Opioid-induced hypogonadism: the role of androgens in the well-being and pain thresholds in men and women with advanced disease

Hypogonadism is probably very common among patients with advanced disease. It may result from the disease itself but might also be caused or exacerbated by the drugs used to treat these patients and their symptoms. Opioids are notorious for their ability to depress the production of androgens by both adrenals and gonads. The corticosteroids used in more than 30% of patients with advanced disease may also contribute to hypogonadism. The symptoms of hypogonadism may involve not only fatigue, lack of energy and loss of libido, but also most probably increased sensitivity to pain. In many cases this may lead to increased doses of opioids and increased inhibition of androgen production. Opioid-induced hypogonadism may thus contribute to the development of opioid tolerance. Treatment with androgens for these indications is still controversial and not widely accepted. Androgens may have different adverse effects and their effect on pain has not yet been confirmed in clinical trials. Many patients (with breast and prostate cancers) may have hypogonadism induced pharmacologically in order to inhibit tumour growth. Treatment with androgens in these cases may be contraindicated. Conversely, patients with iatrogenic hypogonadism may suffer more pain and other symptoms which may negatively influence their quality of life.Hypogonadism is probably very common among patients with advanced disease. It may result from the disease itself but might also be caused or exacerbated by the drugs used to treat these patients and their symptoms. Opioids are notorious for their ability to depress the production of androgens by both adrenals and gonads. The corticosteroids used in more than 30% of patients with advanced disease may also contribute to hypogonadism. The symptoms of hypogonadism may involve not only fatigue, lack of energy and loss of libido, but also most probably increased sensitivity to pain. In many cases this may lead to increased doses of opioids and increased inhibition of androgen production. Opioid-induced hypogonadism may thus contribute to the development of opioid tolerance. Treatment with androgens for these indications is still controversial and not widely accepted. Androgens may have different adverse effects and their effect on pain has not yet been confirmed in clinical trials. Many patients (with breast and prostate cancers) may have hypogonadism induced pharmacologically in order to inhibit tumour growth. Treatment with androgens in these cases may be contraindicated. Conversely, patients with iatrogenic hypogonadism may suffer more pain and other symptoms which may negatively influence their quality of life