madman
Super Moderator
CONCLUSION
The use and abuse of opioids is a critical global concern today. The chronic use of these medications can lead to hypogonadotropic hypogonadism, an underappreciated side effect. When evaluating patients for infertility or sexual dysfunction, it is important to get a complete medical history including medications, and to inquire about drug use, illicit or otherwise. Men on opioid treatment should be monitored for OPIAD while on therapy. Screening with validated questionnaires should be considered for all men receiving therapy. Diagnosis is made based on accepted laboratory values of testosterone deficiency. During the evaluation process, other causes of secondary hypogonadism including metabolic syndrome should be carefully assessed.
Although there is a lack of prospective randomized trials on treatment of OPIAD, current experience and knowledge base on the treatment of secondary hypogonadism can be used for guidance. A multidisciplinary care team is optimally utilized for management. Treatment options include opioid cessation with alternative pain control, use of short-acting narcotics and, when appropriate, testosterone replacement therapy. Exogenous testosterone is available in multiple formulations with generally similar efficacy in this patient population. The advantages and disadvantages of each formulation should be discussed with the patient and the appropriate treatment chosen based on shared decision-making and comprehensive counseling. CC and anatrozole have been used off-label to increase endogenous testosterone in hypogonadal men hoping to preserve fertility, although there is no data yet on their use in the OPIAD population. Literature on cardiovascular risks of testosterone replacement is conflicting and thus a detailed discussion before initiation of therapy is mandatory. With increased awareness of OPIAD, larger prospective, randomized studies are needed to help guide physicians for the diagnosis and management of this disease process.
The use and abuse of opioids is a critical global concern today. The chronic use of these medications can lead to hypogonadotropic hypogonadism, an underappreciated side effect. When evaluating patients for infertility or sexual dysfunction, it is important to get a complete medical history including medications, and to inquire about drug use, illicit or otherwise. Men on opioid treatment should be monitored for OPIAD while on therapy. Screening with validated questionnaires should be considered for all men receiving therapy. Diagnosis is made based on accepted laboratory values of testosterone deficiency. During the evaluation process, other causes of secondary hypogonadism including metabolic syndrome should be carefully assessed.
Although there is a lack of prospective randomized trials on treatment of OPIAD, current experience and knowledge base on the treatment of secondary hypogonadism can be used for guidance. A multidisciplinary care team is optimally utilized for management. Treatment options include opioid cessation with alternative pain control, use of short-acting narcotics and, when appropriate, testosterone replacement therapy. Exogenous testosterone is available in multiple formulations with generally similar efficacy in this patient population. The advantages and disadvantages of each formulation should be discussed with the patient and the appropriate treatment chosen based on shared decision-making and comprehensive counseling. CC and anatrozole have been used off-label to increase endogenous testosterone in hypogonadal men hoping to preserve fertility, although there is no data yet on their use in the OPIAD population. Literature on cardiovascular risks of testosterone replacement is conflicting and thus a detailed discussion before initiation of therapy is mandatory. With increased awareness of OPIAD, larger prospective, randomized studies are needed to help guide physicians for the diagnosis and management of this disease process.
