Dr. Herman Weiss
Oct 1, 2026
Scroll social media this month and you'll hear that testosterone sharpens the menopausal brain - clearer thinking, no more brain fog, your old self back. I told you about the FDA's first-ever meeting on testosterone for women two weeks ago, and the hype has only grown since. So the timing could not be better for what just published: the first systematic review and meta-analysis to gather every study ever done on testosterone therapy and cognition in menopause, and pool what they found.
The research. Alexandra Faulkner, Aimee Spector, and colleagues at University College London searched five medical databases from their beginnings through March 2025 - 3,880 records - for studies testing testosterone therapy against thinking and memory in the menopause transition and postmenopause. After screening, five studies qualified. Three, covering 244 postmenopausal women, could be pooled statistically across three domains: executive function (planning, attention, decision-making), verbal learning and memory, and visuospatial learning and memory.
What they found. Nothing - carefully. The pooled effects of testosterone on every cognitive domain were statistically indistinguishable from zero, with effect sizes mostly close to zero. And here is the part the hype will skip: the authors are explicit that this is not proof testosterone does nothing. It is proof we don't have the data. Five small studies, only 244 women in the pooled analysis, not a single study on subjective brain fog - the thing women actually complain about - and not one study in perimenopause, the stage where cognitive symptoms seem to hit hardest. The verdict is "insufficient evidence," not "no effect."
What you gain from this. If someone - a clinic, an influencer, a friend with a pellet guy - promises you testosterone will clear your brain fog, you now know exactly what the entire scientific literature can and cannot back: nothing, either way, yet. That protects your wallet and your expectations. It also sharpens what the hormone is actually for: the evidence-backed use remains low sexual desire that causes distress, as the FDA panel discussed. For brain fog itself, the levers with real evidence behind them are unglamorous - sleep, exercise, treating depression and anxiety, checking thyroid and B12, and reviewing medications that fog the brain. If testosterone trials for cognition come - and after this paper, expect them - I'll read them for you.
For my PMOS readers: you have a particular reason to read this one. The hormone being marketed to menopausal women as a missing ingredient is the one your body often overproduces - elevated androgens are part of the PMOS picture, not a deficiency to correct. So the cure-all framing was never aimed at your biology, and adding androgens is not your brain-fog fix either. Your cognitive complaints deserve the same evidence-first workup, and the same honesty about what isn't proven.
That's the cycle. Bring your doctor the papers, not just the headlines.
Dr. Herman Weiss
(Faulkner A, Desai R, Keay N, Ellahi SA, Aimee S. Testosterone Therapy for Cognition in Menopause: Systematic review and meta-analysis. Reproduction and Fertility, published online Sep 29, 2026. doi:10.1530/RAF-26-0080)
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