Evidence-based counseling on bilateral salpingo-oophorectomy for individuals using therapeutic testosterone: a narrative review

Abstract

Our objective was to synthesize existing evidence on the risks, benefits, and long-term considerations of bilateral salpingo-oophorectomy (BSO) in individuals using therapeutic testosterone. A structured review identified studies on fertility, cardiovascular and bone health, surgical risks, hormone therapy considerations, and malignancy risk. Studies of adults undergoing BSO who used therapeutic testosterone were included. Nonhuman, pediatric/adolescent, and non-English articles were excluded. Of the 368 articles screened, 88 full texts were reviewed, and 51 met the inclusion criteria. Fertility preservation was the most frequently discussed topic. Oocyte cryopreservation is feasible, including with continued testosterone use, although long-term outcomes remain limited to case-based evidence. Available data suggest a low risk of ovarian malignancy, with no clear evidence that testosterone therapy increases cancer risk. Cardiovascular findings were mixed; some studies reported no significant changes, whereas others noted altered lipid profiles. Although testosterone generally maintains bone mass, several studies observed cortical bone loss after BSO, indicating that testosterone may not fully compensate for estrogen deficiency. Surgical complication rates were comparable with those of other populations, although data on reoperation rates were limited. The bilateral salpingo-oophorectomy counseling should be individualized and guided by current evidence, which supports continuation of testosterone therapy and suggests a low malignancy risk with ovarian retention. Clinicians should address existing uncertainties as part of shared decision-making. Further high-quality, longitudinal research is needed to guide clinical recommendations and optimize care for individuals using therapeutic testosterone who are considering BSO.