Opioids are medications that include many of the common pain drugs that are prescribed for acute and chronic conditions. A few common examples of these drugs include:
- Morphine
- MS Contin
- Oxycontin
- Percocet
- Oxycodone
- Vicodin
- Hydrocodone
- Methadone
- Dilaudid
- and many are trade name medications
How Opioids Impact Testosterone
They are effective medications for management of pain at times, and block transmission and perception of sensory signals related to pain. However, in recent studies long-term use has been shown to cause significant hormone problems, especially androgen deficiency and low testosterone.
Androgen deficiency affects both males and females and may have a significant impact on quality of life. Common symptoms and complaints include loss of libido, fatigue, erectile dysfunction, hot flashes and depression. Physical findings may be:
- Loss of muscle mass
- Body hair loss
- Anemia
- Osteoporosis
- Hypogonadism
Diagnosis & Treatment
Diagnosis is made by history of symptoms, exam, and laboratory analysis of blood for hormone levels. Treatment can be two-fold:
- Reduce opioids
- Hormone replacement
Opioids can affect the brain and the regions that control hormone production. Specifically, they affect the hypothalamus region and inhibit the gonad releasing hormone. This causes a decrease in critical hormones for both males and females including FSH, LH, and testosterone. Opioids also are thought to increase enzymes that metabolize and breakdown the above hormones in the body. Thus, these medications decrease these critical hormones in several ways causing significant side affects.
Long-term opioids are not a benign treatment for pain. If the pain is better, why would a person want to have depression, loss of hair and muscles? The problems associated with opioids are significant, and treatment with hormone replacement is often helpful, but may not reverse the damage these medications can cause.
No silver bullet exists for treating pain. Every treatment has risks and benefits. A good pain physician looks at problems in a comprehensive manner to reduce all risks and maximize benefits.