Opiates effects on your body can be both positive and negative. Opiates include drugs of abuse such as heroin but also prescription pain medications such as oxycodone.
While reducing pain these drugs can also be addictive and have a significant effect on your quality of life – opiates can lower your testosterone levels.
If you’re addicted to heroin, methadone, or prescription opiates having low testosterone levels may even make it more difficult to stop using these drugs. Some research has shown that recovering from opiate addiction is more difficult if you have low testosterone.
Whether used for pain management or recreation, opioids have a number of adverse effects including hormonal imbalances. These imbalances have been reported to primarily involve testosterone and affect both males and females to the point of interfering with successful treatment and recovery.[fn id=”1″]
Opiates are one of the most common drugs used to treat pain and their use has risen greatly over the past years. Many taking opiate pain medications or abusing heroin have low testosterone and this may go untreated and rarely even discussed with patients.
Opioid associated androgen deficeincy (OPIAD) is low testosterone caused by use of opiates and can have a serious impact on your quality of life.
Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone.[fn id=”2″]
Symptoms of low testosterone in men using opiates can include:
- Reduced sex drive (libido)
- Erectile Dysfunction
- Fatigue or Low Energy
- Hot Flashes
- Depression or Low Mood
Men experiencing low testosterone from opiate use may also experience the following opiate effects:
- Reduced Facial or Body Hair
- Anemia or Low Red Blood Cell Count
- Decreased Muscle Mass or Muscle Loss
- Weight Gain or Increased Body Fat
- Bone Loss or Reduced Bone Density
Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken.
Some doctors urge that patients being treated with opiate medications for long-term should all be evaluated for low testosterone as testosterone is not only important for quality of life but also better pain control.
Testosterone deficiency in chronic pain patients has now been recognized by many observers. Due to its critical biologic functions in pain control, testosterone testing and replacement (TR) should now become a mandatory component in the treatment of chronic pain.[fn id=”3″]
Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males.[fn id=”2″]
Short-term use of opiates, such as taking oxycodone for a week or two after surgery, likely does not warrant testing your testosterone levels to check for hypogonadism (also known as “low t”).
Long-term use of opiates that is expected to last over just a few months does warrant a thorough check for low testosterone. If a man already has low testosterone it should be expected that his testosterone levels will be even lower when taking opiates.
Opioid-induced endocrinopathy, specifically hypogonadism, is a physiological side effect in which opiate use suppresses the sex hormones, among other substances.[fn id=”4″]
Put simply, opioids generally and acutely increase GH, TSH, and prolactin, and decrease LH, testosterone, estradiol, and oxytocin.1 Chronic opioid use, however, may not lead to this pattern.
Some doctors may be unwilling to even check your testosterone levels due to stigmas around testosterone therapy and personal bias that may not be fully grounded in medical science.
Over the years there has been conflicting research on the safety and benefits of testosterone replacement therapy with medications such as topical testosterone and testosterone injections.
Testosterone replacement suffers from old prejudices about its utility and safety. With this review we illustrate the available therapeutic choices able to maintain T concentration into physiological ranges and reduce nociception with a final goal of improving patients’ quality of life.[fn id=”5″]
Some studies have shown increased risks of heart attack and stroke from the use of testosterone therapy while others have no increased risk and possibly a decreased risk of heart attack and stroke.
One study that caused a lot of controversy was done at by doctors at the Veteran’s Administration here in my home state of Washington. This study showed increased risks of heart attack or stroke in patients on testosterone therapy but after a thorough review it was shown that many of these patients they counted as evidence of increased risk may not have even been on testosterone therapy since there were no follow ups with these patients after being put on testosterone therapy.
In this review we discuss the adverse effect of testosterone deficiency and highlight the numerous proven benefits of testosterone therapy on men’s health and debunk the myth that testosterone therapy increases cardiovascular risk. Ultimately, we believe that there is considerable scientific and clinical evidence to suggest that testosterone therapy is safe and effective with restoration of physiological levels in men with testosterone deficiency, irrespective of its etiology.[fn id=”6″]
There are certainly risks associated with testosterone therapy that should be considered and likely there are potential unknown side effects. This is generally the case with any medical treatment. If you are diagnosed with low testosterone and thinking about testosterone therapy it is importance to weight the pros and cons and consider the potential risks as well as benefits.
In my experience, some patients with low testosterone benefit greatly from testosterone therapy (TRT) while other may notice no benefits at all or even feel worse.
Benefits are clearly established for sexual function, increase in lean muscle mass and strength, mood and cognitive function, with possible reduction in frailty and osteoporosis. There remains no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia, yet the decision to initiate and continue therapy is often decided by urologists. The cardiovascular issues associated with TRT have been clarified by recent studies showing clearly that therapy associated with clear rise in testosterone levels are associated with reduced mortality.[fn id=”7″]
Some patients have come to our clinic frustrated that their doctors either refused to check their testosterone levels or checked them and then refused to provide any treatment. Some patients who receive treatment also complain that their doctor lacks experience to help them get the most benefits from testosterone therapy.
The most common issue I’ve noticed in patients being treated by other doctors is that they rarely have their estrogen levels checked. Testosterone converts to estrogen naturally in the body but sometimes we end up with too little or too much estrogen and most guys prefer to avoid growing breasts…
Studies reporting to show increased risk have been subject to flawed designs with inadequate baseline diagnosis and follow-up testing. Effectively they have compared non-treated patients with under-treated or on-compliant subjects involving a range of different therapy regimens.[fn id=”7″]
The multiple effects of TRT may add up to a considerable benefit to the patient that might be underestimated by the physician primarily concerned with his own specialty.