Testosterone Therapy for Cognition in Menopause: Systematic review and meta-analysis

Abstract To explore the effect of testosterone therapy on objective and subjective cognition in 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 3880 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 model, used 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 in 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. There is a need for further adequately powered trials of testosterone therapy and its impact on cognition, particularly during menopause transition, the period in which cognitive problems appear to be most pronounced. Lay Summary Menopause is a stage of life that can affect thinking and memory, often colloquially called ‘brain fog’. Brain fog, can affect daily life and relationships. Hormone treatments are often used to manage symptoms, but it is still not clear how well they work. Testosterone is sometimes prescribed for low sex drive, but its effects on thinking and memory are unclear. This study reviews the existing evidence. Five studies were identified. These studies looked at different areas of thinking and memory, including attention, planning, decision-making and learning. We found no clear evidence that testosterone impacts thinking and memory. However, there were only a few small studies, so the results need to be interpreted carefully. This research highlights a knowledge gap. More studies are needed on testosterone to guide effective treatment and support women to make informed decisions about their health.