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Opioids and Low Testosterone

Men who take a class of drugs called opioids may see their testosterone levels decrease, especially if they take the long-acting variety, according to a recent study.

Opioids, such as hydrocodone, oxycodone, morphine, and codeine, are painkillers and may be short-acting or long-acting. Short-acting opioids release medication quickly and are usually taken every 4 to 6 hours. Long-acting opioids take longer to release medication and are usually taken every 8 to 12 hours.

While past research has shown that opioids can lower men’s testosterone levels, they weren’t sure how time – short-acting vs. long-acting – fit into the picture.

Researchers from Kaiser Permanente conducted a study involving 81 men with chronic pain. Each man had been taking an opioid for at least 3 months and none had had low testosterone readings before.

The researchers tested each man’s testosterone and considered 250 nanograms per deciliter (ng/dL) as “low.” Normal testosterone levels are between 300 and 800 ng/dL.

Seventy-four percent of the men who took long-acting opioids were found to have low testosterone. For the men taking short-acting opioids, the rate was 34%.

Even after the researchers accounted for daily dosage amounts and body mass index, the risk of developing low testosterone was almost 5 times greater for men taking long-acting opioids.

Low testosterone can lead to several problems, including diminished sex drive and mood changes. It can also increase the risk of osteoporosis.

The condition can be treated, however, so men who suspect they have low testosterone should talk to their doctor.


The Clinical Journal of Pain

Rubenstein, Andrea, MD, et al.

“Hypogonadism in Men With Chronic Pain Linked to the Use of Long-acting Rather Than Short-acting Opioids”

(Abstract. January 24, 2013)


Baroni, Dana

“Downside for Men Taking Daily Pain Rx”
(February 7, 2013)

Kaiser Permanente

“Kaiser Permanente Study Finds Men Taking Long-Acting Chronic Pain Medications Five Times more Likely to have Low Testosterone Levels”

(Press release. January 31, 2013)

National Institute on Drug Abuse

“What are opioids?”

(October 2011)