Paulson Deployed $2.7B in One Quarter and Built a $994M Rezdiffra Bet Alongside a $1.3B Gold Mining Empire: Inside the Q4 2025 Comeback

John Paulson — the man who made $4 billion shorting subprime in 2007 and has spent the last decade converting his hedge fund into a family office — just made his loudest statement since the financial crisis. In Q4 2025, Paulson & Co. went from a $520 million portfolio with just 3 positions to a $3.26 billion portfolio with 9 holdings. That is a 527% AUM increase in a single quarter and roughly $2.7 billion of net new capital deployed.

This is not incremental repositioning. This is a man who sees gold heading to $5,000 and the first FDA-approved MASH drug crossing $1 billion in annual sales — and is putting serious money behind both convictions simultaneously.

TL;DR

• AUM: $3.26B in Q4 2025, up from $520M in Q3 — a 527% quarter-over-quarter explosion
• Holdings: 9 positions (up from 3 in Q3) — 6 entirely new positions
• Top position: Madrigal Pharmaceuticals (MDGL) at $994M = 30.5% of portfolio — NEW
• #2 position: Perpetua Resources (PPTA) at $783M = 24.0% — gold/antimony miner, NEW
• #3 position: Bausch Health (BHC) at $509M = 15.6% — pharma turnaround, NEW
• Gold/mining sleeve: PPTA + NovaGold + Agnico Eagle + Tower Hill + Solstice = ~$1.37B (42% of portfolio)
• Pharma sleeve: MDGL + BHC = $1.50B (46% of portfolio)
• Barbell strategy: Two uncorrelated macro themes — inflation hedge (gold) and biotech growth (MASH blockbuster)
• Signal: Paulson predicts gold at $5,000 by 2028; Rezdiffra just reported $958M in 2025 sales, annualizing above $1B

The Filing Snapshot

Metric	Q3 2025	Q4 2025	Change
13F AUM	$518M	$3,262M	+530%
Holdings count	3	9	+6 new
Top-1 concentration	72.0% (AAMI)	30.5% (MDGL)	−41.5pp
Top-3 concentration	100%	70.1%	−29.9pp
Filing date	2025-11-14	2026-02-17	—

The concentration story is almost as dramatic as the AUM story. In Q3, Paulson had 72% of his entire portfolio in a single asset management holding (Acadian Asset Management). By Q4, no single position exceeds 31%, and the portfolio spreads across two entirely distinct macro themes.

The $994M Madrigal Bet: Paulson Backs the First MASH Blockbuster

Madrigal Pharmaceuticals (MDGL) is now Paulson’s single largest holding at $994 million — a brand-new position representing 30.5% of the portfolio. This is not a speculative biotech play. Rezdiffra (resmetirom) is the first and only FDA-approved drug for metabolic dysfunction-associated steatohepatitis (MASH), a liver disease affecting an estimated 6–8 million Americans with moderate to advanced fibrosis.

The numbers behind this bet are compelling:

• 2025 full-year sales: $958.4 million (reported Feb 19, 2026)
• Q4 2025 alone: $321.1 million — annualizing above $1.28B
• Patients on therapy: 36,250+ as of year-end, with 90%+ of the target population still untreated
• Patent protection: Extended to 2045 via new patent grant
• European expansion: Launched in Germany following EC approval — first approved MASH therapy in the EU

Paulson is betting that Rezdiffra’s trajectory resembles other first-in-class specialty launches that scaled from $1B to $3–5B in peak sales. With a $11.6B market cap as of early 2026, MDGL trades at roughly 9–10x 2026 estimated revenue — expensive for pharma, but defensible if the drug reaches its addressable market.

The $1.3B Gold Mining Empire: Antimony, Donlin, and the $5,000 Thesis

Paulson has been vocal about his gold thesis. In an April 2025 Reuters interview, he predicted gold would reach $5,000 per ounce by 2028, driven by central bank buying and global trade tensions. His Q4 2025 13F is the financial proof of that conviction — roughly 42% of the portfolio is now allocated to gold and critical mineral miners.

Perpetua Resources (PPTA) — $783M (24.0%)

The second-largest holding and the centerpiece of the gold thesis. Perpetua Resources is developing the Stibnite Gold Project in central Idaho — a $1.3 billion mine that is the only domestic U.S. source of antimony, a critical mineral used in defense applications and batteries. China recently imposed export restrictions on antimony, making domestic supply a national security priority.

Key milestones:

• Broke ground on early construction in October 2025 after 9 years of permitting
• Selected Hatch Ltd. as EPCM contractor (December 2025), with Hatch making a $4M equity investment
• Final investment decision expected spring 2026, with EXIM Bank funding pending
• Paulson also invested $1B alongside NovaGold for a 50% stake in Alaska’s Donlin Gold project (39M oz reserves)

NovaGold Resources — $254M (7.8%)

Paulson’s partner in the Donlin Gold venture. The 39-million-ounce deposit in Alaska is one of the largest undeveloped gold projects globally. At $2,800+ gold, the economics are transformational.

Agnico Eagle Mines (AEM) — $133M (4.1%)

Agnico Eagle is the third-largest gold producer globally, with operations across Canada, Australia, Finland, and Mexico. This is Paulson’s “operating producer” complement to the development-stage miners — cash-flowing exposure to current gold prices.

International Tower Hill Mines (THM) — $131M (4.0%)

Another Alaska gold development play. Tower Hill’s Livengood project sits on a 16-million-ounce resource. Paulson held this position through Q3 at $115M and let it appreciate.

