Men who take long-acting opioids for chronic pain appear to be at greater risk of developing low testosterone than men taking short-acting opioids, American researchers have found.
Opioids are pain relievers. Commonly prescribed opioids include hydrocodone, oxycodone, morphine, and codeine.
Opioids are classified as long-acting or short-acting. Long-acting opioids generally provide relief for at least 8 hours. Short-acting opioids release medicine more quickly and relieve pain for less than six hours.
Impact of Opioids on Testestosterone Levels
The retrospective study focused on 81 men between the ages of 26 and 79 who had been taking an opioid for at least three months. None of the men had been diagnosed with low testosterone before. All of the men were being treated for chronic pain conditions (such as low back pain, chronic headaches, and rheumatoid arthritis) at Kaiser Permanente’s Santa Rosa Medical Center in California.
The hormone testosterone plays a large role in a man’s sex drive. But it is also involved with muscle mass, bone density, and mood. Low testosterone can lead to problems in all of these areas.
Normal testosterone levels are typically between 300 and 800 nanograms per deciliter (ng/dL). For this study, men were considered to have hypogonadism (low testosterone) if their total testosterone levels were less than or equal to 250 ng/dL. All levels were measured before 10 a.m.
Overall, 56.8% of the men were hypogonadal. Rates varied depending on opioid length of action, however. Of the men taking long-acting opioids, 74% had low testosterone. Thirty-four percent of the men taking short-acting opioids were hypogonadal.
After adjusting for daily dosage and body mass index, the researchers found that the risk of developing low testosterone was 4.78 times greater for men taking long-term opioids compared to those who take the short-acting variety.
No association was found between dose and an increased risk of low testosterone.
“We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks,” said researcher Dr. Andrea Rubinstein in a press release. Dr. Rubinstein is from the Departments of Chronic Pain and Anesthesiology at Kaiser Permanente Santa Rosa Medical Center.
“These medications work well for short-term, acute pain,” Dr. Rubinstein added. “It has long been extrapolated that they can also be used safely long-term to control chronic pain. We are now finding that the long-term use of opioids may have important unintended health consequences.”
The study was published online ahead of print in January in The Clinical Journal of Pain.
The Clinical Journal of Pain
Rubinstein, Andrea L., MD, et al.
“Hypogonadism in Men With Chronic Pain Linked to the Use of Long-acting Rather Than Short-acting Opioids”
(Full text. Published ahead of print: January 24, 2013)
(Note: Full-text was accessed at the Baystate Health Sciences Library; Baystate Medical Center; Springfield, Massachusetts on April 18, 2013)
”Kaiser Permanente Study Finds Men Taking Long-Acting Chronic Pain Medications Five Times More Likely to Have Low Testosterone Levels”
(Press release. January 31, 2013)
National Institute on Drug Abuse
“What are opioids?”