Testosterone Therapy Boosts Mood and Brain Fog in Menopausal Women

Perimenopause and menopause are associated with declining testosterone levels—up to 50% lower than in younger women—which may contribute to brain fog, low mood, anxiety, and fatigue. While HRT (oestrogen ± progestogen) is the standard treatment, many women continue to experience cognitive and psychological symptoms despite adequate hormone therapy. This pilot study investigated whether adding transdermal testosterone could address those residual symptoms.

Researchers conducted a retrospective cohort study at the Newson Health Menopause and Wellbeing Centre in the UK. 510 women (mean age 54; 34% perimenopausal, 66% postmenopausal) who had been on HRT for at least three months but still reported low libido plus at least one mood or cognitive symptom were prescribed transdermal testosterone—primarily AndroFeme 1% cream (87%). Symptom severity was assessed before and approximately four months after starting testosterone using a modified Greene Climacteric Scale (the clinic's Menopause Symptom Questionnaire), covering three cognitive items and six mood items plus libido.

All nine cognitive and mood symptoms improved significantly (all p < 0.001). Mood improved more than cognition: 47% of women reported mood improvement versus 39% for cognition, with mean score reductions of 34% and 22% respectively. The greatest individual improvements were seen in 'loss of interest in most things' (56% improved) and 'crying spells' (55% improved). Libido improved in 52% of women, a magnitude similar to mood gains. The prevalence of moderate-to-severe symptoms fell substantially across all domains.

These results have meaningful clinical implications. Testosterone is currently licensed only for hypoactive sexual desire disorder in postmenopausal women, yet this study suggests it may offer broader neuropsychiatric benefits—particularly for mood—beyond libido. The differential improvement (mood > cognition) suggests testosterone may act through distinct neurobiological pathways for each symptom cluster, warranting further mechanistic investigation. The finding that mood and libido improved to a similar degree further challenges the narrow framing of testosterone as purely a sexual health intervention.

Important caveats temper enthusiasm. The study is retrospective, uncontrolled, and single-centre, with no placebo arm, making it impossible to rule out placebo effect, regression to the mean, or confounding by concurrent antidepressant use (17% of participants). Symptom assessments were self-reported. The four-month follow-up is short, and longer-term efficacy and safety data are lacking. The authors appropriately call for randomised controlled trials to confirm these findings and identify which women are most likely to benefit.