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  • Writer's pictureDr. Harold Pierre

Can Long-Term Opioid Use Cause Low Testosterone Levels?

Updated: Apr 26


Can Drug Addiction Cause Low Testosterone Levels in Men


Low testosterone is associated with drug abuse. It occurs frequently with opioid abuse. Opioid medications like morphine, oxycodone, and fentanyl are commonly prescribed for pain management. However, whether they are abused or legally prescribed, long-term opioid use can lead to lowered testosterone levels in men. Lower levels of testosterone cause symptoms like reduced libido, erectile dysfunction, and fatigue. Opioid users may not be aware that reduced testosterone levels are the cause of their symptoms. This article explores the connection between opioid use and low testosterone, why it matters, and potential treatment options.


What Are Opioids and How Are They Used?


Opioids are a class of medications that work by binding to opioid receptors in the body to block pain signals. Some common opioid medications include:

  • Morphine - used to treat moderate to severe pain. Available in short and long-acting forms.

  • Oxycodone - treats moderate to severe pain. Short-acting oxycodone is taken every 4-6 hours. Long-acting oxycodone is taken every 12 hours.

  • Fentanyl - a potent synthetic opioid used for chronic pain management. Available as a transdermal patch, lozenge, or nasal spray.

  • Methadone - a long-acting opioid used to treat opioid addiction and pain. Taken once daily.

  • Hydrocodone - used for relief of moderate to severe pain. Typically taken every 4-6 hours.

  • Suboxone - used to relieve opioid withdrawal, cravings, pain, and addiction.

Opioids work by binding to opioid receptors in the brain, spinal cord, and gastrointestinal tract. This blocks pain signals from reaching the brain.


While effective for pain relief, long-term opioid use can lead to dependence and tolerance, requiring higher doses over time to achieve the same effect.


How Do Opioids Lower Testosterone Levels in Men?


Testosterone is the main male sex hormone. The role of testosterone is to control libido, muscle mass, bone density, and energy levels.

Studies show that chronic opioid use can decrease testosterone levels in men through several mechanisms:

  • Suppression of GnRH - Opioids inhibit the release of gonadotropin-releasing hormone (GnRH) in the hypothalamus. This leads to reduced luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion from the pituitary gland. These hormones normally signal the testes to produce testosterone.

  • Direct effect on testes - Opioids may act directly on opioid receptors in the testes to inhibit testosterone production.

  • Increased prolactin - Opioids can raise prolactin levels, which inhibits GnRH release from the hypothalamus. High prolactin reduces LH and the production of testosterone.

  • Lower DHEA - Opioids reduce DHEA, a testosterone precursor produced by the adrenal glands. This lowers testosterone synthesis.

The testosterone suppression is dose-dependent, with higher opioid doses causing greater suppression of the hypothalamic-pituitary-gonadal (HPG) axis. However, even low doses taken chronically can impact levels of testosterone over time.


Effects of Alcohol on Testosterone

  • Alcohol damages Leydig cells in the testes that produce testosterone

  • Alcohol increases estrogen levels, lowering testosterone

  • Alcohol damages the liver, which regulates estrogen and testosterone

  • Alcohol causes zinc deficiency, and zinc is needed to produce testosterone

  • Alcoholism stresses the adrenals, increasing cortisol which further lowers testosterone

How Methamphetamine Causes Low Testosterone


Meth use wreaks havoc on the male endocrine system. It crashes testosterone levels through several mechanisms:

  • Meth damages dopamine and serotonin receptors. This disrupts hormonal balance.

  • Chronic meth impairs testosterone synthesis in the testes.

  • Meth stresses the hypothalamus and pituitary. These glands signal testosterone production. Their disruption decreases these signals.

  • Meth causes adrenal fatigue. It leads to high cortisol. Cortisol suppresses testosterone.

  • Malnutrition is common with meth abuse. Key nutrients for testosterone production are lacking.

  • Meth wrecks sleep cycles. The body needs sleep to recover testosterone.

  • Meth accelerates the conversion of testosterone into estrogen.

Physically fit man running after another running man during sunrise

What Is Considered Low Testosterone?


Normal total testosterone levels in adult men typically range from 300-1000 ng/dL. Doctors diagnose low testosterone or hypogonadism when the serum testosterone levels consistently fall below 300 ng/dL.


However, every man responds differently to the effects of low testosterone concentrations based on individual sensitivity to androgens. Some men develop symptoms of low T at levels of 400-500 ng/dL.


Men with low testosterone levels are associated with:

  • Reduced sex drive and erectile dysfunction

  • Loss of muscle mass and strength

  • Increased body fat and reduced bone density

  • Mood changes like depression or irritability

  • Difficulty concentrating

  • Low energy and fatigue

  • Hot flashes and night sweats

What Percentage of Men on Opioids Develop Low T?


Studies report a wide range in the prevalence of low testosterone among men taking opioids chronically for pain management. Rates vary between 40-90% depending on the drug, dose, and duration of use.


For example, a study found 65% of men on intrathecal opioids for over one year had low testosterone levels. Another study reported 86% of men taking sustained-release oral opioids long-term had hypogonadism.


