Vitality Unleashed: The Functional Medicine Podcast

Rethinking Menopause: Is Testosterone The Missing Link In Women’s Cognitive Health

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 192

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Brain fog, low drive, and that heavy feeling of “I can’t get going” don’t have to be the new normal. We take a close look at why so many midlife women still struggle with mood and cognition even on standard estrogen therapy, and we unpack compelling new evidence that targeted testosterone can restore motivation, clarity, and emotional resilience when HRT falls short.

Drawing on a large real-world cohort from a UK specialist clinic, we walk through who was treated, how therapy was delivered, and which symptoms moved most. The findings are eye-opening: a 35% drop in moderate to severe symptoms across the board in just four months, with mood improvements outpacing cognitive gains and the largest turnarounds in loss of interest, crying spells, and libido. We explain the neuroscience too—why androgen receptors in the hippocampus and frontal cortex matter, how testosterone’s anti-inflammatory and neuroprotective roles support memory, executive function, and day-to-day energy, and why addressing drive often unlocks better thinking.

We also explore the limits and ethics of research in this space. Without a placebo arm and with a short follow-up, the study isn’t definitive—but with 510 participants, it provides rare, meaningful data for women already on transdermal estrogen yet still suffering. We share our clinical perspective on screening for hormonal drivers before defaulting to antidepressants that tend to underperform in hormonally driven mood symptoms, and we outline practical next steps you can take to your doctor, including why a female-formulated transdermal option matters for dosing and safety.

If you’ve hit a wall with fatigue, fog, and flat mood, there may be more to try. Subscribe for more evidence-based guidance on women’s health, share this with someone who needs a path forward, and leave a review with your top question about midlife brain health so we can tackle it next.

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

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Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

SPEAKER_00:

Welcome back to the deep dive. Our mission today is it's really laser focused. We're getting into a specific, I think often really misunderstood area of medicine. It's just crucial for wellness, for longevity, especially for women in midlife. And that is the powerful link between testosterone and cognitive health.

SPEAKER_01:

Aaron Powell Yeah. And this is a deep dive into what so many women and a lot of clinicians are starting to call the missing piece of comprehensive midlife care. Trevor Burrus, Jr.

SPEAKER_00:

The missing piece. I like that.

SPEAKER_01:

It is. We're looking at sources that really highlight the complexity of these persistent menopausal symptoms, the anxiety, the brain fog, that feeling of just no drive. Trevor Burrus, Jr.

SPEAKER_00:

Even when they're already on standard treatment.

SPEAKER_01:

Exactly. Even when they're on traditional hormone replacement therapy or HRT, it just sticks around.

SPEAKER_00:

Aaron Powell So we're going to unpack a really powerful piece of evidence today. It's a retrospective cohort study published in the archives of women's mental health.

SPEAKER_01:

Right.

SPEAKER_00:

And it looked at hundreds of women who, you know, despite doing everything right, were still struggling.

SPEAKER_01:

Aaron Powell And it asks this really fundamental question. We know testosterone is licensed very strictly for low libido, but does it offer these substantial neuropsychological benefits?

SPEAKER_00:

Meaning what?

SPEAKER_01:

Meaning real help for brain fog, for memory, for motivation, for mood, the kind of benefits that modern clinicians focusing on longevity, like we do at Life WellMD, really need to recognize.

SPEAKER_00:

Okay. Let's just let's establish the stakes here. This isn't just about hot flashes and you know achy joints anymore.

SPEAKER_01:

Not at all.

SPEAKER_00:

We are talking about neurological symptoms that can totally derail a woman's life, her career, her mental well-being. Trevor Burrus, Jr.

SPEAKER_01:

Precisely. Perimenopause and menopause, they're not just physical, they are neurological events. And they're driven by declining sex steroid hormones right in the brain. The impact is it's staggering.

SPEAKER_00:

Aaron Powell So what does that look like for you, the listener, on a day-to-day basis?

SPEAKER_01:

Well, it shows up as what we call brain fog or subjective cognitive impairment. And something like two-thirds of women report it. Two-thirds. Yeah. And this isn't just, you know, where did I put my keys? This is a systematic breakdown, difficulty concentrating, real memory problems, a reduced ability to prioritize, to plan. It's it's like trying to run complex software on a really old operating system.

SPEAKER_00:

Aaron Powell That sounds just debilitating. And that's before we even get to the emotional side of it.

SPEAKER_01:

Aaron Powell The emotional toll is where it gets really severe. You see low mood, anxiety, irritability, and maybe the most crushing thing is this profound lack of motivation, of drive.

SPEAKER_00:

Aaron Powell Which leads to what?

SPEAKER_01:

That feeling of being constantly overwhelmed, even by really simple tasks.

SPEAKER_00:

Aaron Powell And if we connect that to the bigger picture of mental health, I mean the source had some stats that just they really stop you in your tracks.

SPEAKER_01:

Trevor Burrus We have to pause here. We really do. The mental health risks are they're enormous. The risk of a major depressive episode is increased two to fourfold. Wow. But here's the one that really gets me. Suicidal thoughts are reported to be up to eight times more prevalent in perimenopausal women. Eight times. Eight times. And this contributes to a higher suicide rate for women aged 45 to 64. So when we talk about wellness and longevity, this isn't just about comfort. It can be a matter of life and death.

