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Review
. 2018 Dec;41(12):1377-1388.
doi: 10.1007/s40618-018-0964-3. Epub 2018 Oct 20.

Testosterone deficiency in non-cancer opioid-treated patients

F Coluzzi  1 , D Billeci  2 , M Maggi  3 , G Corona  4
Affiliations
Review

Testosterone deficiency in non-cancer opioid-treated patients

F Coluzzi et al. J Endocrinol Invest. 2018 Dec.

Abstract

Purpose: The use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD.

Methods: A database search was performed in Medline, Embase and Cochrane using terms such as "analgesics", "opioids" and "testosterone". Relevant literature from January 1969 to March 2018 was evaluated.

Results: The prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment.

Conclusions: OPIAD is a common adverse effect of opioid treatment and contributes to sexual dysfunction, impairs pain relief and reduces overall quality of life. The evaluation of serum testosterone levels should be considered in male chronic opioid users and the decision to initiate testosterone treatment should be based on the clinical profile of individuals, in consultation with the patient.

Keywords: Chronic non-cancer pain; Opioid-induced androgen deficiency; Opioids; Testosterone.

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Conflict of interest statement

Conflict of interest

FC and DB served as consultants and speakers for Grunenthal. GC served as speaker for Bayer and MM served as consultant and speaker for Bayer and Kyowa Kirin.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Figures

Fig. 1
Fig. 1
Summary of mechanisms involved in the pathogenesis of opioid-induced androgen deficiency. GnRH gonadotropin-releasing hormone, FSH follicular-stimulating hormone, LH luteinizing hormone, DHT dihydrotestosterone
See this image and copyright information in PMC

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