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

Handout - ORN Summer 2026 - Basaria

Pdf Summary

The presentation reviews opioid-induced androgen deficiency (OPIAD), a condition in which long-term opioid use suppresses the hypothalamic-pituitary-gonadal (HPG) axis and lowers testosterone. It explains normal HPG physiology, types of hypogonadism, and how opioids can reduce gonadal function, sometimes causing testosterone levels to fall to castrate range.<br /><br />OPIAD is common and clinically important: it is associated with fatigue, sexual dysfunction, low testosterone in many opioid users, and frequent osteopenia/osteoporosis. The talk recommends evaluating men with symptoms of hypogonadism and low morning testosterone, repeating testing for confirmation, and measuring LH/FSH to distinguish primary from secondary hypogonadism. Evaluation may be postponed in acute illness or other reversible conditions. Additional workup may include prolactin, iron studies, pituitary hormones, MRI, and assessment for medication causes.<br /><br />The lecture also reviews testosterone replacement options, especially injections, noting benefits and drawbacks such as cost, self-administration, and fluctuating hormone levels. It then explores the relationship between sex steroids and pain, describing the TAP (Testosterone and Pain) trial. In that proof-of-concept study, testosterone therapy in men with opioid-induced hypogonadism improved trends in clinical pain, pain tolerance, sexual function, and body composition, without changes in inflammatory cytokines, suggesting possible central anti-nociceptive effects.<br /><br />Finally, the PATH trial is introduced as a larger randomized, placebo-controlled study testing injectable testosterone undecanoate in men with chronic back pain, long-term opioid use, and low testosterone. Its goals include assessing clinical pain, experimental pain, brain connectivity, sexual function, fatigue, mood, quality of life, energy, and opioid dose changes. The overall conclusion is that opioid analgesics suppress the HPG axis, symptomatic men should be evaluated for testosterone deficiency, and ongoing trials will clarify testosterone’s role in pain relief.

Keywords

opioid-induced androgen deficiency

OPIAD

hypogonadism

testosterone deficiency

hypothalamic-pituitary-gonadal axis

opioid use

testosterone replacement therapy

sexual dysfunction

osteopenia osteoporosis

PATH trial