E-Poster Presentation ESA-SRB-ANZBMS 2021

Opioid induced androgen deficiency in an outpatient clinic (#335)

Mike Lin 1 , Kenneth W Ho 1 2
  1. Department of Diabetes and Endocrinology, Ryde Hospital, Ryde , NSW, Australia
  2. Department of Clinical Medicine, Macquarie University Hospital, Macquarie University, NSW, Australia

Background
Opioid induced androgen deficiency (OPIAD) is prevalent among opioid users. Testosterone replacement therapy (TRT) can improve quality of life, body composition and pain sensitivity1. We sought to differentiate clinical characteristics of OPIAD patients with other hypogonadal males.

Method
Audit was performed on adult male patients diagnosed with hypogonadotropic hypogonadism (early morning testosterone <10mmol/L, FSH and LH in low-normal range) in a general endocrinology clinic. Exclusion criteria: primary hypogonadism, pituitary disorder, PSA>4ng/mL and malignancy. Data was analysed using SPSS expressed as mean+SEM and statistical significance determined at p<0.05.
 
Results
17 of 46 patients used opioids for >3 months. Buprenorphine (35%) was most common opioid followed by Targin (24%). Baseline characteristics were as follows:

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Main indication for opioid use was musculoskeletal pain (96%) and mean morphine equivalent daily dose (MED) was 141+60mg. MED correlated inversely with baseline testosterone (p=0.006). Opioid users reported more fatigue (100%) but less libido (12%) and erectile dysfunction (12%) compared to non-opioid users (p<0.01). Hypogonadal symptoms were unrelated to opioid-type when testosterone, weight, and MED were considered. Anaemia (Hb<130g/L) was significantly associated with opioid use (11.8% vs none) (p<0.01). There were no significant associations with other co-morbidities (e.g. osteoporosis, diabetes, cardiovascular disease, depression).

Thirty-nine patients received intramuscular testosterone undecanoate (Reandron). Treatment led to rise in haemoglobin and testosterone levels. It was also associated with symptomatic improvement and reduced self-reported pain.


Conclusion
OPIAD is under-recognised, and highly prevalent. In this audit, opioid users had significantly lower baseline testosterone levels and lower haematocrit values. All opioid users complained of fatigue and a significant proportion had mild anaemia. TRT leads to symptomatic improvement and increased testosterone levels.

  1. Ho K. Opioid-induced androgen deficiency (OPIAD): prevalence, consequence, and efficacy of testosterone replacement. Current Opinion in Endocrine and Metabolic Research. 2019;6:54-59.