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The Impact of Opioids on the Endocrine System

Katz, Nathaniel MD, MS*; Mazer, Norman A. MD, PhD

doi: 10.1097/AJP.0b013e3181850df6
Review Article

Objectives Opioids have been used for medicinal and analgesic purposes for centuries. However, their negative effects on the endocrine system, which have been known for some times, are barely discussed in modern medicine. Therefore, we conducted a systematic review of the impact of opioids on the endocrine system.

Methods A review of the English language literature on preclinical and clinical studies of any type on the influence of opioids on the endocrine system was conducted. Preliminary recommendations for monitoring and managing these problems were provided.

Results Long-term opioid therapy for either addiction or chronic pain often induces hypogonadism owing to central suppression of hypothalamic secretion of gonadotropin-releasing hormone. Symptoms of opioid-induced hypogonadism include loss of libido, infertility, fatigue, depression, anxiety, loss of muscle strength and mass, osteoporosis, and compression fractures in both men and women; impotence in men; and menstrual irregularities and galactorrhea in women. In view of the increased use of opioids for chronic pain, it has become increasingly important to monitor patients taking opioids and manage endocrine complications. Therefore, patients on opioid therapy should be routinely screened for such symptoms and for laboratory abnormalities in sex hormones.

Conclusions Opioid-induced hypogonadism seems to be a common complication of therapeutic or illicit opioid use. Patients on long-term opioid therapy should be prospectively monitored, and in cases of opioid-induced hypogonadism, we recommend nonopioid pain management, opioid rotation, or sex hormone supplementation after careful consideration of the risks and benefits.

*Analgesic Research, Tufts University School of Medicine

Department of Endocrinology, Diabetes and Nutrition, Boston University Medical Center, Boston, MA

Reprints: Nathanial Katz, MD, MS, Analgesic Research, 109 Highland Avenue, Needham, MA 02494 (e-mail:

Received for publication March 25, 2008; revised June 26, 2008; accepted June 28, 2008

© 2009 Lippincott Williams & Wilkins, Inc.