Laughlin G A, Barrett-Connor E, Kritz-Silverstein D, von Mühlen D
Department of Family and Preventive Medicine, University of California-San Diego School of Medicine, La Jolla 92093, USA.
J Clin Endocrinol Metab. 2000 Feb;85(2):645-51. doi: 10.1210/jcem.85.2.6405.
This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in community-dwelling postmenopausal women who were not using estrogen replacement therapy. Six hundred and eighty-four women, aged 50-89 yr, were surveyed for hysterectomy and oophorectomy status and had plasma obtained between 1984-1987. Of these, 438 (67%) had not undergone hysterectomy or oophorectomy (intact), 123 (18%) reported hysterectomy with bilateral oophorectomy, and 123 (18%) reported hysterectomy with conservation of 1 or both ovaries. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% (P < 0.001) in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with ovarian conservation. Androstenedione levels were about 10% lower in hysterectomized women with or without ovarian conservation compared to those in intact women (P = 0.039). Total estradiol levels tended to be lower (P = 0.095) in bilaterally oophorectomized women. Levels of bioavailable estradiol, estrone, and SHBG did not differ by hysterectomy and oophorectomy status. Among intact women, total, but not bioavailable, testosterone levels increased with age (P = 0.015), reaching premenopausal levels for the 70-79 decade with relatively stable levels thereafter. Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr age range. Androstenedione levels decreased 27% and SHBG levels increased 30% (P < 0.001) with age in intact, but not oophorectomized, women. Levels of other hormones did not vary with age. Stratification by years since menopause or surgery yielded similar results. These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women. The clinical consequences of lower testosterone levels years after oophorectomy are unknown. Reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed.
本研究调查了未接受雌激素替代治疗的社区绝经后女性子宫切除术和卵巢切除术状态、实际年龄以及绝经年限与血浆总睾酮、生物可利用睾酮、雌二醇、雄烯二酮、雌酮和性激素结合球蛋白（SHBG）水平之间的横断面关联。对684名年龄在50 - 89岁的女性进行了子宫切除术和卵巢切除术状态的调查，并于1984 - 1987年采集了她们的血浆样本。其中，438名（67%）未接受子宫切除术或卵巢切除术（完整组），123名（18%）报告接受了双侧卵巢切除子宫切除术，123名（18%）报告接受了保留一侧或双侧卵巢的子宫切除术。在调整年龄和体重指数后，与完整组女性相比，接受双侧卵巢切除子宫切除术的女性总睾酮和生物可利用睾酮水平均降低了40%以上（P < 0.001），而保留卵巢的子宫切除组女性睾酮水平处于中间值。无论是否保留卵巢，子宫切除组女性的雄烯二酮水平均比完整组女性低约10%（P = 0.039）。双侧卵巢切除的女性总雌二醇水平有降低趋势（P = 0.095）。生物可利用雌二醇、雌酮和SHBG水平在不同子宫切除术和卵巢切除术状态的女性中无差异。在完整组女性中，总睾酮水平随年龄增加（P = 0.015），但生物可利用睾酮水平无此变化，70 - 79岁时总睾酮水平达到绝经前水平，此后相对稳定。在卵巢切除组女性中，总睾酮和生物可利用睾酮水平不随年龄变化，在50 - 89岁年龄段内均比完整组女性低40 - 50%。在完整组女性中，雄烯二酮水平随年龄下降27%，SHBG水平上升30%（P < 0.001），而卵巢切除组女性无此变化。其他激素水平不随年龄变化。按绝经或手术后年限分层得出了类似结果。这些结果表明，绝经后卵巢在老年女性的整个生命周期中仍是雄激素的关键来源。卵巢切除多年后睾酮水平降低的临床后果尚不清楚。需要重新考虑预防性卵巢切除术，并开展临床试验以评估卵巢切除术后雄激素替代治疗的效果。
