Testosterone Deficiency: A Key Factor in the Increased Cardiovascular Risk to Women Following Hysterectomy or with Natural Aging?

The ovaries are a critical source not only of estrogen but also of testosterone. On removal of the uterus, even in instances where ovaries have been spared, their function can be compromised. Women who have had a simple hysterectomy (ovaries remaining intact), even if treated postsurgically with supplementary estrogen, have three times the risk of cardiovascular disease compared with women who have not had a hysterectomy. In men, testosterone has been demonstrated to have beneficial fibrinolytic effects and beneficial effects on blood vessel endothelium, in blood sugar and insulin metabolism, and in maintaining coronary artery circulation. Studies on the potential cardiovascular protective effects of physiologic levels of testosterone in women are critically needed. Restoring a physiologic level of testosterone to women after hysterectomy not only can improve quality of life in terms of sexual libido, sexual pleasure, and sense of well-being but also can build bones—and may be a key to protecting cardiovascular health. Women developing testosterone deficiency as a consequence of natural aging/menopause may similarly benefit from physiologic testosterone supplementation.