Testosterone Supplemental Therapy after Hysterectomy with or without Concomitant Oophorectomy: Estrogen Alone Is Not Enough

Abstract

Hysterectomy has the potential for generating serious consequences in terms of health, including two to seven times greater incidence and prevalence of cardiovascular disease, and quality of life, including loss of sexual libido and pleasure. More than a half-million American women undergo hysterectomy every year. Both in premenopausal women and in postmenopausal women, the ovaries are a critical source not only of estrogen but also of testosterone. Even in instances where ovaries have been spared on removal of the uterus, their function may be compromised. Today, women for whom estrogen replacement therapy is not contraindicated are routinely given supplemental estrogen following hysterectomy/oophorectomy. Many women develop and suffer symptoms of testosterone deficiency that go unrecognized and untreated. Testosterone supplemental therapy for women following hysterectomy not only can improve the quality of their lives in terms of sexual libido, sexual pleasure, and sense of well-being but also can - as does supplementary estrogen - contribute to the prevention of osteoporosis. Most importantly, an increasing body of evidence suggests that testosterone may be cardiovascular protective. As testosterone, the most potent anabolic steroid, has some anabolic effect on virtually every tissue in the body, it is likely that supplementing testosterone to physiological levels contributes to health maintenance in as yet undefined ways and that testosterone deficiency in women may be costing more in morbidity and mortality than we know at present.