Berberine: same dose, different effect in women and men (2026 study)

A man and a woman take exactly the same berberine capsule, at the same dose, for three months. Logically, they should achieve the same result. A study published in October 2026 shows the opposite: in women, the decrease in cholesterol was almost three times stronger, and testosterone moved in the opposite direction depending on the sex.

I devoted a video to this study. This article follows its reasoning with the figures, the limitations, and the state of the file in Europe, where berberine is subject to a provisional unfavorable opinion. I am the founder of DIX, and our Fat Burner contains berberine: we therefore have an interest in this subject, and each figure below has its source.

Berberine in a nutshell

Berberine is a yellow molecule found in several plants, including barberry (Berberis vulgaris), and has long been used in traditional Chinese medicine. In the United States and the United Kingdom, it is freely sold as a supplement. On social media, it is nicknamed “the natural Ozempic.” However, no trial has directly compared it to this medication: the nickname stems from marketing, not science.

What is better established is its effect on blood lipids. Several trials and meta-analyses support this, and according to the study authors, the 2019 European recommendations on dyslipidemias cite it among the options for people who poorly tolerate statins. [1] [2] One question remained that no one had really asked: does it act the same way in women and men?

The study: two trials conducted in Hong Kong

A team from the University of Hong Kong conducted two randomized, double-blind, placebo-controlled trials. The first involved 84 men and was completed at the end of 2020. The second, years later, involved 100 women. All were between 20 and 65 years old and had slightly elevated cholesterol or triglycerides. For 12 weeks, half took 500 mg of berberine twice a day, the other half an identical capsule without berberine. [1]

The interesting detail: the men’s blood had been frozen at −80 °C. The researchers took it out to analyze it exactly like the women’s, with the same technique and in the same laboratory. This is what makes the comparison possible. The main criterion was apolipoprotein B (apoB). The trials were funded by a public fund from Hong Kong, and the authors declare no conflicts of interest.

Cholesterol: an effect almost three times stronger in women

In women, the results are clear. Compared to the placebo, apoB decreased by 0.13 g/L, from a baseline value of 0.9 g/L: about 14% less. Total cholesterol, LDL, triglycerides, and lipoprotein(a) also decreased, and these effects remain significant after correction for multiple comparisons. [1]

In men, the direction is the same, but the effect is much smaller: almost three times weaker on apoB, and nothing significant on LDL or Lp(a). The gender gap is significant on apoB, total cholesterol, LDL, and Lp(a), with heterogeneity from 83 to 85%.

The results are expressed in standard deviations, a unit that allows different measurements to be compared with each other. Click on “Testosterone” in the chart: it’s the strangest part of the study.

Why apoB instead of LDL?

Each particle of “bad” cholesterol, LDL, IDL, or VLDL, carries a single apoB. Measuring it is like counting the trucks rather than weighing the goods. It is these particles that are directly involved in artery diseases, hence the growing interest of cardiologists in this marker.

The surprise of Lp(a)

Lipoprotein(a) is a cholesterol mainly determined by your genes, which diet and exercise have little effect on. The kind of guest who settles on your couch and never leaves. Seeing it decrease in women is therefore an interesting signal. With a caveat: most participants already had normal Lp(a) levels (medians around 18 to 20 mg/dL), and we don’t know what berberine would do for someone with very high levels.

Testosterone: the same capsule, the opposite effect

The researchers also looked at hormones. After 12 weeks, berberine lowered total testosterone in women (−0.42 standard deviation) and increased it in men (+0.43). [1] Same product, opposite effect.

In women, this is not necessarily bad news. In polycystic ovary syndrome, where testosterone is often too high, this is even what we seek to achieve, and this is where the only two previous trials in women had been conducted.

Why the same dose does not have the same effect

The authors propose two avenues, without deciding.

What really happens in the blood. Another study, published in 2025, measured berberine after a single intake: in women, there was about 2.8 times more in total in the blood, with a peak 3.6 times higher. [3] A liver enzyme that breaks it down, CYP2D6, might not work the same way depending on the sex. At the same dose, women would therefore retain much more. It’s a bit like ordering the same coffee as your partner and seeing her receive, without extra charge, a gourmet coffee.

The hormones. Berberine activates AMPK, a kind of energy switch for cells, which fasting and physical activity also stimulate. Estrogens activate this same switch. In women, the two effects could add up. The authors themselves write that this mechanism remains to be verified, and in this study, no one measured berberine in the blood.

