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.
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.