For decades, testosterone has been misunderstood—reduced to a “male sex hormone” associated primarily with libido and muscle mass. Modern neuroscience and clinical medicine tell a far more nuanced and powerful story.

Testosterone is a critical neuromodulatory hormone in both men and women, influencing cognition, memory, processing speed, visuospatial abilities, and motor coordination. At the brain level, it plays a central role in how we think, move, respond, and perform across the lifespan.

Recent research published in Frontiers in Human Neuroscience confirms that testosterone is deeply involved in multidomain brain and motor performance, extending well beyond reproductive biology (PMID: 41601607).

Testosterone and Cognitive Function: Beyond Energy and Desire

Higher testosterone levels have been associated with:

• Improved working memory and visual memory in both males and females
• Enhanced processing speed and visuospatial abilities, particularly in males
• Greater efficiency in integrating cognitive rules into motor planning during complex or decoupled movements

In clinical practice, this often translates into sharper mental clarity, faster reaction times, improved coordination, and a greater sense of cognitive resilience—especially as patients age.

These findings reinforce what we see every day: hormones are not cosmetic or optional—they are foundational to brain performance.

Neural Connectivity, Motor Planning, and Brain Architecture

At the neural level, testosterone influences:

1. Functional connectivity between the prefrontal and parietal cortices, key regions for executive function and spatial processing
2. Increased activation of premotor and sensorimotor regions, supporting coordination and pain modulation
3. Greater cortical thickness in the prefrontal cortex and precuneus—areas involved in attention, integration, and higher-order cognition

On a cellular level, testosterone has been shown to:

1. Increase dendritic arborization and spine density, enhancing neuronal communication
2. Support dopamine transporter activity and GABA receptor modulation
3. Promote larger motor neurons and improved corticospinal pathway excitability

Collectively, these effects explain why testosterone is increasingly recognized as a master regulator of cognitive-motor integration and neural efficiency (PMID: 41601607).

Testosterone Is Not a “Male Hormone”—It Is a Human Hormone

Testosterone is, in fact, the most abundant steroid hormone in both men and women. Its role in women has historically been underappreciated, despite its importance in:

• Cognitive clarity and memory
• Motivation and drive
• Neuromuscular coordination
• Overall vitality and longevity

When testosterone declines—whether due to age, stress, inflammation, or metabolic dysfunction—the effects are often misattributed to “normal aging,” rather than recognized as correctable biological signals.

The Mirelle Institute Approach to BHRT & TRT: Precision, Physiology, and the Complete Hormonal Cascade

At Mirelle Institute for Anti-Aging Medicine, we take a clinician-led, physiology-first approach to bioidentical hormone replacement therapy (BHRT) and testosterone optimization.

Hormones do not operate in isolation. They function in interdependent cascades, and effective therapy must respect that complexity.

Why We Use Salivary Hormone Testing

We rely primarily on salivary hormonal assessment, which measures the bioavailable, active fraction of hormones at the tissue level. Unlike standard blood testing—which reflects total circulating hormone (much of it bound and inactive)—saliva testing provides a more accurate picture of what your cells are actually able to use.

Blood tests can be helpful for trend monitoring, but they often fail to capture:

• Diurnal hormone rhythms
• Tissue-level activity
• Neurosteroid dynamics

When precision matters—as it does in brain health and longevity—bioavailability matters more than totals.

Why Estradiol Alone Is Not Enough for Women

One of the most common and consequential errors in women’s hormone therapy is prescribing estradiol in isolation.

Estradiol (E2) is essential—but it is not sufficient.

Women also require:

• Estriol (E3) – a protective, anti-proliferative estrogen that helps counterbalance estrone (E1)
• Progesterone – critical for neuroprotection, sleep, mood, and breast/endometrial safety
• Pregnenolone – the “mother hormone,” foundational for cognitive function and stress resilience
• DHEA – essential for immune health, energy, and downstream androgen balance

Without estriol, estrone dominance may go unopposed—particularly in perimenopause and menopause—potentially increasing inflammatory and proliferative signaling. A complete, well-balanced estrogen strategy must account for all three estrogens, not just estradiol.

At Mirelle, every prescription is customized, compounded, and designed to restore harmony across the entire hormonal cascade, never a one-size-fits-all protocol.

A Thoughtful, Individualized Path Forward

Hormone optimization is not about chasing numbers. It is about restoring communication between the brain, nervous system, and body in a way that supports cognition, movement, energy, and long-term health.

This requires:

• Advanced diagnostics
• Clinical expertise
• Respect for individual physiology

It also requires time, listening, and precision.

If this approach to hormone therapy resonates—if you value science, precision, and a truly personalized strategy—you are welcome to schedule a private consultation with our clinician-led team.

At Mirelle Institute, consultations are designed to be thoughtful, educational, and individualized, allowing us to determine whether advanced BHRT or TRT is appropriate for your unique biology and goals.

Appointments may be self-scheduled online at your convenience or by phone with our team at 732-292-0100. 

Reference

Smeha N, et al. Beyond sex: the effects of testosterone on visuomotor performance in men and women. Frontiers in Human Neuroscience. 2026. PMID: 41601607.