Opioids Associated with Androgen Deficiency

LAS VEGAS—Testosterone levels should be checked regularly in men who are prescribed opioids for chronic pain, according to findings from a new retrospective cohort study.

Fentanyl, methadone, and oxycodone were significantly more likely to be associated with androgen deficiency than hydrocodone; these odds ratios were large,” reported Andrea Rubinstein, MD, of Kaiser Permanente Medical Group in Santa Rosa, California, and Diane Carpenter, MPH, of Kaiser Permanente's Division of Research in Oakland, California.

Androgen associations were analyzed using data from Kaiser Permanente Northern California's administrative database, for men (n=1121) on stable doses of a single opioid for 100 days before testosterone tests, statistically controlling for dose, obesity, age, hypertension, and hyperlipidemia.

Men with cancer diagnosis, unstable endocrine disorders, or treated primary hypothyroidism, were not included in the analysis. “Men on fentanyl were more likely to be androgen deficient than men on hydrocodone (odds ratio [OR] 26.40, 95% CI 2.88-241.87),” they reported. “Men on methadone (OR 7.39, 95% CI 3.31-16.49) and men on oxycodone (OR 3.17, 95% CI 1.87-5.36) were also more likely to be androgen deficient than men on hydrocodone.”

“Dose was associated with increased odds of androgen deficiency, but only for the two opioids that were available in short-acting forms,” they reported: hydrocodone (OR 1.18, 95% CI 1.09-1.27) or oxycodone (OR 1.01, 95% CI 1.00-1.02).

Morphine was not significantly more associated with androgen deficiency than hydrocodone, but only 48 men were taking morphine alone, the coauthors noted.

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