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The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism. A Collaborative Prospective Analysis: Beyond the Abstract

With the substantial rise in the use of opioid prescriptions to treat chronic pain, opioid dependence has become an epidemic in our society. This alarming pattern of increased opioid prescriptions and its serious health related risks, including hypogonadism, has prompted numerous studies to further investigate what is so called Opioid Induced Hypogonadism (OIH).

More specifically, chronic opioid therapy can induce several endocrine changes and alter nociception. Moreover, it was hypothesized that treatment of OIH can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. In this paper, we examined the effect of testosterone supplemental therapy (TST) in patients with chronic, non-cancer pain undergoing opioid therapy. We hypothesize that treatment of OIH can reduce opioid requirements for chronic patients in addition to improving their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center at the University of California San Diego (UCSD), Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean follow-up total testosterone was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups (p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group (p <0.05). This is the first report of TST can reduce opioid requirements in men with chronic pain.  It also confirms previous reports and that TST is effective in correcting opioid-induced endocrine abnormalities. Clinicians should be aware of OIH in chronic pain patients and should offer TST treatment when clinically indicated coupled with appropriate monitoring and follow-ups. Indeed, future study is needed to better understand the role of testosterone on nociceptive processing and transmission.

Written by Omer Raheem, MD and Mike Hsieh, MD
Department of Urology, University of California, San Diego, California, USA.

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