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. 2009 Jan;117(1):38-43.
doi: 10.1055/s-2008-1076715. Epub 2008 Jun 3.

Oral opioids for chronic non-cancer pain: higher prevalence of hypogonadism in men than in women

L-A Fraser  1 , D Morrison, P Morley-Forster, T L Paul, S Tokmakejian, R Larry Nicholson, Y Bureau, T C Friedman, S H M Van Uum
Affiliations

Oral opioids for chronic non-cancer pain: higher prevalence of hypogonadism in men than in women

L-A Fraser et al. Exp Clin Endocrinol Diabetes. 2009 Jan.

Abstract

The effect of chronic oral opioids on hypothalamus-pituitary-gonadal axis in women, and on bone mineral density (BMD) in men and women is not known. The objective of this cross-sectional study was to determine the effect of long-term oral opioids on gonadal status and BMD in male and female patients with chronic non-cancer pain (CNCP). We included 26 community-dwelling CNCP patients, 12 men and 14 premenopausal women, treated with oral opioids for at least one year. We obtained Visual Analogue Scale for pain score, BMD and plasma LH and FSH in all patients; menstrual history and estradiol in women; free androgen index and total and free testosterone in men. Men were older then women (p<0.05) and had used opioids for a longer period (7.2+/-3.8 and 4.1+/-1.8 years, respectively; p<0.05), but there was no difference in opioid dose or pain score between sexes. The prevalence of hypogonadism was high in men (75%), while only 21% of the women reported oligo- or amenorrhea indicating hypogonadism (P<0.01, between sexes). Osteopenia was found in 50% of men and 21% of women (p=NS). We conclude that in CNCP patients receiving chronic opioid therapy there is a much higher prevalence of hypogonadism in men then in women. This needs to be considered clinical practice.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Recruitment flow chart. Specific reasons for exclusion are given in the text.
Fig. 2
Fig. 2
Total testosterone levels in men (circles; left panel) and estradiol levels in women (triangles; right panel). For men, the dashed lines indicate the lower end of the reference range for men aged 20–49 years, while the lower end of the reference range for men over 49 years of age is 6.1 nmol/L. For women, the dashed line represents the lower limit of normal estradiol throughout the menstrual cycle.
Fig. 3
Fig. 3
Sex-specific results of bone mineral density measurements in lumbar spine (left panel) and proximal femur (right panel). Men are represented by circles, women by triangles. The dashed lines represent the T-scores below which there is osteopenia/osteoporosis.
See this image and copyright information in PMC

References

    1. Abs R, Verhelst J, Maeyaert J, Buyten JP, Van Opsomer F, Adriaensen H, Verlooy J, Havenbergh T, Van Smet M, Van Acker K. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000;85:2215–2222. - PubMed
    1. Adams ML, Sewing B, Forman JB, Meyer ER, Cicero TJ. Opioid-induced suppression of rat testicular function. J Pharmacol Exp Ther. 1993;266:323–328. - PubMed
    1. Azizi F, Vagenakis AG, Longcope C, Ingbar SH, Braverman LE. Decreased serum testosterone concentration in male heroin and methadone addicts. Steroids. 1973;22:467–472. - PubMed
    1. Bliesener N, Albrecht S, Schwager A, Weckbecker K, Lichtermann D, Klingmuller D. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005;90:203–206. - PubMed
    1. Block RI, Farinpour R, Schlechte JA. Effects of chronic marijuana use on testosterone, luteinizing hormone, follicle stimulating hormone, prolactin and cortisol in men and women. Drug Alcohol Depend. 1991;28:121–128. - PubMed

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