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

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.