Opioid-induced androgen deficiency (OPIAD): prevalence, consequence, and efficacy of testosterone replacement

Kenneth W. K. Ho*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)


Opioid analgesics are increasingly prescribed for both cancer-related and noncancer pain. Chronic opioid use suppresses the hypothalamic pituitary gonadal axis resulting in secondary testosterone deficiency known as Opioid-Induced Androgen Deficiency. Persistently, low testosterone levels are associated with adverse musculoskeletal, metabolic, and neuropsychiatric consequences. Opioid adverse effects occur soon after administration, is dose-duration dependent, and often durable despite withdrawal of opioids. All forms of opioids are implicated. Long-acting opioids may be more harmful, and opioids with reduced μ-receptor agonism may be protective. Testosterone replacement may modulate pain threshold and improve function. Some hypogonadal symptoms may improve with testosterone replacement. Testosterone replacement is recommended for symptomatic hypogonadal males with unequivocally low testosterone levels.

Original languageEnglish
Pages (from-to)54-59
Number of pages6
JournalCurrent Opinion in Endocrine and Metabolic Research
Publication statusPublished - 1 Jun 2019


  • Depression
  • Dose reduction
  • Hypogonadism
  • Opioids
  • Receptors
  • Testosterone replacement


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