Rationale for the use of testosterone propionate in the immediate treatment of excessive uterine bleeding

Abstract

All of the sexual hormones possess bisexual properties to varying degrees. Testosterone, in particular, is not only a powerful androgen, but also a very potent gynecogen. As regards the female, the effects exerted by testosterone are dual, for it may behave as an estrogen or a progestogen.A physiodynamic explanation is offered of the modus operandi by which excessive uterine bleeding is controlled by testosterone propionate. This interpretation is based, in main, upon the response of the myometrial elements to testosterone propionate.Substantial anatomic evidence is presented to show clearly that the close structural interrelationship between the blood vessels and the muscle fibers of the myometrium is such that adequate contraction of the myometrium will bring about a functional constriction of these vessels, especially the proximal (myometrial) portion of the spiral arterioles. Consequently, the volume of blood flowing to the endometrium, and thus, the amount of uterine bleeding, will be decidedly decreased.The essential role played by the myometrial elements in controlling the amount of uterine bleeding now becomes manifest. It follows, then, that excessive uterine bleeding will occur if the proximal (myometrial) portion of the spiral arterioles fails to constrict, or be constricted, following the initial extravasation of blood distally. A basic cause, therefore, for excessive bleeding, regardless of the precipitating factor, be it myomas, subinvolution, pelvic inflammatory disease, or merely “functional,” is a disruption in the normal hemodynamics of the uterine circulation accompanied by a disturbance in the pattern of uterine contractility at the time of menstruation.The response of the myometrial elements to testosterone propionate is twofold. First, this hormone will inhibit rhythmic, intermittent uterine contractions, thereby eliminating the pumping action of these movements. As a result, the volume of blood flowing to, and thus through, the uterus will definitely decrease, for the degree of activity of muscle and its blood supply are directly proportional. Second, the direct stimulative, squeezing effect of testosterone upon the myometrial elements will bring about a functional constriction of the myometrial vessels. The sum total of the twofold effects of testosterone propionate (inhibition of intermittent uterine contractions, direct stimulative action upon the myometrial elements) acting simultaneously upon the myometrial elements will result in a decided reduction in the flow of blood to the endometrium. Consequently, the amount of uterine bleeding will be very considerably diminished. Upon these considerations, the use of testosterone propionate for the immediate treatment of excessive uterine bleeding finds its rationale.