SPEAKER_00:

Plus figures are just staggering. And uh they demand a totally new level of clinical attention. Now the traditional route is HRT, right? Estrogen.

SPEAKER_01:

Correct. HRT is the cornerstone, absolutely. But it doesn't solve it for everyone. Right. Some women still have these life-altering mood and cognitive issues. And critically, the source reminds us that there's very limited evidence that antidepressants like SSRIs are a big help here.

SPEAKER_00:

For this specific kind of low mood.

SPEAKER_01:

For this hormonally driven low mood, yes. In women who don't have a formal clinical depression diagnosis.

SPEAKER_00:

Okay, so if the gold standard, estrogen, only gets you part of the way there, and psychiatric meds aren't a reliable fix. The next question is obvious.

SPEAKER_01:

What's missing?

SPEAKER_00:

What hormone is missing? And this is where we turn to testosterone.

SPEAKER_01:

And the biological rationale is just, it's incredibly compelling. We know testosterone levels decline with age. By the time a woman is postmenopausal, her levels can be up to 50% lower than when she was younger.

SPEAKER_00:

50%. And that's not a trivial drop.

SPEAKER_01:

Not at all. It directly impacts brain function because testosterone does so much more in the brain than just libido.

SPEAKER_00:

This is where we get into the neuroprotective side of things.

SPEAKER_01:

Exactly. What's fascinating is that testosterone has these specific binding sites, these androgen receptors, and they are packed into the most important parts of the brain.

SPEAKER_00:

Like where?

SPEAKER_01:

The hippocampus, which is your memory center, and the frontal cortex, which handles executive function planning mood. So this isn't some vague benefit, it's receptor-specific. Testosterone is anti-inflammatory, it's neuroprotective. It basically fuels the pathways for motivation and energy.

SPEAKER_00:

Which makes sense because we see the flip side in men. When their testosterone is low, you see fatigue, depressed mood, cognitive problems.

SPEAKER_01:

Trevor Burrus, Jr.: It stands to reason we need to investigate that link in women just as thoroughly. But let me just push back a little, because we're talking about a big drop in T levels, but these women are also, you know, just older. How can the research be so sure that the symptoms are from the decline in testosterone and not just aging or other changes?

SPEAKER_00:

Aaron Powell And that's the brilliant part of the study's design. It tries to isolate that exact variable.

SPEAKER_01:

How so?

SPEAKER_00:

It looked at 510 women in a UK specialist clinic, and they were specifically chosen because they were already on transdermal estrogen for at least three months.

SPEAKER_01:

Ah, okay. That's the critical detail. So these are basically the treatment-resistant patients of standard care. They were already on good HRT.

SPEAKER_00:

Aaron Powell But they still had low libido and at least one of these mood or cognitive symptoms. They were the ones still suffering.

SPEAKER_01:

Got it. And what about the actual intervention, the testosterone itself?

SPEAKER_00:

Aaron Ross Powell, it was very specific. The mean age was 54. The majority of the women, 87%, were treated with a cream called andropheme.

SPEAKER_01:

And that's important because it's a licensed product for women designed and dosed for female physiology.

SPEAKER_00:

Exactly. This wasn't just, you know, borrowing some high-dose male product. This was targeted.

SPEAKER_01:

Okay. So before we get to the results, just how bad were the symptoms for these women at the start?

SPEAKER_00:

The prevalence was immense. Cognitive symptoms like the brain fog were actually more frequently reported than mood symptoms.

SPEAKER_01:

Really? Yeah.

SPEAKER_00:

89% for cognition versus about 65% for mood.

SPEAKER_01:

And what were the top complaints?

SPEAKER_00:

Number one was feeling tired or lacking in energy at 92%. And right behind it, memory problems at 91%. But when they were asked what was most bothersome, the symptom they rated as moderate or severe, loss of libido was at the top. But and this is surprising, cognitive symptoms as a whole group were rated as more bothersome than mood symptoms.

SPEAKER_01:

Okay. So we have this large group of women, they're on HRT, but they are mentally exhausted, foggy, no drive, they get transdermal testosterone for four months. What happens?

SPEAKER_00:

The results were they were really compelling. All ten symptoms that they measured showed significant improvement. All ten. All ten. And here's the headline metric. The total number of women experiencing moderate or severe symptoms across the board dropped by 35%.

SPEAKER_01:

Aaron Powell A 35% reduction in suffering in just four months.

SPEAKER_00:

Yes. That's a clear sign that something fundamental was being addressed. But let's dig into the nuances, because it didn't fix everything equally.

SPEAKER_01:

Aaron Powell And that's the key takeaway, isn't it? The study found that overall, mood improved significantly more than cognition.

SPEAKER_00:

Aaron Powell Right. Break that down for us. What does a stronger mood improvement tell us?

