title: Opioid analgesics suppress male gonadal function but opioid use in males and females does not correlate with symptoms of sexual dysfunction.
abstract: BACKGROUND
  Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.
  
  
  OBJECTIVE
  To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.
  
  
  METHODS
  A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone- binding globulin, progesterone, luteinizing hormone and follicle- stimulating hormone, and estradiol) were obtained.
  
  
  RESULTS
  In men, a low FT level was more common in opioid users (20⁄26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32⁄47) and controls (13⁄18; P=0.75), and also did not relate to any hormone abnormality.
  
  
  CONCLUSIONS
  Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.
  
  
  CONCLUSIONS
  Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Dana
authors: D
authors: Wong
authors: Dan P
authors: DP
authors: Gray
authors: Mark
authors: M
authors: Simmonds
authors: Saifee
authors: S
authors: Rashiq
authors: Igor
authors: I
authors: Sobolev
authors: Donald W
authors: DW
authors: Morrish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D042341:Gonadal Hormones / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000503:physiopathology; D010907:Pituitary Hormones / Q000378:metabolism; D011388:Prolactin; D011446:Prospective Studies; D012737:Sex Factors; D020018:Sexual Dysfunctions, Psychological / Q000503:physiopathology*; D013223:Statistics as Topic
chemical_list: D000701:Analgesics, Opioid; D042341:Gonadal Hormones; D010907:Pituitary Hormones; D011388:Prolactin