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Opioid (Pain) Medication May Decrease Testosterone   arrow

Opioid (pain) medication, including morphine sulfate and oxycodone, commonly used for patients with chronic pain, carries risks of addiction and side effects including nausea, itching, constipation, and low testosterone.  This problem is often not recognized since a patient with persistent pain (of many causes) has many symptoms which may be similar to symptoms of low testosterone.  Opioids are among the most frequently prescribed analgesic drugs but may lead to low testosterone in 20 to 80% of men with decreased attention span, decreased sex drive (libido), fatigue, depressive state, erratic mood.  In addition, muscle loss, bone loss (osteoporosis), low blood count (anemia), erectile dysfunction, delayed ejaculation (semen emission) may occur.  In addition, the risk of cardiovascular disease and diabetes mellitus (increased blood sugar which has many negative effects on the body) are increased.  Chronic opioid use may also adversely affect sperm function (very few studies have addressed this).


The treatment of patients with low testosterone (due to pain medication) is the same as for those with low testosterone of other causes and is managed by a urologist.  Testosterone replacement therapy (TRT) in multiple preparations may have beneficial effects on serum testosterone and qualtity of life.  An alternative to topical or injected testosterone would be the use of human chorionic gonadotropin (hCG injection) or clomiphene citrate (oral pill) which act through a different mechanism to “turn on” the body’s natural testosterone production.

See the following for more detailed information about opioid medication effect on testosterone.  For more information on low testosterone treatment, see the testosterone topic.  Additionally, there are studies including a clinical trial in the New York area recruiting men with chronic pain (treated with narcotic or other pain medication) and diagnosed low testosterone.  Additional information regarding management of chronic pain is available here.

Matthew Wosnitzer, M.D.

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