Opioid (pain) medication, including morphine sulfate and oxycodone, commonly used for patients with chronic pain or abused by those with addiction, carries many risks and side effects. In addition to the most devastating complication of overdose, pain medication side effects include nausea, itching, constipation, depression, and endocrine abnormalities such as low testosterone in both males and females. The focus here is on males, but females are also affected and remain understudied in terms of endocrine problems stemming from pain medication overuse.
The issue of pain medications affecting the hormones produced by the brain are often not recognized, and are not well studied in pediatric, adolescent, or adult popluations. A patient with narcotic medication addiction or those taking pain medication for chronic pain may have many symptoms which overlap with symptoms of low testosterone. Opioids are among the most frequently prescribed analgesic drugs but may lead to low testosterone in 20 to 80% of men with decreased attention span, decreased sex drive (libido), fatigue, depressive state, erratic mood. In addition,muscle loss, bone loss (osteoporosis), low blood count (anemia), erectile dysfunction, delayed ejaculation (semen emission) may occur. In addition, the risk of cardiovascular disease and diabetes mellitus (increased blood sugar which has many negative effects on the body) are increased. Chronic opioid use may also adversely affect sperm function (very few studies have addressed this).
The treatment of patients with low testosterone (due to pain medication) is the same as for those with low testosterone of other causes and is managed by a urologist. Testosterone replacement therapy (TRT) in multiple preparations may have beneficial effects on serum testosterone and qualtity of life. An alternative to topical or injected testosterone would be the use of human chorionic gonadotropin (hCG injection) or clomiphene citrate (oral pill) which act through a different mechanism to “turn on” the body’s natural testosterone production.
Matthew Wosnitzer, M.D.
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