Chronic opioid use leads to low levels of Testosterone

[triathloncoach]

Although most patients did not care.

They used 250 and below to diagnosis low T. That's pretty low.



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Short-Acting Opioids May Have Less Impact on Testosterone
By Kristina Fiore, Staff Writer, MedPage Today
Published: February 26, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that low testosterone occurred with significantly more frequency among men taking long-acting rather than short-acting opioids for chronic pain.
Note that controlling for body mass index or dose of drug did not change the finding.
PALM SPRINGS, Calif. -- Men who take long-acting opioids for chronic pain may have a higher risk of hypogonadism than those on short-acting formulations of the drugs, researchers said here.

Those on long-acting opioids such as oxycodone (OxyContin) were nearly five times as likely to have low testosterone than men on short-acting versions such as hydrocodone (Vicodin) (P=0.008), reported Andrea Rubinstein, MD, of Kaiser Permanente in Santa Rosa, Calif., and colleagues, at the American Academy of Pain Medicine meeting here.

It's been well documented that opioid use is linked with hypogonadism in men, though much research has focused on long-acting opioids, particularly methadone, Rubinstein said. But less is known specifically about short-acting opioids and their ties to low testosterone.

So Rubinstein and colleagues conducted a retrospective cohort study of 81 men, ages 18 to 80, with hypogonadism, who were referred to a chronic pain clinic within Kaiser Permanente Northern California between January 2009 and June 2010.

All had been on stable, daily doses of daily opioids for chronic pain for at least three months. None had a previous diagnosis of hypogonadism.

The majority of the cohort (57%) had low morning testosterone levels, based on a cut-off of 250 ng/dL. As expected, Rubinstein said, testosterone levels differed in terms of body mass index (BMI) and Morphine Sulfate Equivalent dose.

She and colleagues found that a significantly larger proportion of men on long-acting opioids were hypogonadal compared with those on short-acting drugs (74% versus 34%, P<0.001).

Even when controlling for dose and BMI, those on long-acting opioids had a far higher risk of being hypogonadal than those on short-acting drugs (OR 4.78, 95% CI 1.51 to 15.07, P=0.008).

"It's easy to see that there's something going on there," Rubinstein told MedPage Today. "Duration of action appears to be the primary culprit."

She added that in those multivariate analyses, BMI was independently associated with low testosterone, but the effect was small. Dose, on the other hand, wasn't associated with hypogonadism and neither was age.

Rubinstein explained that opioids may interfere with the action of luteinizing hormone, which is involved in testosterone production. It has a pulsatile release, peaking every 90 minutes or so. Troughs in short-acting opioid release may allow time for testosterone synthesis. Long-acting opioids, which have a continuous release, don't offer this same kind of opportunity, she said.

Still, she cautioned that it's too early to tell for sure whether long-acting opioids have worse effects on testosterone than their short-acting counterparts, but she said that clinicians should "check for low testosterone regularly, regardless of what type of opioid patients are on."

She added that doctors currently don't look for low testosterone often enough in their chronic opioid patients, but doing so could stave off some of the complications of hypogonadism, including osteoporosis, low libido, insulin resistance, and obesity.

Steven Linder, MD, of the VA Hospital in Palo Alto, Calif., who was not involved in the study, said it's especially relevant to watch for this condition given the rising rate of young war veterans on chronic opioid therapy.

"It's one thing to have a 70-year-old patient on long-term opioids be hypogonadal," he said, "but it's another when you have 26-year-olds on long-term [opioid] therapy."

 

[j-hawk]

Thanks Coach

I was always convinced that suboxone treatment was causing my Low T. Ever since starting a TRT of my own I feel like a new man.

 

[TNH]

I've got two friends being treated with Suboxone at the moment. One in his late 20's, the other in his late 30's, and both needed test at HRT doses to feel normal while under treatment.

I think that most doctors either don't know or don't care, because I never hear of test levels being addressed when someone is recovering from opiate use/abuse.

I have another good friend on copious amounts of opiates, and he says his sex drive is non existent. He seems very depressed and has very little motivation.
I have a little experience with opiates here and there, I found them to be too good to be true at first; high energy, high motivation, feeling good and positive. The longer I stayed on them, the more I got the opposite effect. Towards the end of my higher usage (doctor prescribed, but I still considered myself abusing them), I felt no motivation at all, and very low libido. I thought it was strange the way the medication completely changed over time. The body adapts to things in odd ways, IMO.