Testosterone therapy for cognition in menopause: A systematic review and meta-analysis

The objective of this review was to explore the effect of testosterone therapy on objective and subjective cognition during the menopause transition and postmenopause through a systematic review and meta-analysis. A systematic search was conducted in PsycINFO, MEDLINE, Embase, Web of Science and the Cochrane Library from database inception to March 2025 using predefined eligibility criteria. A total of 3,880 records were identified. After screening, five studies were eligible for inclusion. Three studies including 244 postmenopausal participants were included in a random-effects meta-analysis to estimate pooled effects. Three cognitive domains were covered: executive function, verbal learning and memory and visuospatial learning and memory. Studies excluded from the meta-analysis were reported narratively. The meta-analysis found no statistically significant pooled effects of testosterone therapy across the cognitive domains analysed, with effect sizes mostly close to zero. No studies explored the effect of testosterone therapy on subjective cognition or during perimenopause. The findings should be interpreted as insufficient to establish an effect rather than as evidence of no effect, given the small number of available studies and their limited sample sizes. Further adequately powered trials are needed to investigate the effects of testosterone therapy on cognition, particularly during the menopause transition, the period in which cognitive problems appear to be most pronounced.

Menopause is a stage of life that can affect thinking and memory, often colloquially referred to as 'brain fog'. Brain fog can affect daily life and relationships. Hormone treatments are often used to manage symptoms, but it is still unclear how well they work. Testosterone is sometimes prescribed for low sex drive, but its effects on thinking and memory remain unclear. This study reviews the existing evidence. Five studies were identified. These studies examined different areas of thinking and memory, including attention, planning, decision-making and learning. We found no clear evidence that testosterone affects thinking and memory. However, only a few small studies were available, so the results need to be interpreted carefully. This research highlights a knowledge gap. Further studies are needed on testosterone to guide effective treatment and support women to make informed decisions about their health.