Opioid-induced androgen deficiency in men: Prevalence, pathophysiology, and efficacy of testosterone therapy.

IF 3.2 2区 医学 Q1 ANDROLOGY
Andrology Pub Date : 2025-02-21 DOI:10.1111/andr.70013
Hussein Kafel, Milena Braga-Basaria, Shehzad Basaria
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引用次数: 0

Abstract

Background: Opioid analgesics are frequently prescribed for the treatment of chronic pain and are a common cause of male androgen deficiency. Despite its high prevalence, this adverse effect of chronic opioid use remains underappreciated by clinicians. As a result, androgen deficiency remains underdiagnosed and likely undertreated. This focused review discusses the expanding literature on opioid-induced androgen deficiency and the efficacy of testosterone therapy, with a particular focus on its anti-nociceptive effects.

Methods: Original and review articles on opioid-induced male androgen deficiency published from 1950 through June 2024 were retrieved from PubMed using the key terms "opioids," "hypogonadism," "low testosterone," and "testosterone therapy." References within the retrieved publications were also researched.

Results: Opioids suppress the gonadal axis mainly by inhibiting GnRH synthesis and secretion. The prevalence of opioid-induced androgen deficiency in men varies between 20% and 80% and is influenced by the type of opioid used, duration of exposure, age of the cohort, and how low testosterone was defined. Limited data from clinical trials suggest that testosterone therapy improves libido, body composition, and certain domains of quality of life. Early evidence also suggests that testosterone has anti-nociceptive properties, confirming findings from preclinical and population studies.

Conclusion: Chronic opioid use is a common but underappreciated cause of androgen deficiency in men. There is a need to raise awareness among clinicians regarding this adverse effect of opioid use. Testosterone therapy could be considered in men with unequivocal androgen deficiency after a thorough clinical evaluation. Ongoing clinical trials will shed further light on the efficacy of testosterone therapy, particularly regarding its anti-nociceptive effects.

阿片类药物引起的男性雄激素缺乏:患病率、病理生理学和睾酮治疗的疗效。
背景:阿片类镇痛药经常用于治疗慢性疼痛,也是男性雄激素缺乏的常见原因。尽管发病率很高,但临床医生仍未充分认识到慢性阿片类药物使用的这种不良影响。因此,雄激素缺乏症仍未得到充分诊断和治疗。这篇综述讨论了阿片类药物引起的雄激素缺乏和睾酮治疗的疗效的文献,特别关注其抗伤害作用。方法:使用关键词“阿片类药物”、“性腺功能减退”、“低睾酮”和“睾酮治疗”,从PubMed检索1950年至2024年6月发表的关于阿片类药物诱导的男性雄激素缺乏的原始和综述文章。还研究了检索到的出版物中的参考文献。结果:阿片类药物主要通过抑制GnRH的合成和分泌来抑制性腺轴。阿片类药物引起的男性雄激素缺乏症患病率在20%至80%之间,受使用阿片类药物类型、暴露时间、队列年龄以及如何定义低睾酮的影响。临床试验的有限数据表明,睾酮治疗可以改善性欲、身体成分和某些领域的生活质量。早期证据还表明,睾酮具有抗伤害性,证实了临床前和人群研究的发现。结论:慢性阿片类药物使用是男性雄激素缺乏的常见但未被充分认识的原因。有必要提高临床医生对阿片类药物使用的这种不良影响的认识。在彻底的临床评估后,可以考虑对雄激素缺乏的男性进行睾酮治疗。正在进行的临床试验将进一步阐明睾酮治疗的疗效,特别是其抗伤害作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Andrology
Andrology ANDROLOGY-
CiteScore
9.10
自引率
6.70%
发文量
200
期刊介绍: Andrology is the study of the male reproductive system and other male gender related health issues. Andrology deals with basic and clinical aspects of the male reproductive system (gonads, endocrine and accessory organs) in all species, including the diagnosis and treatment of medical problems associated with sexual development, infertility, sexual dysfunction, sex hormone action and other urological problems. In medicine, Andrology as a specialty is a recent development, as it had previously been considered a subspecialty of urology or endocrinology
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