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.