Did You Know That Opioids and Low T Are Linked?

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By Dr. Leeann Prochaska, N.D.

Chronic pain is one of the most common reasons for a visit to a doctor’s office.5Although healthcare providers have successfully reduced opioid prescriptions, it remains a fixture of pain management. In 2020 alone, over 140 million prescriptions for opioids were given.

For some, this may be a necessary strategy to address relentless pain. But, it can come at a large price.

Most are aware of the addictive qualities of opioids, but did you know that your pain management program can cause low testosterone?

In fact, some studies indicate that nearly 100% of patients treated with opioids experience low testosterone and many continue to experience this side effect even after treatment is discontinued.1,4

In patients who treat their pain with long-term opioid use, reduced libido and impotency is extraordinarily common. One small study found that 23 out of 24 men receiving opioids complained of these side effects.Low testosterone can impact muscle mass, energy levels, mood, and even blood sugar regulation.4

It is thought that opioids cause testosterone deficiency through two important side-effects: reduced release of the hormone gonadotropin from the brain, and direct inhibition of testosterone production in the testes as opioid receptors can be found in the testes and in the pituitary gland. Opioid pain reliever use can further exacerbate this problem by increasing 5-alpha reductase, the enzyme responsible for turning testosterone into estrogen, leading to higher estrogen production and more low testosterone symptoms.1

Treating low testosterone can improve pain patients’ quality of life, especially those largely impacted by testosterone, namely mood, energy, erectile performance, and libido.1,2,4There is even evidence to suggest that testosterone replacement can improve pain tolerance, with researchers finding that a number of patients on testosterone replacement also reported improved perception of pain.1

Opioid-induced hypogonadism is under-diagnosed and undertreated. Dealing with high levels of pain can be difficult enough without the treatment causing exhaustion, changes in mood, and erectile dysfunction. Luckily, testosterone replacement done right can be a safe and efficacious way to address the cause of the symptoms and get you feeling and performing your best again. The experts at Revibe Men’s Health can help you get your testosterone replacement right.


  1. Aloisi AM, Ceccarelli I, Carlucci M, Suman A, Sindaco G, Mameli S, Paci V, Ravaioli L, Passavanti G, Bachiocco V, Pari G. Hormone replacement therapy in morphine-
    induced hypogonadic male chronic pain patients. Reprod Biol Endocrinol. 2011 Feb 18;9:26. doi: 10.1186/1477-7827-9-26. PMID: 21332999; PMCID: PMC3049183
  2. Daniell HW, Lentz R, Mazer NA. Open-label pilot study of testosterone patch therapy in men with opioid-induced androgen deficiency. J Pain. 2006 Mar;7(3):200-10. doi: 10.1016/j.jpain.2005.10.009. PMID: 16516826.
  3. Abs R, Verhelst J, Maeyaert J, Van Buyten JP, Opsomer F, Adriaensen H, Verlooy J, Van Havenbergh T, Smet M, Van Acker K. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000 Jun;85(6):2215-22. doi: 10.1210/jcem.85.6.6615. PMID: 10852454.
  4. De Maddalena C, Bellini M, Berra M, Meriggiola MC, Aloisi AM. Opioid-induced hypogonadism: why and how to treat it. Pain Physician. 2012 Jul;15(3 Suppl):ES111-8. PMID: 22786450.
  5. Finley CR, Chan DS, Garrison S, et al. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832-840.