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Old 04-13-2009, 11:26 AM   #1 (permalink)
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Opiates and Testosterone?

I was going to post this on the new forum, since it has to do w/MMT - but I think it may be more generally drawn to the topic of opiates and substance abuse. My fiancÚ has had a pretty much life long struggle with anxiety and depression -significantly worsening in his teens and peaking in early adulthood. He has gone through probably every single a/d and anti-anxiety med under the moon, and is currently taking Effexor w/consistently positive results. In the past, other a/ds have worked and after time sputtered out on him. He’s also had great success w/benzos, but his addictionologist is very reluctant to rx these now, due to his addictive tendencies (though he has never abused them - opiates were his DOC.) He also struggles with debilitating degenerative disk disease and it gets awful at times.

He's done the opiate merry go round, used and abused them all, and finally decided he wanted off for good. He tried long-acting morphine, an oxycontin regime, suboxone, finally settling on MMT - which has worked great until recently. His depression and anxiety has come out with a vengence. For almost months now he’s been completely out of sorts - no energy, lethargic, no desire to do anything but sleep (which he cannot do peacefully), low libido, emotional, afraid - all of it. He’s had past dx of bi-polar and GAD, but I’ve never seen him like this. It was kind of a fluke, but one doctor (after about 20 telling him this is all in his head) did a blood test which found extremely depleted testosterone levels - I’m not sure the unit of measure - but I believe for a man the average is something like 400-500, and even for a woman it’s 20 -100...his level was 14!!!!!!!!!!!!!

So they’ve given him this testosterone gel which he is to use daily - it absorbs through the skin. Dr says this could def be due to long-term use of opiates, especially methadone, and accounts for many if not all of his symptoms. He’s had the gel for 2 days now and felt an instant surge of ‘himself’ only side effects were a little agitation and anxiety and feeling 'weird.' I’m happy we’ve finally got some answers - but it almost seems too good to be true - this is the answer we’ve been searching for, for like 3 yrs??? I’ve done soooo much research on opiates and opiate addiction treatment for both of us....I've never came across this! I wonder if he should go to a specialist? He seems to think he’ll be fine now. Has anyone else heard of this, or been through it???
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Old 04-13-2009, 11:54 AM   #2 (permalink)
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I haven't heard of this scenario specifically, but would be completely unsurprised if opioid abuse didn't result in low testosterone levels, nor would I be surprised to find out that low levels of it could cause the sorts of side-effects you're talking about.

Also, has your fiance had his thyroid checked? I know it's REAL common for opioids to screw up the levels of whatever hormones the thyroid usually puts out, and this has similar effects to what you're talking about... or ... maybe testosterone is one of them, and we're really talking about the same thing ...
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Old 04-13-2009, 12:14 PM   #3 (permalink)
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I would not be surprised either, I had some of those symptoms and my libido was low when I was on opiates. I will say that after nearly 6 months things are seemingly getting back to normal. Unfortunately I never had this tested..
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Old 04-13-2009, 08:05 PM   #4 (permalink)
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No doubt opiates lead to reduced libido, but the link between testosterone and libido is not as clear-cut as one may think. The naive layman's interpretation is that testosterone is what makes men "manly" (while estrogen is what makes the females so feminine) ... but like most things in medicine, the truth is nowhere nearly that simple and tidy. Both men and women have both testosterone and estrogen in their systems, although they play different roles. I can't really explain it any better because I don't understand it myself, but I'll say that if there is some sort of link between opiates and testosterone I wouldn't be surprised in the least.
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Old 04-14-2009, 09:18 AM   #5 (permalink)
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My RAH has always suffered with low testosterone also. Was on the patch and gels for a long time. Nobody has ever correlated the two, but it makes sense though.
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Old 04-14-2009, 04:25 PM   #6 (permalink)
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Well I've been taking oxycontin daily for years and my testosterone levels are above average. It all depends on your body chemistry I guess.
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Old 06-01-2009, 05:23 AM   #7 (permalink)
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Yep chronic opiate use lowers testosterone level.

Int J Androl. 2009 Apr;32(2):131-9. Epub 2007 Oct 30.Click here to read Links
Hypogonadism in men receiving methadone and buprenorphine maintenance treatment.
Hallinan R, Byrne A, Agho K, McMahon CG, Tynan P, Attia J.

The Byrne Surgery, Redfern, NSW, Australia. [email protected]

The aim of this study was to determine the prevalence and investigate the aetiology of hypogonadism in men on methadone or buprenorphine maintenance treatment (MMT, BMT). 103 men (mean age 37.6 +/- 7.9) on MMT (n = 84) or BMT (n = 19) were evaluated using hormone assays, body mass index (BMI), serological, biochemical, demographic and substance use measures. Overall 54% of men (methadone 65%; buprenorphine 28%) had total testosterone (TT) <12.0 nm; 34% (methadone 39%; buprenorphine 11%) had TT <8.0 nm. Both methadone- and buprenorphine-treated men had lower free testosterone, luteinising hormone and estradiol than age-matched reference groups. Methadone-treated men had lower TT than buprenorphine-treated men and reference groups. Prolactin did not differ between methadone, buprenorphine groups, and reference groups. Primary testicular failure was an uncommon cause of hypogonadism. Yearly percentage fall in TT by age across the patient group was 2.3%, more than twice that expected normally. There were no associations between TT and opioid dose, cannabis, alcohol and tobacco consumption, or chronic hepatitis C viraemia. On multiple regression higher TT was associated with higher alanine aminotransferase and lower TT with higher BMI. Men on MMT have high prevalence of hypogonadotrophic hypogonadism. The extent of hormonal changes associated with buprenorphine needs to be explored further in larger studies. Men receiving long term opioid replacement treatment, especially methadone treatment, should be screened for hypogonadism. Wide interindividual differences in methadone metabolism and tolerance may in a cross-sectional study obscure a methadone dose relationship to testosterone in individuals. Future studies of hypogonadism in opioid-treated men should examine the potential benefits of dose reduction, choice of opioid medication, weight loss, and androgen replacement.

