madman
Super Moderator
* The available literature suggests BUP may impact male sex hormones to a lesser degree than full-agonist opioids. High-quality research is needed to explore the relationship between BUP and OIH in comparison to full opioid agonists and non-opioid controls.
Objective
Individuals with opioid use disorder have reduced life expectancy and quality of life, which is associated with higher levels of depression, fracture risk, and sexual dysfunction. Their elevated risk of opioid induced hypogonadism (OIH) may contribute to all of these relationships. Buprenorphine (BUP) is increasingly utilized to treat opioid use disorder (OUD), and it is not clear whether this medication contributes to OIH. The purpose of this scoping review is to identify studies that explore the relationship between BUP and OIH among men with a specific focus on sexual function and testosterone.
Methods
Searches were conducted in five bibliographic databases: PubMed, CINAHL, Scopus, PsycINFO, and Embase in June of 2025. The search algorithm was developed in coordination with a health-sciences librarian and the review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., 2021). We included studies if they were randomized controlled trials, non-randomized trials, pilot studies, feasibility studies, and observational studies (ie, prospective cohort, retrospective cohort, and case control studies). We produced a narrative synthesis of data and summarized data on an aggregate level.
Results
There were 3,269 abstracts identified and after review of 35 full-text articles we identified 17 studies that met our inclusion criteria. The majority of the studies followed a prospective cross-sectional design (N=15, 83%) and evaluated sexual function exclusively (N=12, 70%). There were 5 studies that measured testosterone levels. All studies that compared BUP to full opioid agonists, such as methadone found higher testosterone levels in the BUP exposed individuals. There were 3 studies that compared sexual function for people exposed to BUP with healthy controls; 2 of the 3 reported higher levels of sexual function among non-opioid exposed patients with mean differences of 6.83 (CI 5.08-8.58) and 2.34 (CI 1.01-3.67) on self-reported sexual function scales.
Conclusions
The evidence describing the impact of BUP on testosterone levels for men is extremely limited. The available literature suggests BUP may impact male sex hormones to a lesser degree than full-agonist opioids. High-quality research is needed to explore the relationship between BUP and OIH in comparison to full opioid agonists and non-opioid controls. Additional research is also needed to explore the dose-response relationship between BUP and OIH.
Objective
Individuals with opioid use disorder have reduced life expectancy and quality of life, which is associated with higher levels of depression, fracture risk, and sexual dysfunction. Their elevated risk of opioid induced hypogonadism (OIH) may contribute to all of these relationships. Buprenorphine (BUP) is increasingly utilized to treat opioid use disorder (OUD), and it is not clear whether this medication contributes to OIH. The purpose of this scoping review is to identify studies that explore the relationship between BUP and OIH among men with a specific focus on sexual function and testosterone.
Methods
Searches were conducted in five bibliographic databases: PubMed, CINAHL, Scopus, PsycINFO, and Embase in June of 2025. The search algorithm was developed in coordination with a health-sciences librarian and the review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., 2021). We included studies if they were randomized controlled trials, non-randomized trials, pilot studies, feasibility studies, and observational studies (ie, prospective cohort, retrospective cohort, and case control studies). We produced a narrative synthesis of data and summarized data on an aggregate level.
Results
There were 3,269 abstracts identified and after review of 35 full-text articles we identified 17 studies that met our inclusion criteria. The majority of the studies followed a prospective cross-sectional design (N=15, 83%) and evaluated sexual function exclusively (N=12, 70%). There were 5 studies that measured testosterone levels. All studies that compared BUP to full opioid agonists, such as methadone found higher testosterone levels in the BUP exposed individuals. There were 3 studies that compared sexual function for people exposed to BUP with healthy controls; 2 of the 3 reported higher levels of sexual function among non-opioid exposed patients with mean differences of 6.83 (CI 5.08-8.58) and 2.34 (CI 1.01-3.67) on self-reported sexual function scales.
Conclusions
The evidence describing the impact of BUP on testosterone levels for men is extremely limited. The available literature suggests BUP may impact male sex hormones to a lesser degree than full-agonist opioids. High-quality research is needed to explore the relationship between BUP and OIH in comparison to full opioid agonists and non-opioid controls. Additional research is also needed to explore the dose-response relationship between BUP and OIH.
