Testosterone Where Did It Go!

[Guest guest]

Dr. Grim, do you think being on Oxycodone and Methodone for 5+ years could have

any effect on my adverse reaction to Spironolactone? What about street drugs

which I don't use? Maybe at the minimum there should be a drug test so you know

what may be ahead! Maybe Inspra would be a better choice!

Health Information, Tips, Community and More at HealthCentral.com

http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/

ChronicPainConnection.com

See all of our health sites at www.HealthCentral.com

Chronic Pain Home >

General >

Treatment >

Alternative Treatment >

Chronic Pain Medication Lead to Sexual Dysfunction, Other Problems for Men

Testosterone Replacement Therapy for Men in Pain

by Lasich, MD

Monday, June 14, 2010

How many men would take pain pills if they knew that the pills might shrink

their testicles? Besides testicular size, pain pills can wreck havoc on a man's

ability to have sex, make babies, build muscles, and enjoy life. All of these

side effects to opioid medications are caused by the fact that chronic opioid

use lowers testosterone levels. This fact is not widely known, yet widely

experienced. " Opioid-induced androgen deficiency " affects thousands of men. In a

complex process that involves some very important hormones, both men and women

can experience symptoms of low testosterone.

The most common symptoms from abnormally low testosterone levels - hypogonadism

- are:

Fatigue

Depression

Low libido

Erectile dysfunction

Sexual dysfunction

Osteoporosis

Low muscle mass

Infertility

Hot flashes

Night sweats

Testicular atrophy

If any of this sounds familiar, a doctor can order a simple blood test (the

Total Testosterone Level) to check your testosterone level. This test is best

done early in the morning to get the most accurate reading. Checking baseline

hormonal levels, including the testosterone level, before and after initiating

opioid treatment is recommended by some experts. Additionally, when consenting

for opioid treatment, the patient should also be informed about the potential

for opioids to drastically lower testosterone levels.

If this discussion took place, many men might elect to avoid opioids. If men

knew that upwards of 80% of those who begin taking opioids will experience

erectile dysfunction from low testosterone levels, they might want to seek

alternative pain relieving options. Those who do agree to opioid pain management

despite the risks should know about testosterone-replacement therapy.

Testosterone-replacement therapy is utilized to treat opioid-induced

testosterone insufficiency. Prior to initiating testosterone treatment men need

to have the prostate specific antigen level (PSA) test because testosterone can

worsen prostate conditions like cancer and hypertrophy. Additionally, other

conditions could also worsen like heart failure and sleep apnea. So, not every

man is a candidate for testosterone replacement. Those who are candidates have a

few different modes of replacement like injections, patches, gels and

bio-identicals hormones. One study showed that the testosterone patch delivering

7.5 mg per day was effective at normalizing testosterone levels and relieving

symptoms of hypogonadism. In fact, that same study showed that pain intensity

actually improved as the testosterone levels normalized.

Testosterone-replacement therapy is probably the most underutilized, yet most

often needed adjunct therapy for someone who is a long-term opioid user.

Everyone, both men and women need to be more aware of the long-term effects that

opioids have on the human body. Testosterone and all the hormones related to the

hypothalamic-pituitary axis (thyroid, adrenaline, and sex hormones) have the

potential for becoming abnormally low. At some point, these hormonal imbalances

have the potential to affect quality of life more than the pain itself. At that

point, the risks of long-term opioid use needs to be re-evaluated because the

risks might outweigh the benefits. At some point, opioid pain management might

not be worth the price.

We comply with the HONcode standard for

trustworthy health information: verify here.

About Us |

Contact Us |

Privacy Policy |

Terms of Use |

Security Policy

By using this service, you accept our Terms of Use. Please read them. The

consumer health information on is for informational purposes only and is not a

substitute for medical advice or treatment for any medical conditions. You

should promptly seek professional medical care if you have any concern about

your health, and you should always consult your physician before starting a

fitness regimen. Copyright © 2012 Remedy Health Media, LLC. .

Current Opinion in Endocrinology & Diabetes:

June 2006 - Volume 13 - Issue 3 - p 262-266

doi: 10.1097/01.med.0000224806.08824.dc

Androgens

Opioid-induced androgen deficiency

l, Harry W

& #65532;

Abstract

Purpose of review: Opioid-induced androgen deficiency has become one of the most

common causes of testosterone deficiency among men in many communities. Its

increase parallels the large increase in opioid use. This form of

hypogonadotrophic hypogonadism is present in most men chronically consuming

sustained-action opioids, including those receiving methadone for heroin

addiction and those consuming opioids for control of either malignant or

non-malignant chronic pain. A similar, but less well defined illness occurs in

women. Opioid-induced androgen deficiency is not widely recognized. This review

examines its pathophysiology, some of its signs and symptoms, and indicates some

areas where current observations suggest additional investigations would be

fruitful.

Recent findings: Recognition of opioid-induced androgen deficiency in men not

receiving methadone for heroin addiction is a new observation, and in these men

contributes to fatigue, depression, vasomotor phenomena, anemia, diminished

libido, erectile dysfunction and osteoporosis. These signs and symptoms improved

during testosterone replacement therapy in several small non-placebo-controlled

trials.

Summary: A large majority of men consuming sustained-action opioids have

symptomatic androgen deficiency which apparently responds to replacement

therapy. Opioid-induced androgen deficiency is frequently overlooked, with its

symptoms attributed to underlying disease states including malignant disease,

chronic back disorders, HIV disease, and psychosocial illnesses contributing to

opioid habituation.

© 2006 Lippincott & Wilkins, Inc.

- 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with

previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59

BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.