Correlation Between Baseline Serum Testosterone Levels and Cognitive Gain Following Combined Oral Contraceptive Treatment in Patients With Polycystic Ovary Syndrome

Background Combined oral contraceptives (COCs) are the cornerstone therapy for polycystic ovary syndrome (PCOS). While COCs have been shown to improve cognitive performance, the relationship between these gains and hormonal profiles, especially testosterone, remains unclear. This study investigated whether baseline testosterone levels correlate with cognitive changes after COC treatment. Methods This quasi-experimental study evaluated 35 nulliparous women (aged 18-35 years) with PCOS. Baseline total serum testosterone levels were measured before starting a three-cycle course of COCs (levonorgestrel and ethinyl estradiol). Cognitive function, working memory (digit span test or DST), attention (continuous performance test or CPT), and executive function (trail making test or TMT) were assessed at baseline and post-treatment. Spearman’s correlation was used to analyze the relationship between baseline serum testosterone levels and individual cognitive change scores (Δ values). Results The cohort had a mean age of 21.1 years (BMI of 24.1 kg/m2) and a mean baseline testosterone level of 33.6 ng/dL. Analysis revealed no statistically significant correlation between baseline testosterone levels and changes in any cognitive parameters (DST, CPT, TMT), except for a statistical correlation between basal serum testosterone and change in mean RT of the hit rate in continuous performance test, identical pairs (CPT-IP) (p=0.04, r=0.34). Conclusions The study did not provide sufficient evidence to conclude that baseline testosterone levels have any predictive or associative relationship with cognitive improvement following three months of COC therapy in women with PCOS. These findings suggest that cognitive gains in this population are likely influenced by factors beyond the baseline total testosterone concentrations.