Can a woman have elevated testosterone and estradiol levels after undergoing a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries)?

From the Guidelines

Yes, a woman can have high testosterone and estradiol levels after bilateral salpingo-oophorectomy, though this is not the typical outcome. After this surgery, hormone levels usually drop significantly since the ovaries are the primary source of estrogen and a significant source of testosterone in women. High levels post-surgery typically occur due to hormone replacement therapy (HRT), which may include estradiol and sometimes testosterone supplementation 1. Other causes include adrenal gland production, which continues after surgery and can produce both hormones, particularly in conditions like adrenal hyperplasia or tumors. Peripheral conversion of other hormones in fat tissue can also contribute to estrogen levels. Medication interactions, particularly with certain antibiotics or antifungals, can affect hormone metabolism. If unexpectedly high hormone levels occur after surgery, medical evaluation is important to determine the cause and appropriate management.

Causes of High Hormone Levels

• Hormone replacement therapy (HRT) with estradiol and testosterone supplementation
• Adrenal gland production, particularly in conditions like adrenal hyperplasia or tumors
• Peripheral conversion of other hormones in fat tissue
• Medication interactions, particularly with certain antibiotics or antifungals

Importance of Medical Evaluation

Medical evaluation is crucial to determine the cause of high hormone levels after bilateral salpingo-oophorectomy and to provide appropriate management. This evaluation can help identify any underlying conditions that may be contributing to the high hormone levels and prevent potential complications. As noted in the study by Rebbeck et al. 1, the risk of ovarian cancer is lower than the risk of breast cancer in BRCA1/2 mutation carriers, but the effectiveness of RRSO in reducing the risk of ovarian cancer has been shown in several studies. However, this study does not directly address the issue of high hormone levels after surgery, highlighting the need for further research and individualized medical evaluation.

Management of High Hormone Levels

Management of high hormone levels after bilateral salpingo-oophorectomy may involve adjusting HRT, treating underlying conditions, and monitoring hormone levels. It is essential to work with a healthcare provider to determine the best course of treatment and to prevent potential complications. The study published in 2015 1 provides guidance on breast cancer risk reduction and monitoring after RRM, but it does not specifically address the management of high hormone levels after bilateral salpingo-oophorectomy. Therefore, healthcare providers must rely on their clinical judgment and expertise to provide individualized care.

From the Research

Hormone Levels After Bilateral Salpingo-Oophorectomy

• Bilateral salpingo-oophorectomy can significantly reduce circulating testosterone (T) and estradiol (E2) levels in both pre- and postmenopausal women 2.
• The postmenopausal ovary continues to produce T, and bilateral oophorectomy can decrease serum T levels in postmenopausal women 2, 3.
• Total and bioavailable testosterone levels are reduced by more than 40% in hysterectomized women with bilateral oophorectomy compared to those in intact women 3.
• Estradiol levels tend to be lower in bilaterally oophorectomized women, but the difference is not always significant 2, 3.

Effects of Hormone Replacement Therapy

• Hormone replacement therapy (HRT) is indicated after bilateral oophorectomy until the age of expected natural menopause, like in premature or early primary ovarian insufficiency 4.
• Oral estrogen therapy in postmenopausal women increases sex hormone-binding globulin and decreases T bioavailability 5.
• Transdermal T patches can produce a significant improvement in hypoactive sexual desire disorder in postmenopausal women who had bilateral oophorectomy and in some women who had a natural menopause 5.

Clinical Implications

• The clinical consequences of lower testosterone levels years after oophorectomy are unknown, and reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed 3.
• Bilateral oophorectomy can have long-term harmful consequences, and restrictive indications for the procedure in premenopausal women are justified by current scientific evidence 4.