Published in Reproduction and Fertility, the review examined five existing studies of women aged 41 to 65 to understand whether testosterone treatment improves thinking and memory in women during and after menopause.
Senior author and Director of the UCL Menopause Mind Lab Professor Aimee Spector (UCL Psychology and Language Sciences) said: "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 menopause is when a woman's periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55. Post menopause is the stage of life that begins 12 consecutive months after a woman's final menstrual period and lasts for the rest of her life.
The menopause transition and post menopause have been associated with cognitive complaints, often described as 'brain fog'. This includes difficulties recalling words and numbers, misplacing items, trouble concentrating and forgetfulness. It is thought that testosterone levels do not acutely change during menopause but instead begin to decline from a woman's mid-20s to early 30s.
Researchers reviewed five different studies to determine whether testosterone improved executive function, verbal learning and memory, and visuospatial learning and memory in post-menopausal women.
Many of the study participants were given testosterone while most of the other participants were given a placebo, administered on a daily, weekly or monthly basis for periods ranging between four to 26 weeks. Researchers then compared the effects of cognition between testosterone and the placebo.
The authors conducted a meta-analysis on the results of three of the five studies, which examined a total of 244 women in randomised controlled trials, and they did not find any statistically significant improvements for cognitive function among participants taking testosterone.
Hormone treatments are often used to manage menopause symptoms, but it is unclear whether they help with brain fog. Current guidance from the British Menopause Society and the International Menopause Society only supports testosterone therapy for low libido, and the researchers note its effects on thinking and memory are not well understood.
The researchers say that testosterone prescribing has anecdotally increased across NHS and private clinics in the UK, reflecting growing interest in its role during menopause.
Corresponding author Dr Alexandra Faulkner (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."
Further research is needed to guide treatment decisions and support women in making informed choices about their care, particularly in women going through the menopause. Future research should also explore how women perceive changes in their thought processes and memory.
Data was included from Australia, Canada, the USA and Sweden to complete this review.
Study limitations
The researchers note that the studies available were limited in number and sample size, with the existing evidence base too small to draw firm conclusions about whether testosterone therapy helps cognitive symptoms during menopause. The findings should not be interpreted as proof that testosterone has no effect on cognition.