The limits of the study

Before rushing to buy, let’s look at what these two trials do not say.

1. Men and women were not tested at the same time. The authors compare each berberine group to its own placebo, which limits bias, without eliminating it.
2. The trials were not designed to compare sexes. The difference is clear, but it needs to be confirmed by a trial that includes both from the start.
3. Twelve weeks, blood markers. Cholesterol was measured, not heart attacks. No one knows yet if this translates to fewer cardiovascular diseases.
4. Neither weight nor waist circumference was measured. Twenty women reported digestive disorders under berberine, compared to eight under placebo. Does the lipid decrease come from a reduced appetite or direct action? For Lp(a), less sensitive to weight, the question is less relevant; for triglycerides, doubt remains.
5. More dropouts under berberine. Among women, 8 out of 50 stopped in the berberine group compared to 2 out of 50 under placebo, mostly due to side effects, especially digestive. The main analysis only keeps those who completed it; redone with a more cautious method, it reaches the same conclusions, with slightly weaker effects.

Let’s add that all participants were of Chinese origin. On the safety side, no serious effects were reported over these three months, and liver enzymes (ALT and AST) remained stable. Keep in mind that berberine is not suitable for everyone: your stomach may let you know very quickly.

What Europe thinks of berberine

While Hong Kong tests berberine against cholesterol, Europe is closely examining it. On January 29, 2026, the EFSA, the European Food Safety Authority, adopted a draft opinion on plant preparations containing berberine, at the request of the French agency, Anses. [4] [5]

His conclusion: no dose can be considered safe. The EFSA relies in particular on genotoxicity signals observed in the laboratory, on data in rodents, on rare liver damage that cannot be predicted, and on missing studies.

A nuance matters: “we cannot set a safe dose” does not mean “it is dangerous”: it means that we do not have enough data to assert that it is safe.

A three-month trial on 100 people may show the absence of frequent severe effects. It cannot detect a rare reaction that would affect one person in several thousand. It is precisely this type of reaction that concerns the EFSA.

And our Fat Burner?

Our Fat Burner contains 350 mg of berberine extract for 4 capsules, alongside nine other active ingredients: L-carnitine, L-tyrosine, ginger, mate, guarana, green tea, coleus, grapefruit, and cayenne pepper, plus a bit of black pepper. Each dose is indicated in milligrams on the label.

This is a much lower dose than the gram of pure berberine given daily in the study. So we won’t tell you it lowers your cholesterol: no such claims are allowed, and the study didn’t test it. We keep berberine because it remains a relevant molecule, with more and more studies, and we closely follow the EFSA’s opinion. If the regulations change, our formula will change with it.

What we retain

1. Berberine does lower cholesterol in trials, and this study suggests it works better in women. It is a serious lead, which remains to be confirmed.
2. It is neither a testosterone booster nor a replacement for your treatment.
3. In Europe, its future is not written. The doses or recommendations may change, and berberine may no longer be authorized as a simple supplement. As of today, it is.

Ultimately, the most interesting lesson goes beyond berberine: the same dose does not mean the same effect. Before this study, there were only two trials on berberine in women, both in polycystic ovaries. A result obtained in men does not always copy-paste to women, and the vast majority of studies are still conducted on men.

To go further on berberine

To go further, this article covers the weight side.

Sources and studies cited

1. Zhao JV, Chen B, Chan YH et al. Sex-Specific Lipid, Apolipoprotein B, and Lipoprotein(a) Responses to Berberine Based on 2 Randomized Placebo-Controlled Trials. JACC: Asia, 2026;6(10):2204-2216. Trials NCT06782646 (women) and NCT03770325 (men).
2. Mach F et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal, 2020, cited by Zhao et al.
3. Blocher JA et al. Sex-dependent effects of CYP2D6 on the pharmacokinetics of berberine in humans. Clinical Pharmacology & Therapeutics, 2025;117:250-260, cited by Zhao et al.
4. EFSA. Draft opinion on the safety of plant preparations containing berberine (EFSA-Q-2022-00803), adopted on January 29, 2026, public consultation from March 2 to May 4, 2026.
5. NutraIngredients. No safe intake level for berberine: EFSA opens consultation, March 10, 2026, and Safety in question: what is the future of berberine?, July 31, 2026.

Article from the video by Cyril Certain, supplemented by the full reading of the study. This content is informative and does not replace the advice of a healthcare professional.