Medications for Pain Cause Low Testosterone in Men & Women
Posted: Sat Nov 19, 2011 10:15 pm
Testosterone Deficiency In Men & Women is Caused from Chronic Pain Patients Taking Opioids These Opiods Include Tramadol, Hydrocodone, Methadone, Morphine, Oxycodone, Paregoric, Sufentainil, Codeine, Fentanyl, Hydromorphone, and many Antidepressants. This is important I share this because I have suffered from Low Testosterone since being on Tramadol for over 1 year and it has Low Testosterone caused Insomnia, Extreme Fatigue, Hot Flashes, and more. Everyone who takes these medications (male or female) should be tested for Testosterone because Low Testosterone can also cause more problems or make existing problems worse such as Heart Problems Diabetes, and organ problems. You can also have Low Testosterone (Male or Female) from taking certain antidepressants which people use for chronic pain and depression. Doctors normally do not recognize Low T and the only way to know is by insisting your doctor test for it, which I recommend anybody taking these meds to do. If your results are borderline low side of normal take it again 1 or 2 months later, because it can be low one day and just above normal the next. I had 4 tests done, and three were below normal one was slightly normal and now being treated for Low T and decreasing slowing Tramadol medication with doctor supervision.
Posted on 08 September 2010.
By Chris Faubel, MD –
Image from Bioscience.org
Does the chronic use of opiates/opioids/narcotics lead to testosterone deficiency?
§ YES!! Testosterone deficiency has been observed in both males AND females taking pain-relieving narcotics for their chronic pain. [1,2]
How does this happen?
§ First you must have a basic understanding ofhow testosterone is produced in the body.
§ By the testes (#1 way) – see the image to the right
§ Testosterone is primarily made in the testicles by way of hormones from thehypothalamus and anterior pituitary
§ Gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which then stimulates the anterior pituitary to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The FSH and LH then leads to testosterone production by the testes.
§ By the adrenal glands
§ GnRH also stimulates the pituitary to release (ACTH), which then tells the adrenals to make testosterone.
§ Theories of how chronic pain and chronic opioid use causes testosterone deficiency
§ Opioid suppression of GnRH
§ Most common cause
§ Suppression of GnRH and LH/FSH due to the stress of severe, uncontrolled pain over time
What are the signs and symptoms of testosterone deficiency in patients?
§ Poor pain control
§ Low libido
§ Erectile dysfunction (Impotence)
§ Depression
§ Lack of energy
§ Poor sleep
§ Compression fractures
Is testosterone related to pain perception?
§ Yes…at least in rats.
§ Forman et al. found that castrated rats responded to painful stimuli quicker, and that treatment with testosterone propionate caused a normalization of the response. [3]
§ What about in humans?
§ Boston University is currently recruiting participants to see if testosterone administered to men with opioid-inducted hypogonadism leads to a change in their pain perception, pain sensitivity in response to noxious stimuli, and changes in the requirement of opioids.
How is this testosterone deficiency tested?
§ Morning (8am – 11am) serum TOTAL testosterone level
§ Serum levels of testosterone peak in the morning .
§ Some consider free testosterone to be a better judgment of testosterone level, because it is the unbound, bioavailable portion (most involved with libido and erectile dysfunction). But others feel the protein portion is more critical for pain management purposes.
§ Other tests to consider
§ LH level to determine if the low testosterone is primary (low testosterone; high LH) or secondary (low testosterone; low LH)
§ Prolactin level
§ Bone densitometry – to check if osteoporotic
How is opioid-induced androgen deficiency treated?
§ This may be determined by which version the insurance company pays for.
§ Cheapest
§ Injectable testosterone is the cheapest
§ Compounding pharmacies may make topical creams and gels for a similar price
§ Table of commercially available preparations
§ A trial can be given with 200-mg (1-ml) of injectable testosterone (or one-week supply of commercial testosterone) to see if symptoms improve within one week
§ Side effects of testosterone replacement
§ The severe, highly-publicized effects of anabolic steroids in athletes is from use of extremely high doses
§ Link to table with list of potential effects
§ For the most part, acne (males) and beard growth (females) is the tip off that too much testosterone is being administered, and a reduction is needed.
—————————————————–
REFERENCES:
1. Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain. 2009 Feb;25(2):170-5
2. Daniell, H.W. Opioid-induced androgen deficiency. Current Opinion in Endocrinology & Diabetes. 2006 June;13(3):262-266
3. Forman et al. The response to analgesia testing is affected by gonadal steroids in the rat. Life Sci. 1989;45(5):447-54
4. Tennant F, Lichota L. Testosterone Replacement In Chronic Pain Patients. Practical Pain Management. July/August 2010. Vol 10, Issue 6, Pages 12-15
Read more: http://www.livestrong.com/article/18257 ... z1eBPkkRj9
Other info about Opiates
Drug Interactions
While people are using an opioid drug, they cannot take certain medications at the same time. Examples include benzodiazepines, antihistamines, barbiturates and general anesthetics. Combining an opioid drug with alcohol can also cause problems. The National Institute on Drug Abuse explains that combining an opioid drug with a medication that decreases activity in the central nervous system can increase the risk of serious respiratory depression.
Opioid Addiction
People who take an opioid drug for recreational purposes can develop an addition. The American Academy of Family Physicians points out that addiction can occur even in people who take an opioid drug from medical purposes if they use more of the drug than recommended by their doctors. When people develop an addiction, they have cravings for the drug, which drives them to use more.