The risk of low T appears highest with potent synthetic opioids like fentanyl and methadone. Up to 70% of men may develop suppressed testosterone with chronic use of these drugs.

Higher doses also increase the likelihood of hypogonadism. But even low opioid doses taken daily for months can inhibit natural testosterone production over time.


The Dangers of Low Testosterone from Long-Term Opioid Use?


The suppression of testosterone levels can significantly reduce a man's quality of life. The symptoms of hypogonadism go far beyond just sexual health.

Untreated testosterone deficiency is linked to:

  • Depression, irritability, and mood disorders

  • Loss of muscle mass and physical function

  • Increased body fat and obesity

  • Osteoporosis and higher fracture risk

  • Reduced motivation, lack of focus, and "brain fog"

  • Fatigue and low energy

By causing hypogonadism, chronic opioid use can exacerbate issues like depression, weight gain, and low bone density - compounding the challenges of living with chronic pain.

There is also evidence that decreased levels of testosterone can increase pain perception and sensitivity. This may lead to needing higher opioid doses for pain management over time, worsening the cycle of hypogonadism.


Can Opiate Addiction Cause Low Testosterone?


Studies have found men addicted to opioids like heroin or prescription pain pills tend to have very low testosterone levels. Their pituitary glands release less luteinizing hormone and follicle stimulating hormone. These are the messengers that carry instructions to produce testosterone.


Researchers are not totally sure why opioid addiction has this effect on the pituitary gland. The opioids may confuse the gland's normal rhythm of hormone production. They may also block hormone release by causing inflammation in the brain.


Whatever the cause, the result is less testosterone being made by the testes. One study tested men addicted to heroin who were not yet in treatment. Their testosterone levels were only half as high as men who did not use heroin.


Should Men Have Their Testosterone Levels Checked While on Opioids?


Given the high risk of developing low T, it is advisable for men taking daily opioids to have their testosterone levels monitored periodically.


Doctors may recommend testing total and free testosterone levels:

  • Before initiating long-term opioid therapy

  • Within 1-3 months after starting daily opioids

  • Annually while on stable opioid doses

  • Anytime opioid doses are significantly increased

  • If symptoms of low T develop

This allows detecting deficient testosterone levels early. Catching and addressing opioid-induced hypogonadism can help improve a man's mental health, body composition, pain management, and overall wellbeing.


What Treatment Options Exist for Opioid-Induced Low Testosterone?


Doctor holding a test blood sample tube with Testosterone test on the background of medical tests tubes with analyzes

If discontinued, opioids affect testosterone levels temporarily. Levels typically normalize within one to two months after stopping opioids. However, this may not be feasible if opioids are needed for chronic pain management.


Some strategies to treat opioid-induced low T include:

  • Reduce opioid dose - Lowering the dose may help lessen the impact on testosterone production. However, this risks worsening pain control.

  • Opioid rotation - Switching to an alternative opioid medication may reverse low T in some cases. But research on this approach is limited thus far.

  • Treating underlying conditions - Manage weight, diabetes, or other health conditions contributing to low testosterone. Optimize vitamin D, zinc, and magnesium intake. Reduce alcohol use and quit smoking.

  • Testosterone replacement therapy (TRT) - Initiating testosterone therapy in men using gels, injections, patches, or pellets to restore testosterone levels to normal range. This can effectively alleviate low T symptoms but does have potential side effects.

  • Adjunctive medications - Drugs like clomiphene citrate or human chorionic gonadotropin (hCG) stimulate the body's own natural testosterone production and may help normalize levels.

  • DHEA supplementation - Taking over-the-counter DHEA, a testosterone precursor, may help boost low levels in some men but requires further study.

If hormone replacement is pursued, it’s vital to work closely with your doctor to tailor treatment and monitor for adverse effects.


I am Here to Help


I lead a team with decades of experience, and a commitment to providing you with comfort, care, and respect as you navigate this challenging time in your life. We also make treatment super convenient with hours of operation that extend from 0800 AM to 0900 PM, 7 days a week through scheduled appointments, accept most insurances, making treatment accessible to practically all who call. I am waiting for your call.


Takeaways on Opioids and Low Testosterone

  • Chronic opioid use commonly causes lower testosterone levels in men due to suppression of the HPG axis.

  • Symptoms like low libido, erectile dysfunction, reduced muscle mass, and fatigue can significantly impact quality of life.

  • The risk of developing hypogonadism is highest with potent synthetic opioids and higher doses. However, even low doses may decrease natural testosterone production over time when taken daily.

  • Checking testosterone levels periodically is recommended for men on long-term opioid therapy.

  • If low T develops, reducing opioid dose, changing medications may help.

  • Testosterone replacement in men may be needed if other methods fail.

The connection between prescription opioid painkillers and testosterone deficiency in men is well established. Raising awareness about this side effect is key, as untreated low T worsens the burden of chronic pain. Use this information to discuss with your doctor. Working proactively with doctors to monitor hormone levels and adjust treatment can help improve outcomes. Call my clinic today for more information at 918-518-1636.


About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.


This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.




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