Opiates and Low Testosterone: The Risks and Mitigating Treatment Options You Need to Know

It may seem out of character for a blog about the treatment of low testosterone to be addressing opiates and pain management, but research shows long-term use can affect your endocrine system and cause hormone imbalances like Low T.

Many people are aware of the increasing epidemic of opioid abuse in the United States. The Centers for Disease Control and Prevention (CDC) indicates that the number of drug overdose deaths increased by nearly 5% from 2018 to 2019, quadrupling since 1991. Over 70% of all overdose deaths involve opiates.

This clearly indicates that there are significant risks involved in using opioids. Those risks are particularly high when these medications are used for an extended period of time by people who must rely on these medications, taken exactly as prescribed, to manage their pain and maintain an acceptable quality of life.

A doctor with a stethoscope around his neck writes a prescription, possibly unaware of the connection between opiates and low testosterone.

How Opioid Pain Medication Can Affect Your Hormone Balance

Research trends indicate that long-term use of opioids can impair the production of important hormones in men’s bodies, including:

  • Testosterone
  • Cortisol
  • Estradiol

Two primary causes have been identified by scientists who have studied this issue. One is that opioid use alters gonadotropin pulse patterns, which affects plasma testosterone and other adrenal and gonadal hormones. The other is that opioids affect the hypothalamus or the anterior pituitary (controlled by the hypothalamus), which are responsible for governing your body’s production of testosterone, along with growth hormone (GH), prolactin, thyroid stimulating hormone (TSH), as well as other important hormones.

The inefficient hormone production that results from abnormal endocrine system function causes hormone imbalance leading to the disruption of critical bodily systems and the life-impacting symptoms associated with hormonal conditions like Low T.

According to a study published in Endocrine Reviews by Cassidy Vuong, et al., the primary disorder caused by opioid abuse is hypogonadism (the medical term for low testosterone) in men. The data collected led researchers to conclude:

“(Patients using opiates) must be aware of not only the prevalence of this disorder on their sexual functioning, but also the effects of the opioids on the other hormones in their system, which may lead to harmful long-term effects.”

In another study, researchers examined 73 patients (29 men and 44 women with an average age of 49) who were taking opioid pain medication for an average duration of 26 months to treat chronic pain not related to cancer. These patients’ hormonal output was compared to a control group consisting of 20 patients (11 men and 9 women with an average age of 54) who had similar chronic pain, but weren’t treated with opioid pain medication.

A large majority of the men developed clinically diagnosed low testosterone, and decreased libido or erectile dysfunction was found present in 23 of 24 men receiving opioids.

Treating these men with supplemental testosterone therapy improved sexual function in most of these patients, leading researchers to the following conclusion:

“These findings suggest that further investigations are required to determine the need for systematic endocrine work-up in these patients and the necessity for substitutive therapy.”

An exhaustive review of 15 unique studies that was presented in 2019 supported these conclusions, finding that as many as 65 percent of the 3,250 men who used opioids for more than 6 months developed chronic low testosterone.

Researchers also discovered that almost 20% of the subjects suffered from low levels of the hormone cortisol, a stress hormone that contributes to the body’s fight-or-flight response and also serves a critical function in the regulation of metabolism.

Is TRT Recommended for Patients Taking Opiates for Pain Management?

In patients requiring pain management, the presence of Low T symptoms may not be, on its own, an indicator of the need for Low T treatment. Pain patients suffering badly enough to warrant opioid prescription commonly suffer symptoms common to low testosterone, regardless of hormone levels, such as:

  • Fatigue
  • Loss of bone density
  • Loss of muscle mass
  • Increased body fat
  • Depression
  • Low libido

That said, testing for Low T and treatment with Testosterone Replacement Therapy (TRT) when a deficiency is found has been recommended by the Endocrine Society and is emerging as a routine measure for many pain specialists treating pain patients using opiates.

Talk With Your Medical Provider About Opiates and Low Testosterone

As a patient, you should be asking your medical provider about the risks for hormone changes and imbalances related to any medical treatment that’s recommended. As research indicates, that definitely includes opiate pain management—even when taken exactly as prescribed.

You should be made thoroughly aware of the potential side effects related to all medications, as well what methods are available to minimize any threat to your health or quality of life. If you’re using or considering using opioid pain medications, ask your provider whether Testosterone Replacement Therapy (TRT) could be beneficial in your particular situation.

Learn More About TRT Here


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(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

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