Solstice Advanced Materials (SOLS) — $68M (2.1%)

A smaller position in critical materials. At $68M, this is a satellite bet within the mining theme.

Bausch Health (BHC): The $509M Pharma Turnaround Bet

Bausch Health is the third-largest position at $509 million (15.6%) — a completely new holding. This is classic Paulson event-driven investing:

• Q4 2025 revenue: $2.80B (+9% YoY), with 11 consecutive quarters of revenue and adjusted EBITDA growth
• Full-year 2025 EBITDA: $3.54B (+7%)
• Valuation: Trading at 6.4x earnings — deeply discounted vs. pharma peers
• Catalyst: $9.6B debt refinancing completed, extending maturities and lowering interest costs
• Risk: $20.2B in total debt and an impending patent cliff on key drugs

Paulson is betting that the market is overpricing Bausch’s debt risk and underpricing its operational turnaround. With revenue growing, EBITDA expanding, and refinancing reducing near-term default risk, the 6.4x multiple could re-rate significantly.

Acadian Asset Management (AAMI): From 72% Concentration to 11%

The most telling signal in the Q4 filing is what didn’t change. Paulson held exactly the same 7,743,282 shares of Acadian Asset Management as in Q3 — but its portfolio weight collapsed from 72% to 11.2%. This isn’t a trim. It’s dilution by deployment. Paulson didn’t sell Acadian; he simply added $2.7 billion of new capital around it.

The AUM Roller Coaster: From $5.9B to $320M and Back

Paulson’s AUM history reads like a volatility chart. The fund peaked above $5.8B in mid-2019, then gradually declined through 2022 as Paulson converted from hedge fund to family office. By Q1 2025, the 13F portfolio had shrunk to just $320 million across 5 holdings — the smallest footprint in the fund’s history.

Then came Q2 2025 ($2.01B, 15 holdings), followed by a mysterious collapse to $520M and 3 holdings in Q3, and now this explosive Q4 rebound to $3.26B. The whipsaw pattern suggests Paulson is actively moving capital between 13F-reportable equities and non-reportable assets (gold bullion, private investments, real estate).

What Analysts Might Misread

1. “Paulson is back to running a hedge fund”

No. This is family office capital deployment. Paulson manages his own $3.8B net worth, not outside investor money. The 13F captures only the equity sleeve of a much larger portfolio that includes direct gold holdings, real estate, and private investments. The $3.26B in equities may represent 40–50% of total assets, not 100%.

2. “The gold thesis is a macro hedge”

It’s bigger than that. Paulson isn’t buying GLD for portfolio insurance. He’s investing in development-stage miners that offer 3–5x leverage to gold prices. If gold hits $5,000 (his target), PPTA and NovaGold could see 200–300% returns from current levels. This is a conviction trade, not a hedge.

3. “The MDGL position is speculative biotech”

Rezdiffra is the opposite of speculative. It’s an approved, commercial-stage drug doing nearly $1B in annual sales with 90%+ of the addressable market untouched. This is a growth equity play on a proven product, not a Phase 2 gamble.

4. “The Q3-to-Q4 AUM jump means Paulson bought everything in October”

Not necessarily. 13F filings report quarter-end snapshots. Some positions may have been established earlier in 2025 through vehicles not captured in the Q3 13F (separate accounts, partnerships). The jump from $520M to $3.26B likely reflects both new purchases and the consolidation of existing positions into the reporting entity.

Frequently Asked Questions

What did Paulson buy in Q4 2025?

Paulson added 6 new positions: Madrigal Pharmaceuticals (MDGL) at $994M, Perpetua Resources (PPTA) at $783M, Bausch Health (BHC) at $509M, NovaGold Resources at $254M, Agnico Eagle Mines (AEM) at $133M, and Solstice Advanced Materials (SOLS) at $68M. He also added Thryv Holdings (THRY) at $26M.

Why did Paulson’s AUM jump from $520M to $3.26B?

Paulson deployed approximately $2.7 billion of new capital into 13F-reportable equity positions during Q4 2025. As a family office managing John Paulson’s personal wealth ($3.8B net worth), this likely represents a reallocation from non-reportable assets (physical gold, real estate, private investments) into public equities.

Is Paulson still bullish on gold?

Extremely. Roughly 42% of the Q4 portfolio ($1.37B) is allocated to gold and critical mineral miners. In April 2025, Paulson predicted gold would reach $5,000/oz by 2028, driven by central bank buying and geopolitical instability. He also committed $1B to the Donlin Gold project in Alaska.

What is Perpetua Resources and why is it Paulson’s #2 holding?

Perpetua Resources (PPTA) is developing the Stibnite Gold Project in Idaho, a $1.3B mine that is the only U.S. domestic source of antimony — a critical mineral for defense applications. China’s export restrictions on antimony have elevated the project’s strategic importance. Construction began in October 2025.

How concentrated is Paulson’s portfolio?

The top-3 holdings (MDGL, PPTA, BHC) represent 70.1% of the portfolio. However, this is actually less concentrated than Q3 2025, when AAMI alone was 72% of the portfolio. The Q4 filing shows Paulson diversifying across two macro themes rather than concentrating in one name.

What is Rezdiffra and why does it matter for the MDGL position?

Rezdiffra (resmetirom) is the first and only FDA-approved drug for MASH (metabolic dysfunction-associated steatohepatitis), a liver disease affecting millions. It generated $958M in 2025 sales, is annualizing above $1.28B, and has 90%+ of its target patient population still untreated. European launch began in Germany in late 2025.