Opioid-induced androgen deficiency in men: Prevalence, pathophysiology, and efficacy of testosterone therapy.

The prevalence of opioid-induced androgen deficiency in men varies widely between 20% and 80%.

• Prevalence is influenced by the type of opioid used, duration of exposure, age of the cohort, and how low testosterone was defined.
• Despite its high prevalence, this adverse effect of chronic opioid use remains underappreciated by clinicians.
• As a result, androgen deficiency remains underdiagnosed and likely undertreated.
• Literature reviewed spanned from 1950 through June 2024.

Opioids suppress the gonadal axis primarily by inhibiting GnRH synthesis and secretion.

• The mechanism is described as inhibition of gonadotropin-releasing hormone (GnRH) synthesis and secretion.
• This represents a central (hypothalamic) mechanism of androgen suppression.
• The resulting condition is classified as opioid-induced androgen deficiency.

Testosterone therapy in men with opioid-induced androgen deficiency improves libido, body composition, and certain domains of quality of life.

• These findings are based on 'limited data from clinical trials.'
• The review characterizes the available clinical trial evidence as limited.
• Testosterone therapy could be considered in men with 'unequivocal androgen deficiency after a thorough clinical evaluation.'

Early evidence suggests that testosterone has anti-nociceptive properties in men with opioid-induced androgen deficiency.

• This finding is described as 'early evidence' from clinical studies.
• The anti-nociceptive properties of testosterone confirm findings from preclinical and population studies.
• Ongoing clinical trials are expected to shed further light on the efficacy of testosterone therapy, particularly regarding its anti-nociceptive effects.
• Anti-nociceptive effects of testosterone were identified as a particular focus of the review.

There is a recognized need to raise awareness among clinicians regarding opioid-induced androgen deficiency as an adverse effect of opioid use.

• Opioid analgesics are frequently prescribed for the treatment of chronic pain.
• The adverse effect of androgen deficiency 'remains underappreciated by clinicians.'
• The condition is described as 'a common but underappreciated cause of androgen deficiency in men.'
• Key search terms used were 'opioids,' 'hypogonadism,' 'low testosterone,' and 'testosterone therapy,' with sources from PubMed and references within retrieved publications.