title: The relationship of salivary testosterone and male sexual dysfunction in opioid-associated androgen deficiency (OPIAD).
abstract: BACKGROUND
  Opioids are an effective treatment for chronic non-malignant pain (CNP). Long-term use risks and side effects such as opioid-induced androgen deficiency (OPIAD) exist. This could be measured by saliva testosterone (Sal-T).
  
  
  OBJECTIVE
  To evaluate OPIAD in long-term opioid use in CNP patients.
  
  
  METHODS
  A cross-sectional study included CNP male outpatients under opioid treatment. Total-Testosterone (Total-T), Free-Testosterone (Free-T), Bio-Testosterone (Bio-T) and Sal-T were measured. Correlations were calculated by Spearman's rho (SPSS 20).
  
  
  RESULTS
  From 2012 to 2014, 134 from 249 (54%) consecutive male outpatients reported erectile dysfunction (ED), 37% of them related to opioids and 19% evidenced OPIAD. A total of 120 subjects (94 cases and 26 matched-controls) were included. A significantly lower luteinizing hormone, Total-T and Free-T were found, as well as, a significant correlation between Sal-T and Total-T (r = 0.234, p = 0.039), Bio-T (r = 0.241, p = 0.039), IIEF (r = 0.363, p = 0.003) and HAD-anxiety (r = -0.414, p = 0.012) in OPIAD patients. Sal-T levels were significantly lower in patients with severe-moderate ED versus mild ED (p = 0.045) and in patients with severe ED versus moderate-mild ED (p = 0.036).
  
  
  CONCLUSIONS
  These data demonstrate the high prevalence of ED in long-term use of opioids, part of this is associated to OPIAD, which can be tested by Sal-T as a non-invasive approach.
authors.affiliation: a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Ajo
authors.affiliation: b Andrology Unit, University General Hospital of Alicante (HGUA) , Alicante , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Segura
authors.affiliation: c Occupational Observatory, University Miguel Hernández of Elche (UMH) , Alicante , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Mira
authors.affiliation: a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain.
authors.forename: María-Del-Mar
authors.initials: MD
authors.lastname: Inda
authors.affiliation: d Hormones Laboratory, HGUA , Alicante , Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Alfayate
authors.affiliation: e Computational Research Center, UMH , Alicante , Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez-Barbie
authors.affiliation: f Pain Unit, HGUA , Alicante , Spain , and.
authors.forename: César
authors.initials: C
authors.lastname: Margarit
authors.affiliation: a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain.|g Clinical Pharmacology, HGUA , Alicante , Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Peiró
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000728:Androgens / Q000172:deficiency*; D016022:Case-Control Studies; D059350:Chronic Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012463:Saliva / Q000737:chemistry*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000172:deficiency*
chemical_list: D000701:Analgesics, Opioid; D000728:Androgens; D013739:Testosterone
keywords: OPIAD; Salivary testosterone; chronic pain; erectile dysfunction; opioids; sexual dysfunction