Thursday, December 18, 2008

Opioids and Testosterone

Although I mainly practice sleep medicine, I have been treating patients with opioid dependence at Somnus Sleep Clinic for the last year. I prescribe suboxone. Several of my male patients have complained of decreased libido and erectile dysfunction. After checking a testosterone level and finding it to be low in several of these patients, I referred them to an endocrinologist for testosterone therapy.

Opioids can cause hypogonadism, probably by interfering with the hypothalamic-pituitary-luteinizing hormone (LH) axis.

Unfortunately, for most of these patients I checked testosterone levels after they had been taking suboxone for several months, so it wasn't clear if suboxone was causing the effect or if it was due to prior opioid abuse.

When I see male patients for their initial visit prior to initiating suboxone therapy, I think I am going to start ordering baseline testosterone levels if there are symptoms of hypogonadism present.


Anonymous said...

Hey, rebel doctor!

I will look through your blog and see who you are when I have more time-- but I wanted to make a comment to your post. I am a psychiatrist who works with Suboxone also-- I have a blog called Suboxone Talk Zone that I invite you to check out (

I have noticed the same thing-- I know that there are reports in the literature about all opiates reducing testosterone levels, and I have checked levels and found low-normal results in a couple patients on Suboxone. I should point out for readers that most of the tests came back completely normal; the abnormal ones were in about 2-4% of my Suboxone patients.

I use methyl-testosterone from a compounding pharmacy for replacement, and the patients claim to feel much better after being on it for awhile. The methyl group protects against conversion to estrogen and breast growth-- a valuable thing, since for some reason, the fascination men have for breasts only holds true if the breasts are on someone else!

Feel free to stay in touch, rebel doc, if there are other things you notice, and I will do the same.

SuboxDoc AKA Jeffrey T Junig MD PhD

Michael Rack, MD said...

Dr. Junig, thanks for sharing your experience with opioids and low testosterone levels. I skimmed your blog- looks pretty good. I have added it to my links and plan to check it out in more detail later.

Anonymous said...
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Anonymous said...

The Euphoric Violet Delight

Often, medications for severe pain are made from opoid plants. These purple-flowered plants produce opium poppies, which are used in the production of opium. Opium is what we in the U.S. call narcotics, and they dull and numb one who ingests what may be made by these opium poppies, as there are several drugs that have been developed from what these plants provide that are these prevalent narcotics.
Some medications are from natural opium, such as cocaine, or the opiates from the poppy seeds can be used to create semi-synthetic medications, such as Heroin. Heroin was marketed by Bayer Pharmaceuticals for 12 years by telling others that it was a non-addicting form of morphine (pure opiate drug), since there were many soldiers addicted to morphine after the civil war. During that same period of time, Bayer marketed heroin for children who coughed. Of course, Heroin is very addictive, and is no longer available.
While Poppy plants exist and are grown in areas of IndoChina, Afghanistan is the number one producer of poppy plants. The United States is the number one country that consumes what is derived from these plants. Opium-derived medicines once could be bought freely in the U.S. by anyone less than 100 years ago. Yet now, they are classified by the Drug Enforcement Agency as narcotics, and are scheduled by them, according to the danger they potentially could cause another who takes them.
While prescribed to patients for such issues aside from pain on occasion, such as chronic coughing and diarrhea, their greatest benefit is for the relief of pain experienced often by patients is the primary reason doctors prescribe opoid drugs, and they do so often. Vicodin, a mild narcotic, is the most frequently prescribed medication in the U.S. presently.
If patients take opium-derived drugs for long periods of time, tolerance may develop, and the patient may need to take more of the drug to acquire an effect of relief. In addition, the patient may develop a dependence on these types of drugs, which can lead to addiction and possible abuse. This is why overdose of these types of medicine occur- as the reasons for taking these drugs initially become replaced with relief due to addiction in some who take narcotics for a long period of time.

Dan Abshear

Andre Agassi said...

A pharmacist 70 years of age pleaded innocent to charges of stealing prescription painkillers and trading them for sexual favors. Police said they began investigating P. Lussier after receiving tips that he was trading vicodin, an addictive pain reliever, to a woman in her 30s in exchange for sex. Detective Sgt. S. H. said Lussier was carrying 100 pills when they arrested him as he left work at a Brooks Pharmacy in Palmer, Massachusetts on Wednesday evening.Lussier was arraigned Thursday on charges including drug trafficking and larceny of a controlled substance. He was ordered held on $100,000 bail. Police said they found thousands of prescription pills, including Oxycontin, Oxycodone and Viagra, when they searched Lussier's home on Wednesday. They also found two .38-caliber handguns, Haley said.Lussier's lawyer, Brian L. Blackburn, said his client has not been charged with any offenses in 21 years. In 1984, Lussier, then the owner of a Springfield pharmacy, received two years' probation after pleading guilty to two counts of illegally dispensing the painkiller Percodan. In 1977, he was sentenced to 2 1/2 years in prison after pleading guilty to selling thousands of dollars' worth of stimulants and depressants to undercover narcotics agents, this indicates in his article on findrxonline addiction of vicodin.

Jay Fleming said...

I'm a chronic pain patient who has been on opioids for several years. My testosterone was 57 ng/dl last test. It's easy to tell when it's low, I get teary eyed at silly things on tv, and have no energy.

I take 200mg every 10 days. It seems every dose of opioids knock the heck out of it...

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t.hutson said...

Is there anything other than subxone that can help iopiad withdrawl?

t.hutson said...

Or any Dr around mccomb ms who prisribes it? Need help

teresa bowen said...

Yes, exactly! But how can men prevent these kind of problems? We all know that lots of people specially men are suffering diabetes, high cholesterol and high-blood pressure and as I heard, that are the reasons of having low testosterone levels. Your blog is really helpful, we appreciate it! Please give us more information about this issue. Thanks!

how to boost testosterone

Anonymous said...

The estrogen is to high. When getting your injection you estrogen rises as well.
DO NOT do shot once every 10 days.
Every 5 days in your situation. Just 100ml each time.
I was doing it like that and its all wrong.
Just check half life aftet injection.
I zcrewed up real bad by trying new treatment for low T.
I was on petkaset and yramadol and felt gteat.
Thete is juzt so much more too say
Get Armidex & take 3 time a week,you will cry no more. Estrogen will stay in check.

Anonymous said...

Ask your doc about half life of test
I was doing great
with one shot of 100ml every week. I started noticing that i was not taking that many perkacets for pain. I had many many left aftet each month.
Then. I had to stop shot for 6 weeks to see where level was. It was beyond low. In those 6 weeks i was yaking more pain meds due to constantly feelong like crap.
Had biopsy
Went to using gel and a shot once a month.
Basicly perks were being taken much more and after shot alkot less.
Went to suboxone to avoid the obvios of taking more perks.
Do not go to gels
I would rather take perkacet fir pain than suboxone
Shot will nevet work as wrll after stopping for to many weeks.
Theres allot more
I hope things get better for you, i completely understand the emotional side effects
God Bless.

Anonymous said...

Completly by accident,
I caught a nasty flew and just felt si sick ddnt want to take anything.
However when better and your a smoker and didnt smoke during being sick you start craving it again. Same with opioid. Wont be that bad of a craving though. said...

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Guido said...

so my take from this is that opioids cause sleepnessness or is that wrong?