Hypogonadism and Opioids
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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In a study of 189 men, 94 percent were black. The average age was 43 years, and there was a high prevalence of HCV and HIV.
Hypogonadism was found in 24 percent of the men. Men who used METHADONE or HEROIN had a greater risk of hypogonadism compared to those who did not use drugs.
Treatment of hypogonadism in opioid using males in an inner-city cohort
Hypogonadism is a condition where free testosterone levels are low. This condition is associated with methadone use and is common among males who use drugs such as heroin.
In this study, men in Baltimore were recruited as part of a larger study examining HIV, injection drug use, and nutrition. Researchers found that methadone users were more likely to develop hypogonadism compared to nonusers.
There are a variety of clinical problems that complicate diagnosis and treatment of hypogonadism in opioid users. For example, opioid use is often accompanied by diabetes and other comorbid conditions.
While it is not known whether opioid use causes hypogonadism, experts say that it is worth evaluating the condition. In the meantime, treatment for hypogonadism in opioid using men should be individualized.
One standard treatment for hypogonadism in males is testosterone replacement therapy. However, there are some potential side effects associated with testosterone replacement therapy, including gynecomastia, testicular atrophy, and erythrocytosis.
The drug may also suppress spermatogenesis, so it is not recommended for men who plan to have children soon.
Moreover, testosterone replacement therapy is contraindicated in men with prostate cancer, breast cancer, or severe cardiovascular disease.
The choice of treatment for hypogonadism is an individual decision that should be made based on an individual patient's clinical condition and other contraindications.
This treatment should be initiated only after the symptoms of hypogonadism have been confirmed and any contraindications have been excluded.
The most common symptom of hypogonadism is a general lack of energy. Other symptoms include reduced libido and erectile dysfunction.
Although this disorder is more common in the elderly population, testosterone replacement therapy may interfere with fertility.
Chronic opioid use is a known contributor to hypogonadism. It affects the hypothalamic-pituitary axis and the pituitary-adrenal axis, thereby impairing sperm production and testosterone levels.
This can have profound effects on the quality of life for patients. Additionally, opioid-induced androgen deficiency has been linked to an increased risk of osteoporosis and fractures.
Hypogonadism may also be caused by an organic cause. In some cases, the pituitary gland and hypothalamus do not produce enough of the hormone. In other cases, the problem may be due to excessive drug use.
Regardless of the cause, it is important to monitor the patient's BMD levels. This early detection may reduce fracture risk.
Treatment of hypogonadism in younger men
In order to accurately diagnose and treat young men with hypogonadism, clinicians must use a high index of suspicion.
The underlying cause of the condition should be identified and the treatment should be tailored to the individual patient and their reproductive goals.
Although the link between opioid use and hypogonadism in men is well established, the specific differences between methadone and heroin use have not been determined.
In the current study, the researchers recruited male drug users and non-users from Baltimore, matched for socioeconomic status.
Hypogonadism is a condition where T levels are below the reference range for a healthy young adult. It is most common in developing countries, but may shift to younger age in men with obesity, diabetes, and opioid use.
The most common symptom of hypogonadism is lack of energy. Other common symptoms are decreased libido and erectile dysfunction.
In addition, testosterone replacement therapy can interfere with fertility and spermatogenesis.
The use of testosterone replacement therapy is the standard of care for men with hypogonadism. It is available in different formulations and may produce a variety of side effects.
It may suppress spermatogenesis, so it is not recommended for men who plan to have children in the near future. It is also contra-indicated in patients with high risk for breast cancer, prostate cancer, or thrombophilia.
In the long-term, lifestyle changes are associated with improved sexual function.
In one study, men with obesity who underwent bariatric surgery showed improved erectile function, improved sexual desire, and greater satisfaction with sexual intercourse.
For these reasons, lifestyle changes are important for men with central hypogonadism.
The use of testosterone replacement therapy is generally reserved for men with a well-established diagnosis of hypogonadism.
The diagnosis of primary hypogonadism is usually easier than for secondary or central hypogonadism, which requires more extensive laboratory testing.
In some cases, a male's sperm count must be elevated to confirm a diagnosis of secondary or central hypogonadism.
Treatment of hypogonadism in older men
Treatment of hypogonadism in older opioid-using men is challenging. Many factors can contribute to this condition, including age, drug use, and obesity. Therefore, early diagnosis is critical.
Hypogonadism can affect male fertility, as well as men's quality of life. The first step is to assess the gonadal status.
This can be determined through a comprehensive patient history. If the condition is found, the treatment can begin.
Hypogonadism is a condition characterized by a low total testosterone (T) level. In men, this results in reduced libido and erectile dysfunction. Additionally, the symptoms of hypogonadism can cause impaired fertility and decreased spermatogenesis.
In a new study, researchers examined the associations between hypogonadism and different drug types.
They analyzed data from 189 men with a mean age of 43 years and 94 percent of them were black. In this cohort, 24 percent of the participants had hypogonadism.
Men who had used methadone, heroin, or a combination of both had higher odds of hypogonadism than those who had not taken any drugs.
This new study indicates that treatment of hypogonadism in this cohort may reduce the health consequences of the disorder.
In addition to sexual dysfunction, hypogonadism is also associated with higher rates of osteoporosis and abdominal adiposity, making it important to treat this condition in this population.
For the most appropriate treatment, testosterone replacement therapy should only be used for men with an established diagnosis of hypogonadism.
Primary hypogonadism can be easily established with concurrent elevations in LH and FSH levels. Patients with subclinical hypogonadism may require more thorough laboratory testing.
Further, patients with secondary or central hypogonadism may not respond to GNRH administration.
In addition, older men may experience mixed hypogonadism. This condition is caused by defects in the pituitary, hypothalamus, and testes.
It is often inherited, but can also occur due to a tumour or alcoholism.
In addition to the study of bone density, the researchers studied testosterone levels.
In 17 patients, the free testosterone levels indicated hypogonadism. Free testosterone levels were found to be associated with BMD and the prevalence of osteoporotic fractures in elderly men.
However, in young men, free testosterone is a positive predictor of cortical bone size.
Conclusion
Long-term use of opioids has been associated with an increased risk of hypogonadism in men.
However, the exact cause of this condition is not yet known. A recent study suggests a link between long-term opioid use and the condition.
Nonetheless, periodic evaluation of the gonadal and adrenal axes is advisable.
The current study sought to characterize the prevalence of male hypogonadism among chronic opioid users, and to determine the dose-response relationship between hypogonadism and opioid use.
The study used data from the Ochsner Health Epic EHR database and was approved by the Institutional Review Board. It collected demographic data, medication and diagnosis data.
The researchers found that the screening rate for hypogonadism was low among long-term opioid users.
The results showed that among these patients, serum testosterone levels were 5.8% in one year and 17.2% after five years. The reason for such a low screening rate is unclear.
One of the most widely-known consequences of male hypogonadism is osteoporosis. Studies have shown that up to 50% of men who receive opioids for CNCP are at risk for osteoporotic fractures.
Furthermore, patients over 60 years old are at two times the risk of osteoporotic fractures compared to patients not on opioids. It is believed that opioids cause osteoporosis by inhibiting osteoblastic activity.
