Testosterone Replacement Therapy for Men in Pain

Christina Lasich, MD Health Pro June 14, 2010
  • How many men would take pain pills if they knew that the pills might shrink their testicles? Besides testicular size, pain pills can wreck havoc on a man's ability to have sex, make babies, build muscles, and enjoy life. All of these side effects to opioid medications are caused by the fact that chronic opioid use lowers testosterone levels. This fact is not widely known, yet widely experienced. "Opioid-induced androgen deficiency" affects thousands of men. In a complex process that involves some very important hormones, both men and women can experience symptoms of low testosterone.

     

    The most common symptoms from abnormally low testosterone levels - hypogonadism  - are:

     

    • Fatigue 
    • Low libido
    • Sexual dysfunction 
    • Low muscle mass 
    • Infertility
    • Hot flashes 
    • Night sweats
    • Testicular atrophy

     

    If any of this sounds familiar, a doctor can order a simple blood test (the Total Testosterone Level) to check your testosterone level. This test is best done early in the morning to get the most accurate reading. Checking baseline hormonal levels, including the testosterone level, before and after initiating opioid treatment is recommended by some experts. Additionally, when consenting for opioid treatment, the patient should also be informed about the potential for opioids to drastically lower testosterone levels.

     

    If this discussion took place, many men might elect to avoid opioids. If men knew that upwards of 80% of those who begin taking opioids will experience erectile dysfunction from low testosterone levels, they might want to seek alternative pain relieving options. Those who do agree to opioid pain management despite the risks should know about testosterone-replacement therapy.

     

    Testosterone-replacement therapy is utilized to treat opioid-induced testosterone insufficiency. Prior to initiating testosterone treatment men need to have the prostate specific antigen level (PSA) test because testosterone can worsen prostate conditions like cancer and hypertrophy. Additionally, other conditions could also worsen like heart failure and sleep apnea. So, not every man is a candidate for testosterone replacement. Those who are candidates have a few different modes of replacement like injections, patches, gels and bio-identicals hormones. One study showed that the testosterone patch delivering 7.5 mg per day was effective at normalizing testosterone levels and relieving symptoms of hypogonadism. In fact, that same study showed that pain intensity actually improved as the testosterone levels normalized. Testosterone-replacement therapy is probably the most underutilized, yet most often needed adjunct therapy for someone who is a long-term opioid user.

     

    Everyone, both men and women need to be more aware of the long-term effects that opioids have on the human body. Testosterone and all the hormones related to the hypothalamic-pituitary axis (thyroid, adrenaline, and sex hormones) have the potential for becoming abnormally low. At some point, these hormonal imbalances have the potential to affect quality of life more than the pain itself. At that point, the risks of long-term opioid use needs to be re-evaluated because the risks might outweigh the benefits. At some point, opioid pain management might not be worth the price.