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Opioids and Male Endocrine Function
Nathaniel Katz[9] discussed the impact of long-term therapy with opioids on male endocrine function. He noted that the feminizing effects of opioids on men have been known for centuries, and studies indicate that testosterone levels are reduced in heroin and methadone users. The symptoms of low testosterone include decreased libido, fatigue, depression/anxiety, loss of muscle mass/strength, osteoporosis, and alterations in the male role.
Dr. Katz reviewed data from his patients showing that in opiate users, total testosterone was half that of nonusers and free testosterone was one third that of nonusers. Older age was also a significant factor leading Dr. Katz to conclude that age-related declines in testosterone may be accelerated in opiate users. Because nearly all those taking opiates had hypogonadism, Dr. Katz recommended that patients should undergo routine endocrine screening. In addition, clinical practice guidelines should be developed for the management of opioid-induced hypogonadism.