title: Hypogonadism in men with chronic pain linked to the use of long-acting rather than short-acting opioids.
abstract: OBJECTIVE
  There is a need to elucidate the variables associated with testosterone suppression among men on daily opioid therapy for chronic pain.
  
  
  OBJECTIVE
  The objective of this study was to examine several variables related to opioid use including daily dose, duration of action (long acting vs. short acting), and specific opioid to ascertain specific influences on total serum testosterone levels in men with chronic pain who use opioids daily.
  
  
  METHODS
  This is a retrospective cohort study of men within the Kaiser Permanente, Northern California (KPNC) health care system on some form of daily opioid use for chronic pain.
  
  
  METHODS
  Eighty-one men between the age of 26 and 79 years were seen in a chronic pain clinic between January 2009 and June 2010. All men were on stable dose of an opioid for at least 3 months, none with a previous diagnosis of hypogonadism.
  
  
  METHODS
  Total serum AM testosterone levels were measured at KPNC Regional Laboratory.
  
  
  RESULTS
  Average total serum AM testosterone levels for this population showed 53% of all men receiving daily opioids were hypogonadal (AM total serum testosterone <250 ng/dL). In men receiving long-acting opioids, 74% (34/46) were hypogonadal compared with 34% (12/35) in men using short-acting opioids (hydrocodone or oxycodone) exclusively [AM total testosterone: median, 126 ng/dL; mean, 169 ng/dL (SD, 128 ng/dL) vs. median, 283 ng/dL; mean, 315 ng/dL (SD, 142 ng/dL); P<0.001]. After controlling for daily dosage and body mass index, men on long-acting opioids had 4.78 times greater odds of becoming hypogonadal than did men on short-acting opioids [95% confidence interval (CI), 1.51-15.07; P=0.008]. Body mass index was also significantly associated with hypogonadism (odds ratio, 1.13; 95% CI, 1.03-1.24; P=0.006), whereas daily dose was not (odds ratio, 1.02; 95% CI, 0.99-1.05; P=0.29).
  
  
  CONCLUSIONS
  Among a contemporary sample of men receiving chronic daily opioids, we found a high prevalence of hypogonadism associated with duration of action, but not with total daily dose of the opioid.
authors.affiliation: Departments of *Chronic Pain ‡Endocrinology, Kaiser Permanente, Santa Rosa †Division of Research, Kaiser Permanente, Oakland, CA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Rubinstein
authors.forename: Diane M
authors.initials: DM
authors.lastname: Carpenter
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Minkoff
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects* / Q000145:classification; D059846:Analgesics, Short-Acting / Q000008:administration & dosage / Q000009:adverse effects; D059350:Chronic Pain / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D012189:Retrospective Studies; D018570:Risk Assessment; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D059846:Analgesics, Short-Acting; D013739:Testosterone