title: Testosterone suppression in opioid users: a systematic review and meta-analysis.
abstract: BACKGROUND
  Whether used for pain management or recreation, opioids have a number of adverse effects including hormonal imbalances. These imbalances have been reported to primarily involve testosterone and affect both males and females to the point of interfering with successful treatment and recovery. We conducted a systematic review and meta-analysis to determine the extent that opioids affect testosterone levels in both men and women, which may be relevant to improved treatment outcomes for opioid dependence and for pain management.
  
  
  METHODS
  We searched PubMed, EMBASE, PsycINFO, and CINAHL for relevant articles and included studies that examined testosterone levels in men and women while on opioids. Data collection was completed in duplicate.
  
  
  RESULTS
  Seventeen studies with 2769 participants (800 opioid users and 1969 controls) fulfilled the review inclusion criteria; 10 studies were cross-sectional and seven were cohort studies. Results showed a significant difference in mean testosterone level in men with opioid use compared to controls (MD=-164.78; 95% CI: -245.47, -84.08; p<0.0001). Methadone did not affect testosterone differently than other opioids. Testosterone levels in women were not affected by opioids. Generalizability of results was limited due to high heterogeneity among studies and overall low quality of evidence.
  
  
  CONCLUSIONS
  Our findings demonstrated that testosterone level is suppressed in men with regular opioid use regardless of opioid type. We found that opioids affect testosterone levels differently in men than women. This suggests that opioids, including methadone, may have different endocrine disruption mechanisms in men and women, which should be considered when treating opioid dependence.
authors.affiliation: MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Bawor
authors.affiliation: Undergraduate BHSc Program, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Herman
authors.initials: H
authors.lastname: Bami
authors.affiliation: Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Health Research Methodology Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Brittany B
authors.initials: BB
authors.lastname: Dennis
authors.affiliation: Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Plater
authors.affiliation: Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Varenbut
authors.affiliation: Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Daiter
authors.affiliation: Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Marsh
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada; Department of Obstetrics and Gynecology, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Meir
authors.initials: M
authors.lastname: Steiner
authors.affiliation: Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anglin
authors.affiliation: Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Coote
authors.affiliation: Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Pare
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Biostatistics Unit, Centre for Evaluation of Medicine, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada. Electronic address: samaanz@mcmaster.ca.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samaan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects; D009294:Narcotics / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000378:metabolism*; D012727:Sex Characteristics; D013739:Testosterone / Q000037:antagonists & inhibitors*
chemical_list: D009294:Narcotics; D013739:Testosterone; D008691:Methadone
keywords: Methadone; Opiates; Prescription opioids; Sex hormones; Testosterone