The effect of methadone on the hypothalamic pituitary gonadal axis and sexual function: A systematic review

Ortman, Hayley A.; Siegel, Jessica A.

doi:10.1016/j.drugalcdep.2019.107823

Cited by 12 publications

(13 citation statements)

References 69 publications

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“…More than 50% men in the present study reported erectile dysfunction and 37% of participants were not able to have erection. Impaired sexual function in opioid-treated men is well described (6). Present data support that sexual function is improved but not fully restored during TRT, which could be due to unchanged pain perception during TRT.…”

Section: Sexual Functionsupporting

confidence: 51%

“…The authors concluded that very lowquality evidence supported that TRT was associated with improved pain and emotional functioning, whereas TRT did not affect physical functioning, role functioning, or social functioning (4). Furthermore, sexual function is impaired during opioid treatment (6) and data regarding sexual function during TRT in these men are sparse (5). Obesity is inversely associated with testosterone levels (7).…”

Section: Introductionmentioning

confidence: 99%

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Testosterone replacement therapy of opioid-induced male hypogonadism improved body composition but not pain perception: a double-blind, randomized, and placebo-controlled trial

Glintborg

Vægter

Christensen

et al. 2020

European Journal of Endocrinology

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Background Hypogonadism is prevalent during opioid treatment, but the effect of testosterone replacement treatment (TRT) on body composition, pain perception, and adrenal function is unclear. Purpose To measure changes in body composition, pain perception, quality of life, and adrenal function after TRT or placebo in opioid-treated men with chronic non-malignant pain. Methods Double-blind, placebo-controlled study in 41 men (>18 years) with total testosterone <12 nmol/L were randomized to 24 weeks TRT (Testosterone undecanoate injection three times/6 months, n = 20) or placebo (placebo-injections, n = 21). Outcomes Body composition (lean body mass and fat mass assessed by DXA), clinical pain intensity (numerical rating scale), and experimental pain perception (quantitative sensory assessment), quality of life (SF36), and adrenocorticotrophic hormone (ACTH) test. Data were presented as median (quartiles). Mann–Whitney tests were performed on delta values (24–0 weeks) between TRT and placebo. Results The median age was 55 years (46; 59) and total testosterone before intervention was 6.8 (5.0; 9.3) nmol/L. TRT was associated with change of testosterone levels: 12.3 (7.0; 19.9) nmol/L (P < 0.001 vs placebo), increased lean body mass: 3.6 (2.3; 5.0) kg vs 0.1 kg (−2.1; 1.5) during TRT vs placebo and decreased total fat mass: −1.2 (−3.1; 0.7) kg vs 1.2 kg (−0.9; 2.5) kg, both P < 0.003. Changed pain perception, SF36, and ACTH-stimulated cortisol levels were non-significantly changed during TRT compared with placebo. Conclusions Six months of TRT improved body composition in men with opioid-induced hypogonadism without significant changes in outcomes of pain perception, quality of life, or adrenal function.

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Section: Sexual Functionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Testosterone replacement therapy of opioid-induced male hypogonadism improved body composition but not pain perception: a double-blind, randomized, and placebo-controlled trial

Glintborg

Vægter

Christensen

et al. 2020

European Journal of Endocrinology

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“…For our CMC participants, there is need for more research and scientific reporting on prevalence, pathophysiology, and optimal treatment of sexual dysfunction associated with chronic illness; additionally, screening for and managing co-morbid psychiatric conditions like depression is recommended for patients with sexual dyssfunction. For OUD participants, these risk factors are complicated further by how opioids disrupt the hypothalamic–pituitary–gonadal axis, resulting in hypogonadism and impaired sexual function ( 13 ). CPP also impacts sexual function, with cohort studies reporting erectile dysfunction in 15–55% of males with CPP ( 40 ) and meta-analyses demonstrating lower FSFI scores in lubrication, pain, and total score domains in females with CPP compared to controls ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

“…Closing this gap in knowledge is an important first step to achieving a better understanding of how to manage patients with co-morbid CPP and OUD. Additionally, OUD and OUD medication treatment have been linked with sexual dysfunction, which may further complicate recovery and other health outcomes for these patients (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

et al. 2022

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Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC).Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests.Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups.Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.

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“…There was also interest in male specific services such those that focus on premature ejaculation treatments and erectile function. This aligns with potential sexual dysfunction associated with opioid use (17)(18)(19)(20); however, treatment for these related conditions are often overlooked as part of comprehensive care or focused RSH services. While emergency contraception was not included as a potential "service" to be offered at clinics in our survey, between 27 and 41% of women reported its use suggesting that questions about emergency contraception should be included in future research.…”

Section: Interest In Co-located Reproductive and Sexual Health Servicementioning

confidence: 97%

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The effect of methadone on the hypothalamic pituitary gonadal axis and sexual function: A systematic review

Cited by 12 publications

References 69 publications

Testosterone replacement therapy of opioid-induced male hypogonadism improved body composition but not pain perception: a double-blind, randomized, and placebo-controlled trial

Testosterone replacement therapy of opioid-induced male hypogonadism improved body composition but not pain perception: a double-blind, randomized, and placebo-controlled trial

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

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