Opioid therapy is one of the most effective forms of analgesia currently in use. In the
past few decades, the use of opioids as a long-term treatment for chronic pain has
increased dramatically. Accompanying this upsurge in the use of long-term opioid
therapy has been an increase in the occurrence of opioid associated endocrinopathy,
most commonly manifested as an androgen deficiency and therefore referred to as
opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the
presence of inappropriately low levels of gonadotropins (follicle stimulating hormone
and luteinizing hormone) leading to inadequate production of sex hormones, particularly
testosterone. Symptoms that may manifest in patients with OPIAD include reduced
libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may
include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and
osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer
from infertility. While the literature regarding OPIAD remains limited, it is apparent that
OPIAD is becoming increasingly prevalent among chronic opioid consumers but often
goes unrecognized. OPIAD can have a significant negative impact on the the quality
of life of opioid users, and clinicians should anticipate the potential for its occurrence
whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for
OPIAD may be offered utilizing a number of androgen replacement therapy options
including a variety of testosterone preparations and, for female patients with OPIAD,
dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients
receiving androgen replacement therapy should include a review of any unresolved
symptoms of hypogonadism, laboratory evaluation, and surveillance for potential
adverse effects of androgen replacement therapy including prostate disease in males.
Key words: Opioid, hypogonadism, testosterone, endocrine, androgen