Review finds no evidence that testosterone improves brain fog during menopause

A review of five studies has found insufficient evidence that testosterone treatment improves memory and thinking in women during or after menopause.

The combined analysis of three randomised controlled trials involving 244 women found no statistically significant improvement in cognitive function among those receiving testosterone compared with a placebo.

Researchers stressed that the findings reflect a lack of evidence, rather than proof that testosterone has no effect on symptoms commonly described as brain fog.

Professor Aimee Spector, senior author and director of the UCL Menopause Mind Lab, said claims about testosterone’s benefits for memory were becoming increasingly common.

“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.

“More research is needed to understand any links between testosterone and brain health.”

The review, conducted by researchers at University College London (UCL), examined five studies involving women aged 41 to 65.

It assessed whether testosterone therapy improved executive function, which includes planning and decision-making, as well as verbal and visuospatial learning and memory.

Visuospatial skills involve understanding and remembering where objects are positioned in relation to one another.

Participants received testosterone or a placebo, an inactive treatment, daily, weekly or monthly over periods ranging from four to 26 weeks.

Menopause occurs when menstrual periods stop because of declining hormone levels, usually between the ages of 45 and 55.

Postmenopause begins 12 consecutive months after a woman’s final menstrual period and continues for the rest of her life.

Women going through menopause and those who are postmenopausal may experience forgetfulness, difficulty concentrating, problems recalling words or numbers and frequently misplacing items.

These symptoms are often referred to as brain fog.

Testosterone is not thought to decline sharply during menopause. Instead, levels are believed to begin falling gradually from a woman’s mid-20s to early 30s.

Hormone treatments are commonly used to manage menopausal symptoms, but their effectiveness against cognitive complaints remains uncertain.

Current guidance from the British Menopause Society and International Menopause Society supports testosterone therapy only for low libido, or reduced sexual desire.

The researchers also noted anecdotal reports of increased testosterone prescribing across NHS and private clinics in the UK.

Dr Alexandra Faulkner, corresponding author from UCL Psychology and Language Sciences, said: “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.”

The review included data from Australia, Canada, the US and Sweden.

Researchers identified several limitations, including the small number of studies and their relatively limited sample sizes.

None of the trials included perimenopausal women, leaving unanswered questions about whether testosterone affects cognitive symptoms during the menopause transition.

The authors called for further studies to determine whether testosterone therapy has any effect on thinking and memory, particularly among women going through menopause, and to help guide treatment decisions.

They also recommended research into how women perceive changes in their thinking and memory during menopause.