Withdrawal
All types of opioid drugs can cause withdrawal if a person stops using or decreases how much of the drug they use. Withdrawal occurs when people develop a physical dependence to the drug, and their bodies become used to the effects of the drug. MedlinePlus explains that people can have early withdrawal symptoms and late withdrawal symptoms as more time passes from the last usage. For example, early symptoms include insomnia, runny nose, agitation, yawning, anxiety, sweating, muscle aches and increased tearing. When people experience the late symptoms of withdrawal, they have goosebumps, abdominal cramping, vomiting, nausea, diarrhea and dilated pupils.
Read more: http://www.livestrong.com/article/18257 ... z1eBRQlUtZ
Posted on 08 September 2010.
By Chris Faubel, MD –
Image from Bioscience.org
Does the chronic use of opiates/opioids/narcotics lead to testosterone deficiency?
§ YES!! Testosterone deficiency has been observed in both males AND females taking pain-relieving narcotics for their chronic pain. [1,2]
How does this happen?
§ First you must have a basic understanding ofhow testosterone is produced in the body.
§ By the testes (#1 way) – see the image to the right
§ Testosterone is primarily made in the testicles by way of hormones from thehypothalamus and anterior pituitary
§ Gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which then stimulates the anterior pituitary to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The FSH and LH then leads to testosterone production by the testes.
§ By the adrenal glands
§ GnRH also stimulates the pituitary to release (ACTH), which then tells the adrenals to make testosterone.
§ Theories of how chronic pain and chronic opioid use causes testosterone deficiency
§ Opioid suppression of GnRH
§ Most common cause
§ Suppression of GnRH and LH/FSH due to the stress of severe, uncontrolled pain over time
What are the signs and symptoms of testosterone deficiency in patients?
§ Poor pain control
§ Low libido
§ Erectile dysfunction (Impotence)
§ Depression
§ Lack of energy
§ Poor sleep
§ Compression fractures
Is testosterone related to pain perception?
§ Yes…at least in rats.
§ Forman et al. found that castrated rats responded to painful stimuli quicker, and that treatment with testosterone propionate caused a normalization of the response. [3]
§ What about in humans?
§ Boston University is currently recruiting participants to see if testosterone administered to men with opioid-inducted hypogonadism leads to a change in their pain perception, pain sensitivity in response to noxious stimuli, and changes in the requirement of opioids.
How is this testosterone deficiency tested?
§ Morning (8am – 11am) serum TOTAL testosterone level
§ Serum levels of testosterone peak in the morning .
§ Some consider free testosterone to be a better judgment of testosterone level, because it is the unbound, bioavailable portion (most involved with libido and erectile dysfunction). But others feel the protein portion is more critical for pain management purposes.
§ Other tests to consider
§ LH level to determine if the low testosterone is primary (low testosterone; high LH) or secondary (low testosterone; low LH)
§ Prolactin level
§ Bone densitometry – to check if osteoporotic
How is opioid-induced androgen deficiency treated?
§ This may be determined by which version the insurance company pays for.
§ Cheapest
§ Injectable testosterone is the cheapest
§ Compounding pharmacies may make topical creams and gels for a similar price
§ Table of commercially available preparations
§ A trial can be given with 200-mg (1-ml) of injectable testosterone (or one-week supply of commercial testosterone) to see if symptoms improve within one week
§ Side effects of testosterone replacement
§ The severe, highly-publicized effects of anabolic steroids in athletes is from use of extremely high doses
§ Link to table with list of potential effects
§ For the most part, acne (males) and beard growth (females) is the tip off that too much testosterone is being administered, and a reduction is needed.
—————————————————–
REFERENCES:
1. Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain. 2009 Feb;25(2):170-5
2. Daniell, H.W. Opioid-induced androgen deficiency. Current Opinion in Endocrinology & Diabetes. 2006 June;13(3):262-266
3. Forman et al. The response to analgesia testing is affected by gonadal steroids in the rat. Life Sci. 1989;45(5):447-54
4. Tennant F, Lichota L. Testosterone Replacement In Chronic Pain Patients. Practical Pain Management. July/August 2010. Vol 10, Issue 6, Pages 12-15
Read more: http://www.livestrong.com/article/18257 ... z1eBPkkRj9
Other info about Opiates
Drug Interactions
While people are using an opioid drug, they cannot take certain medications at the same time. Examples include benzodiazepines, antihistamines, barbiturates and general anesthetics. Combining an opioid drug with alcohol can also cause problems. The National Institute on Drug Abuse explains that combining an opioid drug with a medication that decreases activity in the central nervous system can increase the risk of serious respiratory depression.
Opioid Addiction
People who take an opioid drug for recreational purposes can develop an addition. The American Academy of Family Physicians points out that addiction can occur even in people who take an opioid drug from medical purposes if they use more of the drug than recommended by their doctors. When people develop an addiction, they have cravings for the drug, which drives them to use more.
Withdrawal
All types of opioid drugs can cause withdrawal if a person stops using or decreases how much of the drug they use. Withdrawal occurs when people develop a physical dependence to the drug, and their bodies become used to the effects of the drug. MedlinePlus explains that people can have early withdrawal symptoms and late withdrawal symptoms as more time passes from the last usage. For example, early symptoms include insomnia, runny nose, agitation, yawning, anxiety, sweating, muscle aches and increased tearing. When people experience the late symptoms of withdrawal, they have goosebumps, abdominal cramping, vomiting, nausea, diarrhea and dilated pupils.
Read more: http://www.livestrong.com/article/18257 ... z1eBRQlUtZ