ORN Summer 2026: Opioid-Induced Androgen Deficiency: Pathophysiology and Treatment-2026-06-10

Video Transcription

Video Summary

The webinar featured Dr. Shashad Basaria discussing opioid-induced androgen deficiency (OPIAD), including its physiology, diagnosis, and treatment. He reviewed the hypothalamic-pituitary-gonadal axis and explained how opioids suppress GnRH, LH, and FSH, leading to low testosterone and central hypogonadism. He noted that this effect is strongest with mu-opioid agonists such as methadone, oxycodone, fentanyl, and intrathecal opioids, while buprenorphine is less suppressive.<br /><br />Dr. Basaria described common symptoms and consequences of OPIAD, including low libido, erectile dysfunction, fatigue, anemia, low bone density, and reduced quality of life. He emphasized standard diagnostic steps: assess symptoms, obtain two morning testosterone levels, check LH/FSH, and evaluate for other causes of central hypogonadism when testosterone is very low. Short-term opioid-related suppression may resolve after opioid tapering, but long-term cases often require treatment.<br /><br />He reviewed testosterone replacement options and practical points, especially that smaller, more frequent injections produce steadier levels than biweekly dosing. He also highlighted research suggesting testosterone may have analgesic effects. In the TAP trial, testosterone improved sexual desire, body composition, quality of life trends, and some measures of pain tolerance in men with OPIAD. The ongoing PATH trial is examining pain, function, mood, and brain imaging outcomes over six months.<br /><br />In the Q&A, he noted that recovery of the gonadal axis after switching to buprenorphine is not well studied, and that women on opioids can also experience hormonal suppression, though testosterone treatment in women remains limited and is not FDA-approved in the U.S.

Keywords

opioid-induced androgen deficiency

OPIAD

testosterone deficiency

hypothalamic-pituitary-gonadal axis

central hypogonadism

opioid suppression

testosterone replacement therapy

methadone

buprenorphine

sexual dysfunction