SPEAKER_01:

Aaron Powell Well, 47% of women reported an improvement in mood, and their mean mood score went down by 34%. Okay. For cognition, it was 39% of women reporting an improvement, and the score went down by 22%. So the stronger mood impact. It suggests that testosterone's primary benefit might be less about, say, repairing memory circuits.

SPEAKER_00:

And more about what?

SPEAKER_01:

And more about boosting the drivers, the motivation, the energy, the emotional resilience that lets the brain actually work properly in the first place.

SPEAKER_00:

Which brings us to the most memorable findings, the symptoms that had the biggest turnaround.

SPEAKER_01:

And these are so fascinating because they all point to vitality and energy. Number one was loss of interest in most things. 56% of women saw that improve.

SPEAKER_00:

Loss of interest in most things. I mean, it's just a clinical term for a lack of joy and hedonia.

SPEAKER_01:

Exactly. Number two was crying spells with 55% improvement. And number three, loss of interest in sex with 52% improvement.

SPEAKER_00:

So seeing that loss of interest lift so much, that suggests testosterone is acting like a powerful restorer of mental energy. It's not just about feeling sad, it's about feeling nothing for the things you used to love.

SPEAKER_01:

Absolutely. And the study highlighted this directly. The mean mood score decreased by 34%, which was almost identical to the decrease in the libido score at 33%.

SPEAKER_00:

So it's not just about sex.

SPEAKER_01:

Not even close. It strongly supports this idea that the neuropsychological benefits are potent and are fundamentally linked to restoring drive and vitality.

SPEAKER_00:

Okay, now we always have to be critical thinkers. This was a pilot study. What were the limitations?

SPEAKER_01:

The main one, and we have to be upfront about this, is there was no control arm, no placebo group.

SPEAKER_00:

So we can't rule out a placebo effect.

SPEAKER_01:

We can't definitively rule it out. Or other confounding factors. Also, it was short, four months. We definitely need longer studies to prove long-term safety and efficacy.

SPEAKER_00:

Aaron Powell And the population. They were very specific, right? Highly motivated women at a specialist clinic.

SPEAKER_01:

That's true. They may not represent the general population, but and here's the crucial counterpoint. Okay. The study size was 510 women. That is a massive data set in this field. It's actually more women than have been in all previous randomized trials with testosterone combined. So while it's not a perfect RCT, it provides extremely substantial real-world data on what happens when you apply this treatment under specialist care.

SPEAKER_00:

So even with the limitations, what are the clinical implications for our listeners who are trying to find better outcomes?

SPEAKER_01:

I mean, the data really supports the idea that transdermal testosterone offers profound benefits for mood and motivation, even to women who are already on good HRT.

SPEAKER_00:

Even though it's still only officially licensed for low sexual desire.

SPEAKER_01:

Right. And that's the hurdle. But the science is screaming that its function is so much broader. This study is the evidence that supports the urgency for the next step for those well-designed, randomized clinical trials.

SPEAKER_00:

And we have to remember the ethical side of this too. With symptoms, this severe elevated risk of depression, suicidal thoughts, it's very difficult to run placebo controlled trials.

SPEAKER_01:

Exactly. This real-world evidence is vital. When symptoms are this debilitating, a specialized clinic that focuses on longevity and wellness, like Life Well MD, has an ethical duty to explore every viable, safe, personalized solution. And that means addressing the hormonal root cause.

SPEAKER_00:

So what does this all mean for you, the listener? I think this study validates what so many of you are feeling. It shows that if you're experiencing these awful cognitive and mood symptoms and standard HRT isn't fixing it, there might be another path. You might find real improvement with targeted testosterone therapy. This is information you can take to your doctor.

SPEAKER_01:

This isn't just theory. It's about recognizing that this fatigue, this anxiety, this loss of interest, these are real measurable symptoms. They're potentially linked directly to your hormones. The goal isn't just living longer, it's extending your health span, your vitality. And recognizing this is absolutely crucial to better help these women.

SPEAKER_00:

If you're a woman experiencing these kinds of persistent symptoms, the fog, the lack of motivation, and you feel like you've just hit a wall, please know that specialized, comprehensive care is available.

SPEAKER_01:

Don't settle. Don't let someone tell you it's just part of aging or that you just need another antidepressant when the root cause could be hormonal.

SPEAKER_00:

You deserve personalized care focused on hormone balance and longevity. To learn more about customized treatment plans and to start your conversation with Dr. Kumar and the team at LifeWellmd.com, you can call 561-210-9999. Start your wellness journey and get that mental edge back. That number again is 561-210-9999.

SPEAKER_01:

And here's a final provocative thought to leave you with. Considering the huge improvement we saw in mood and that loss of interest in most things, the core indicators of vitality. Should clinicians be screening for testosterone deficiency sooner?

SPEAKER_00:

You mean in perimenopausal women who show up with what looks like depression?

SPEAKER_01:

Exactly. Should we be checking hormones before we immediately turn to conventional psychiatric medications?

SPEAKER_00:

That's a powerful question. It suggests hormone balancing could be a first line of defense for a huge portion of midlife mental health issues. We hope this deep dive has given you the knowledge to start asking those questions yourself. We'll see you next time.