J Pain. 2002 Oct;3(5):377-84.Click here to read Links
Hypogonadism in men consuming sustained-action oral opioids.
Daniell HW.

Department of Family Practice, University of California Davis Medical School, USA. [email protected]

Naturally occurring opiates (endorphins) diminish testosterone levels by inhibiting both hypothalamic gonadotrophin releasing hormone production and testicular testosterone synthesis. Heroin addicts treated with a single daily dose of methadone and nonaddicts receiving continuous intrathecal opioids quickly develop low luteinizing hormone and total testosterone levels. A similar pattern was sought in men consuming commonly prescribed oral opioids. Free testosterone (FT), total testosterone (TT), estradiol (E(2)), dihydrotestosterone (DHT), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured in 54 community-dwelling outpatient men consuming oral sustained-action dosage forms of opioids several times daily for control of nonmalignant pain. Hormone levels were related to the opioid consumed, dosage and dosage form, nonopioid medication use, and several personal characteristics and were compared with the hormone analyses of 27 similar men consuming no opioids. Hormone levels averaged much lower in opioid users than in control subjects in a dose-related pattern (P < .0001 for all comparisons). FT, TT, and E(2) levels were subnormal in 56%, 74%, and 74%, respectively, of opioid consumers. Forty-eight men (89%) exhibited subnormal levels of either FT or E(2). Either TT or E(2) level was subnormal in all 28 men consuming the equivalent of 100 mg of methadone daily and in 19 of 26 (73%) consuming smaller opioid doses. Eighty-seven percent (39 of 45) of opioid-ingesting men who reported normal erectile function before opioid use reported severe erectile dysfunction or diminished libido after beginning their opioid therapy. Commonly prescribed opioids in sustained-action dosage forms usually produce subnormal sex hormone levels, which may contribute to a diminished quality of life for many patients with painful chronic illness.

Endocr Pract. 1996 Jan-Feb;2(1):4-7.Click here to read Links
Hypogonadism and methadone: Hypothalamic hypogonadism after long-term use of high-dose methadone.
de la Rosa RE, Hennessey JV.

Brown University School of Medicine and Division of Endocrinology, Rhode Island Hospital, Providence, Rhode Island 02903, USA.

OBJECTIVE: To assess the relationship between hypogonadism and long-term administration of high-dose methadone. METHODS: We present a case of a 47-year-old man with a history of heroin use and treatment with high doses of methadone (130 mg/day), who complained of gynecomastia and impotence. Baseline levels of serum luteinizing hormone (LH), serum follicle-stimulating hormone (FSH), plasma testosterone, and prolactin were determined, and then the response of gonadotropin levels to stimulation with gonadotropin-releasing hormone (GnRH) was examined at 30, 60, 90, 120, and 180 minutes. RESULTS: Basal values of testosterone, LH, and FSH were below normal levels, whereas prolactin was normal. After administration of GnRH, the patient had a suboptimal increase in LH levels and lack of a response of FSH. When the daily dose of methadone was decreased to 40 mg, the patient's libido returned, and LH, FSH, and testosterone levels increased. CONCLUSION: These findings could indicate the presence of (1) a direct effect of methadone on the hypothalamus that leads to an alteration in normal gonadotropin pulse patterns, or (2) a selective effect of methadone on the anterior pituitary that alters its response to GnRH, with either mechanism leading to a reversible, dose-related depression of testosterone levels.
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Old 06-01-2009, 07:54 AM   #8 (permalink)
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Interesting article - thanks Holku =)
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Old 06-01-2009, 01:04 PM   #9 (permalink)
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Ive only read the origonal post, not all the replies.
I hear what you are saying. However, someone with the level of mental health issues your boyfriend has (just going on what you have described) may need more that testosterone to "fix" him. Sometimes its all in our heads and if we change our way of thinking it can change that too. I was on antidepressants for YEARS looking for some magic drug to fix me. Never happened other than temporarily. Then I started to refuse to except that "Im just a depressed anxious person" and after a while of really working on it, I wasnt. I refused to allow those thoughts into my head and although I have some mild emotional issues, they are not to the level they once were.
I hope the testosterone helps him though. Good luck
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Old 06-01-2009, 01:25 PM   #10 (permalink)
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I quit opiates and a cat couldn't scratch it.
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Old 06-01-2009, 04:25 PM   #11 (permalink)
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hehe thanks for sharing Windy!!

Me personally, it took staying quit for some months for the tingly feelings to come back! Another blessing of recovery!

Love,
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