi, approved a few years later, acted on a melanocortin pathway to stimulate sexual interest. Both were framed as breakthroughs, expected to unlock a vast, underserved market but the reality has been more modest. Adoption was slower than expected. Clinical effects were real, but subtle. Side effects, prescribing restrictions, and reimbursement friction added further barriers. Vyleesi, one of the few approved hypoactive sexual desire disorder (HSDD) drugs, generated just under nine million dollars in gross product sales in Palatin’s fiscal year ended June 2024 before the asset was sold for twelve million dollars upfront, with additional payments tied to future sales milestones. What had been imagined as a blockbuster category began to look more like a collection of niche indications, each with its own biological logic and commercial constraints.

The narrative started to shift. Maybe there wasn’t one female Viagra. Maybe there were several different problems, each requiring a different kind of solution.

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What the Daré trial actually showed

That is where the current moment becomes interesting. A publicly listed company, Daré Bioscience, has been developing a topical sildenafil cream for women with female sexual arousal disorder. At first glance, it sounds like the original idea all over again: take the mechanism that worked for men and apply it to women.

But the company didn’t pursue it as a universal solution. They ran a clinical study across defined patient groups, using specific endpoints. And the data told a more granular story. In the full trial population, the drug did not significantly outperform placebo on its primary endpoints. That means the broad, one-size-fits-all version of the thesis didn’t hold. Yet within a more specific subset of women (those with a defined arousal profile), the drug produced a statistically significant and clinically meaningful improvement in arousal sensation.

So, while it didn’t work for everyone in the study, for some women, it worked enough to matter.

So what does that actually mean for women, for the science, for the market, and for the capital behind it? On paper, libido therapeutics should be enormous. The patient population is large, the unmet need is obvious, and the demand shows up in clinics every day. Yet the financial outcomes tell a very different story.

That disconnect is not accidental. It reflects a deeper structural reality about how female sexual dysfunction actually works; biologically, clinically, and commercially.

In the rest of this piece, I walk through:

• The true size of the libido therapeutics market

• The hidden demand signal most forecasts miss

• Why this is not one market but several overlapping ones

• What that means for patients

• And why capital still hasn’t fully institutionalized the category

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This week, headlines screamed across social media: “Menopause shrinks the brain.” “HRT makes brain shrinkage worse.” My inbox filled almost immediately. The messages came from hundreds of readers. Women weren’t just confused. They were angry.

Here we go again. Nobody seems to know what the hell is happening to our bodies.

For women already navigating sleep disruption, mental fatigue, and moments of cognitive fog, the message landed heavily because it seemed to explain something they were already living.

But did it?

A major UK Biobank study published in Psychological Medicine analysed data from nearly 125,000 women. Around 11,000 of those women also underwent brain imaging. The researchers compared three groups:

• pre-menopausal women (average age 46)

• post-menopausal women not using HRT (average age 58)

• post-menopausal women using HRT (average age 60)

They found differences in brain volume between women who had stopped having periods and women who had not. Specifically, they found post-menopausal women reported higher levels of anxiety and depressive symptoms, poorer sleep quality, and they found differences in brain structure in regions involved in memory and emotional regulation.

Cue the headlines. Cue the panic.

But…and this is a big but…calling this a “menopause study” is like calling a photograph of 20-year-olds and 60-year-olds an “aging experiment.” Sure, the photographs show you a difference but they don’t tell you the why. And that distinction between observing a difference and explaining its cause is where the conversation about women’s health keeps breaking down.

The Question That Wasn’t Answered

The UK Biobank classified women based on a single yes-or-no question: “Have you had your menopause (periods stopped in the last 12 months)?” Yes or No. That was it. There was no tracking of menopause stages, no measurement of perimenopause—the years-long transition where hormones actually fluctuate wildly. There was no hormonal testing and no following the same women over time to see what changed as they specifically moved through menopause.

The study’s own authors acknowledge this limitation explicitly in their paper: “Pre- vs post-menopausal groups were not separated based on STRAW criteria, which would have provided more accurate classification. Instead, self-report measures were used.”

STRAW+10 is the gold-standard staging system for menopause research1. It defines distinct phases: late reproductive, early perimenopause, late perimenopause, early post-menopause, late post-menopause. Each phase follows the journey of ovarian aging and has different hormonal profiles and symptom patterns.

Lumping all “post-menopausal” women together whether they are one year or twenty years past their final period takes away everything meaningful about the transition itself. But there’s an even bigger problem lurking in the data. And it’s one that no amount of sophisticated statistical modeling can fix.

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The Age Problem You Can’t Statistical-Model Away

The pre-menopausal women in this study were, on average, 46 years old while the post-menopausal women were 58 to 60. That’s a 12- to 15-year gap. Here’s the uncomfortable truth: everyone’s brain changes with age. Starting around midlife, adults lose roughly 0.2–0.5% of brain volume per year2. Over fourteen years, that adds up to exactly the kind of difference this study observed.

To be clear, the researchers did adjust for age statistically. They included it in their models alongside education, income, smoking, BMI, and other variables. But.... (and again a big but) controlling for age in a cross-sectional study is not the same as separating age from menopause. You are still comparing different people, born in different decades, at different life stages.

It’s like pointing at a 40-year-old and a 60-year-old, noticing that one has more wrinkles, and announcing a breakthrough discovery.

Think about what else accumulates between 46 and 60:

• years of caregiving stress (caregiving responsibilities often peak, career demands intensify, financial pressures mount)

• metabolic changes (weight gain, insulin resistance and systemic inflammation tend to enter the building)

• sleep architecture changes (independent of hot flashes)

• vascular aging (blood pressure rises, arterial stiffness increases, cholesterol patterns shift)

• decades of lifestyle exposure (diet, exercise, smoking, alcohol consumption) finally show up

All of these affect the brain. All correlate strongly with age and none of them are menopause itself. To isolate menopause, you would have to follow the same women over time (from pre-menopause, through perimenopause, into post-menopause) and observe what changes within individuals that cannot be explained by aging alone. This study was not designed to do that.

And then there was the HRT headline. Let’s unpack that.

The most alarming claim was that women using hormone therapy had the smallest brain volumes and the highest rates of anxiety and depression.

On the surface, that sounds frightening. But this is precisely where observational research can be misleading because association is not causation and patterns without context quickly become weapons.

In the rest of this piece, I walk through:

• what the HRT finding really means

• how “confounding by indication” distorts women’s health research

• what longitudinal menopause studies actually show about cognition

• why brain fog does not equal brain shrinkage

• how age, stress, sleep, and vascular health shape brain function far more than menopause itself

• a practical framework for making decisions without fear

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