Review Finds Insufficient Evidence That Testosterone Improves Memory During Menopause

Testosterone may be gaining popularity as a remedy for menopause-related brain fog, but a new review from University College London (UCL) finds too little evidence to show that it helps. Published in Reproduction and Fertility, the review looked at five existing studies of women aged 41 to 65 to assess whether testosterone treatment improves thinking and memory during and after menopause.

“Social media is flooded with claims that testosterone improves memory and brain fog, and we hear of many women taking testosterone specifically to manage these symptoms during the menopause. While there may be some anecdotal evidence for this in perimenopausal women (who are missing from these trials), we cannot claim testosterone improves cognition during menopause without further evidence,” said senior author Professor Aimee Spector. “More research is needed to understand any links between testosterone and brain health.” 

Both the menopause transition and post menopause have been linked to cognitive complaints, often called “brain fog,” including trouble recalling words and numbers, misplacing items, difficulty concentrating and forgetfulness. Testosterone levels are not thought to change sharply during menopause. Instead, they are believed to start declining in a woman’s mid-20s to early 30s.

The researchers examined whether testosterone improved executive function, verbal learning and memory, and visuospatial learning and memory in post-menopausal women. Across the studies, participants received either testosterone or, in most other cases, a placebo on a daily, weekly or monthly schedule for four to 26 weeks. A meta-analysis of three of the studies, which together included 244 women in randomized controlled trials, found no statistically significant cognitive improvement with testosterone. The review drew on data from Australia, Canada, the USA and Sweden.

Hormone treatments are commonly used for menopause symptoms, but whether they help with brain fog is unclear. The British Menopause Society and the International Menopause Society currently support testosterone therapy only for low libido. According to the researchers, testosterone prescribing has anecdotally risen across NHS and private clinics in the UK. 

“Our review found that the available evidence is limited and insufficient to determine the effect of testosterone therapy on cognition in women during the menopause transition and post menopause. This reflects a lack of sufficient evidence rather than evidence of no effect,” said corresponding author Alexandra Faulkner.

The researchers note that the available studies were few and small, so the findings should not be read as proof that testosterone has no effect on cognition. They call for further research to guide treatment decisions and help women make informed choices about their care, particularly those going through menopause.