Using opioids?  You may be lowering your testosterone

Prescription opioids are often used to treat chronic and acute pain and when used appropriately, can be an important component of treatment. However, serious risks, including misuse, addiction, overdoses and death, have skyrocketed since the 1990’s when prescriptions to patients began to grow. This has led to almost 218,000 people who’ve died in the U.S. from overdoses related to prescription opioids. In fact, overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.

Another serious side effect of opioid use is the suppression of testosterone levels in men. There have been several studies demonstrating that long-term use of opioids appears to suppress testosterone in men.

One such study has shown that patients, who use opioid medication for six months or longer, may not produce enough of two key hormones – testosterone and cortisol. Researchers reviewed 15 previous investigations that looked at the investigation of long-term opioid use and its impact on hormone levels. Most of the participants were taking the drug for pain. They found that up to 65% of men using opioids long-term have low testosterone.  This condition may lead to erectile dysfunction, infertility, less muscle mass and the development of breasts. In addition, up to 19% of men and women with long-term opioid use have low cortisol levels which can lead to fatigue, weight loss and other symptoms.

The authors of this study suggest people who use opioids long-term should be tested for hormone deficiencies in case they need treatment.

Another study, a systematic review and meta-analysis from 2015, found that testosterone level is suppressed in men with regular opioid use regardless of opioid type. This same study also found that opioids affect testosterone levels differently in men than women. This suggests that opioids, including methadone, may have different endocrine disruption mechanisms in men and women, which should be considered when treating opioid dependence. 

A study published in Pain Medicine, found opioid use can suppress testosterone production. This study had over 5,000 people ages 17 and older who had data on prescription medication usage and serum testosterone levels available. The testosterone levels in men who were using opioids were, on average, 20.2 ng/dl lower when compared to men not using opioids.

Takeaway message

Opioids are meant to provide short-term relief from pain; they are not intended to be a long-term solution. It is imperative that opioid use for pain must be carefully reviewed by all doctors for any patient they are considering prescribing this medication to.  When assessing the impact of opioids on testosterone levels, the effects of age and medical conditions should be considered.

Responsible prescribing needs to considered each and every time when assessing if an opioid is the right treatment.  By exploring alternatives to the use of opioids in managing patients’ pain, physicians not only will help prevent the continued spread of opioid addiction, but also will give patients the tools they need to live happier, healthier lives.