Sunday, October 28, 2012

Surgical Menopause and Testosterone for Women

There is a common misconception that only men need testosterone.  The idea that women naturally produce testosterone, that they need testosterone, and that they can take testosterone supplementation to correct a testosterone hormone deficiency needs to be defended.

In women before menopause, about 300 mcg, or 1040 nmol of testosterone are produced each day.  Half of the testosterone production comes from the ovaries.  The other half comes from the adrenal glands.   If you are having a hysterectomy, this is one huge thing to think about before removing the ovaries, too.  Especially if your ovaries are normal.

Some women undergoing a hysterectomy are still being told:

"You don't need your ovaries any way."

Studies show that if you have not gone through natural menopause, and you have a hysterectomy and the ovaries are taken out, too, you could experience a 50% decrease in testosterone production and an 80% decrease in estrogen production.  The ovaries can continue to produce hormones for up to 10 years after the onset of menopause. 

When checking testosterone hormone levels in the blood, it is important to know that there are three possibilities:  
Free Testosterone (pg/ml) 
Bioavailable Testosterone (ng/dl)
Total Testosterone (ng/dl)

Also, an increased sex-hormone binding globulin level leads to a decrease in free testosterone. Related testosterone-pathway hormones that may also be checked include dihydrotestosterone, dehydroepiandrosterone (DHEA), estrone, and estradiol.  So how much of these does a normal pre-menopausal women have in her body?  Here are the normal levels:

DRUG                                                                  NORMAL VALUE*                UNITS
Free Testosterone                                                       1.3 - 6.8                                 pg/ml
Bioavailable Testosterone                                          1.6 - 12.7                               ng/dl
Total Testosterone                                                       14 - 54                                  ng/dl
Sex-hormone binding globulin                                   36 - 185                                 nmol/l
Dihydrotestosterone                                                  4.4 - 20.4                                ng/dl
Dehydroepiandrosterone (DHEA)                             60 - 255                                 mcg/dl
Estrone                                                                       32 - 159                                 pg/ml
Estradiol                                                                     34 - 225                                 pg/ml

There are many variables that go into deciding whether to remove the ovaries at the time of hysterectomy.  If your ovaries are normal, their estrogen, progesterone, and testosterone production may serve to protect you from heart disease, bad moods, insomnia, vaginal dryness, fatigue, losses in bone density, and hot flashes, to name a few.  

If you are at increased risk of ovarian cancer, most doctors would recommend that you do get your ovaries removed.  How do you know if you are at an increased risk?  Family history of ovarian or breast cancer may put you at risk.  If your ovaries have been popping eggs out every month all your life and you have never had a baby or breastfed, this may put you at increased risk but that also depends on your age.  It's more complicated than that, but those are the basics.  If you are at increased risk and you are getting your ovaries out, you may be considered for estrogen and testosterone replacement; many doctors also check the thyroid gland at this time.

Keep your ovaries unless you are at increased risk of ovarian cancer: 
It may be that this is the general word.

Talk to your doctor about what is right for you.
Every woman is different, and you should get a Second Opinion from a different surgeon on the matter of a hysterectomy.

Oh.  And treatment with higher doses of testosterone in women after hysterectomy and oopherectomy have shown marked improvement in both psychological well-being and sexual function.  So don't enter your operation for a hysterectomy wondering whether or not to get your ovaries removed, as the general sentiment today has to do with "ovarian conservation".   

Your ovaries could be your future quality of life.

Medical Disclaimer:  Nothing in this blog is meant to give an individual specific medical advice, treatment,  or recommendation.  Each medical decision must be made between a women and her doctor.  

* = Endocrine Sciences, Calabasas, CA

Full Disclosure:  Dr. Margaret Ferrante is an Institute Physician with Cenegenics Medical Institute, which practices Age Management Medicine components of diet, exercise, hormones, and a balanced lifestyle. She may be contacted at for a Free Consultation.


Abraham GE.  Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle.  J Clin Endocrinol Metab 1974;39;340-6.

Davis S., et al.  Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality.  Maturitas 1996;21:227-36.

Shefrin, J.L., et al.  Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med; Sept 7, 2000;  Vol. 343 (10); 682-8.

Shefrin, J.L., et al.  Incidence of sexual dysfunction in surgically menopausal women.  Menopause 1988;5:189-90.


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