Effects of testosterone replacement on metabolic and inflammatory markers in men with opioid‐induced androgen deficiency

Huang, Grace; Travison, Thomas G.; Maggio, Marcello; Edwards, Robert R.; Basaria, Shehzad

doi:10.1111/cen.13049

Cited by 24 publications

(6 citation statements)

References 36 publications

(91 reference statements)

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“…A Fountas and others Effects of opioids on endocrine system www.eje-online.org occurred in neither group. Notably, Huang et al, in a placebo-controlled, double-blind randomized trial from the same centre of 64 non-diabetic men (aged between 18 and 64 years) on opioid analgesics for chronic noncancer pain and morning total testosterone <12 nmol/L (as measured by liquid chromatography-tandem mass spectrometry), randomised to 14 weeks of transdermal testosterone gel or placebo gel daily, found that changes in lipid profile, fasting glucose and insulin, homeostatic model assessment for insulin resistance and C-reactive protein were similar from baseline to the end of treatment in both groups; glucose and insulin response to 75 g oral glucose load, inflammatory markers and adipokines also did not differ between the two groups (42). However, the duration of this study was not long enough to evaluate cardiovascular safety of testosterone therapy in these patients.…”

Section: :4 R187 Reviewmentioning

confidence: 98%

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

Fountas

Chai

Kourkouti

et al. 2018

European Journal of Endocrinology

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The use of opioids has grown substantially over the past two decades reaching the dimensions of a global epidemic. These drugs have effects on multiple levels of the endocrine system through mechanisms which are still not fully elucidated, and awareness of their endocrine sequelae is vital for all specialists prescribing or managing patients on them. Hypogonadism is the most well recognised consequence of opioid use (prevalence 21-86%) which, however, may remain undiagnosed with potential adverse outcomes for the patients. Although less frequent, cortisol deficiency can be also found. Furthermore, there is negative impact on bone health (with reduced bone mineral density and increased fracture risk) and occasionally hyperprolactinaemia, whereas the clinical significance of alterations in other hormones remains to be clarified. Discontinuation or reduction of the opioid and, in cases of chronic pain, consideration of alternative therapies for pain relief are potential management options. Hormonal replacement, especially when the above measures are not practically feasible, needs to be considered. Further studies are needed to clearly establish the prevalence of hormonal abnormalities with various regimes, doses and routes of opioids and to address reliably the long-term benefits and risks of hormonal treatment in patients on opioids. Until evidence-based, safe and cost-effective clinical guidelines become available, periodical assessment of the gonadal and adrenal function (particularly when relevant clinical manifestations are present) and evaluation of the bone health status are advised.

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Section: :4 R187 Reviewmentioning

confidence: 98%

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

Fountas

Chai

Kourkouti

et al. 2018

European Journal of Endocrinology

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“…In this issue of the journal, Huang and colleagues report secondary analyses of this same trial, but limited to 64 men without diabetes mellitus. 11 Testosterone (n = 36), compared with placebo (n = 28), had no effect on fasting cholesterol (total, HDL and LDL), triglycerides, glucose, insulin, insulin resistance (HOMA), HbA1c, leptin, adiponectin and CRP, as well as glucose and insulin measured one and two hours after a standard 75 g oral glucose tolerance test. In these secondary analyses, smaller changes in lipids that would be relevant over a longer period of exposure were not excluded as the sample size only permitted large effects (exceeding standardized mean differences of 0Á7) to be detected.…”

mentioning

confidence: 95%

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Karanges

Blanch

Buckley

et al. 2016

Brit J Clinical Pharma

154

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Aim The aim of this paper is to investigate 25‐year trends in community use of prescribed opioid analgesics in Australia, and to map these trends against major changes to opioid registration and subsidy. Methods We obtained dispensing data from 1990 to 2014 from two sources: dispensing claims processed under Australia's national drug subsidy programme, the Pharmaceutical Benefits Scheme, including under co‐payment records from 2012; and estimates of non‐subsidized medicine use from a survey of Australian pharmacies (until 2011). Utilization was expressed in defined daily doses (DDD)/1000 population/day. Results Opioid dispensing increased almost four‐fold between 1990 and 2014, from 4.6 to 17.4 DDD/1000 pop/day. In 1990, weak, short‐acting or orally administered opioids accounted for over 90% of utilization. Use of long‐acting opioids increased over 17‐fold between 1990 and 2000, due primarily to the subsidy of long‐acting morphine and increased use of methadone for pain management. Between 2000 and 2011, oxycodone, fentanyl, buprenorphine, tramadol and hydromorphone use increased markedly. Use of strong opioids, long‐acting and transdermal preparations also increased, largely following the subsidy of various opioids for noncancer pain. In 2011, the most dispensed opioids were codeine (41.1% of total opioid use), oxycodone (19.7%) and tramadol (16.1%); long‐acting formulations comprised approximately half, and strong opioids 40%, of opioid dispensing. Conclusions Opioid utilization in Australia is increasing, although these figures remain below levels reported in the US and Canada. The increased use of opioids was largely driven by the subsidy of long‐acting formulations and opioids for the treatment of noncancer pain.

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“…Strong opioids are not recommended by the German and EULAR guidelines, discouraged by the Canadian guidelines and only considered if other medicinal and nonmedicinal therapies have been exhausted in the APS guidelines. They are often poorly effective for the pain and there are significant potential long-term adverse effects including increased risk of mortality, 116,117 reduction of testosterone 118 and opiate-induced hyperalgesia. 119 The WHO pain ladder was designed for cancer pain, and not intended for use in chronic pain.…”

Section: Pharmacologicmentioning

confidence: 99%

Controversies and challenges in fibromyalgia: a review and a proposal

Cohen

2017

Therapeutic Advances in Musculoskeletal

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Fibromyalgia (FM) is the most commonly encountered chronic widespread pain (CWP) condition in rheumatology. In comparison to inflammatory arthritis (IA), it can seem ill defined with no clear understanding of the pathology and therefore no specific targeted treatment. This inevitably raises controversies and challenges. However, this is an outdated view perpetuated by poor teaching of pain at undergraduate and postgraduate levels, and the perennial problem of advances in relevant cross-speciality knowledge penetrating speciality silos. Research has provided a better understanding of the aetiopathology and FM is now regarded as a centralized pain state. Effective treatment is possible utilizing a multidisciplinary approach combining nonpharmacologic and pharmacologic treatments rooted in a biopsychosocial model. This article will provide a review of the mechanisms, diagnosis and treatment of FM, focus on some ongoing contentious issues and propose a change to the diagnostic terminology.

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Effects of testosterone replacement on metabolic and inflammatory markers in men with opioid‐induced androgen deficiency

Abstract: In this 14-week trial, testosterone administration in men with opioid-induced androgen deficiency was not associated with worsening of metabolic and inflammatory markers.

Cited by 24 publications

References 36 publications

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Controversies and challenges in fibromyalgia: a review and a proposal

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