Opioids and the Hypothalamic-Pituitary-Gonadal (HPG) Axis

Area of Science:

• Endocrinology
• Pharmacology
• Men's Health

Background:

• Opioid use is a known cause of hypogonadism, impacting both men and women.
• Opioid-induced hypogonadism (OIH) prevalence varies, with some reviews reporting up to 69% incidence.
• Factors like opioid type, dose, and duration influence OIH development.

Purpose of the Study:

• To review the prevalence, consequences, and management of opioid-induced hypogonadism.
• To assess the current evidence for testosterone replacement therapy (TRT) in treating OIH.

Main Methods:

• Systematic literature search of PubMed for articles on opioids and hypogonadism until December 2019.
• Bibliography review of retrieved articles for additional relevant studies.

Main Results:

• OIH has significant consequences, including sexual dysfunction, depression, reduced quality of life, and low bone density.
• Evidence for TRT efficacy in OIH is limited and shows mixed results, with few randomized controlled trials, especially in women.
• TRT outcomes in men vary, with some studies showing benefits and others no clear advantage.

Conclusions:

• OIH is underrecognized and undertreated, despite its high prevalence and significant health impacts.
• Recommended management includes patient education, screening for hypogonadism symptoms, and hormone level assessment for prolonged opioid use (>3 months).
• Treatment with sex hormones should be considered for diagnosed OIH when clinically indicated, particularly for those on chronic opioid therapy (≥6 months).