Testosterone Shows No Clear Cognitive Benefit in Menopause Review

What the Systematic Review Examined

University College London (UCL) researchers evaluated five studies examining whether testosterone therapy improves thinking and memory in midlife women. The review, published in Reproduction and Fertility, included clinical trials conducted in Australia, Canada, Sweden, and the United States.

Investigators looked at women between the ages of 41 and 65 across the menopause transition and postmenopause. Participants received testosterone or an inactive placebo on daily, weekly, or monthly schedules for duration periods ranging from four to 26 weeks.

Cognitive Outcomes in the Clinical Trials

A meta-analysis of three randomized controlled trials (RCTs) found no statistically significant cognitive differences between testosterone and placebo. This pooled analysis examined 244 postmenopausal women across specific testing categories.

Researchers assessed executive function, verbal learning and memory, and visuospatial learning and memory. Across these measures, participants taking testosterone performed similarly to those assigned to the placebo group.

Current Prescribing Guidance and Clinical Practice

Current medical guidelines authorize testosterone therapy strictly for low sexual desire rather than cognitive complaints. Both the British Menopause Society (BMS) and the International Menopause Society (IMS) support testosterone use solely for hypoactive sexual desire disorder.

Prescriptions for testosterone have increased across private and National Health Service (NHS) clinics in the United Kingdom. This rise reflects growing interest on social platforms, where claims often suggest testosterone relieves forgetfulness, word-finding problems, and poor concentration.

Physiologically, testosterone levels decline gradually starting in a woman's mid-20s to early 30s. This pattern differs from the acute hormonal shifts that characterize the cessation of menses between ages 45 and 55.

Limitations in the Available Evidence

The existing research base contains too few participants to confirm whether testosterone alters cognition in midlife women. Only five clinical studies met the criteria for inclusion, and the total sample size remains small.

Perimenopausal women were absent from the reviewed clinical trials. Senior author Professor Aimee Spector pointed out that while anecdotal reports exist among perimenopausal individuals, trials have not verified those claims.

Lead author Dr. Alexandra Faulkner emphasized that a lack of sufficient evidence is not proof of zero effect. The authors noted that larger clinical trials are needed before clinicians can recommend testosterone for cognitive symptoms during menopause.