Does Opioid Cause Erectile Dysfunction And Infertility?

Yes, long-term opioid treatment can cause erectile dysfunction (ED) and infertility. Opioids are regularly used by 4.3 million Americans for treatment of chronic cancer and non-cancer pain.

Does Opioid Cause Erectile Dysfunction?

How Long Non-Cancer Pain Can Last?

Non-cancer chronic pain may last for several years. Opioid causes hypogonadism in male and female patients.

What is Hypogonadism?

Androgen deficiency or hypogonadism is the most common opioid induced endocrinopathy seen in long-term opioid treatment. Opioid induced androgen deficiency hypogonadism syndrome is also known as OPIAD syndrome.1 In male or female, hypogonadism or OPIAD syndrome causes low testosterone or low female ovarian sex hormone. Low testosterone is also known as male hypogonadism, which causes male erectile dysfunction. In female opioids inhibits ovarian sex hormone and stimulates adrenal androgen production.1,2,3

What Is The Gonadal Hormonal Deficiency?

Gonadal hormonal deficiency is same as hypogonadism or OPIAD syndrome.

What is OPIAD Syndrome?

Opioid syndrome is characterized as low levels of gonadotropins in male and female patients. Long-acting opioid preparation suppresses hypothalamic-pituitary-gonadal axis in male patients and produces a symptomatic state of opioid-induced androgen deficiency (OPIAD). Opioid analgesia impairs gonadal function in men leading to erectile deficiency and in women causes menstrual abnormalities and infertility. Some scientific studies suggest correlation with symptoms, and hormonal measurements of hypogonadism is not well established.1

What is Male Hypogonadism?

One of the side effects of opioid is low testosterone level in male.2 Researches suggests long acting opioids more often causes opioid induced hypogonadism. Hypogonadism is seen in 74% of the men taking long-acting opioids and 34% of the men using short-acting opioids. Testosterone level was significantly lower in patients taking higher dosage of longer acting opioids. Low testosterone level causes erectile dysfunction.

Opioid Use and Erectile Dysfunction

What are the Symptoms of Opioid Induced Hormonal Deficiencies In Female?

Hormonal deficiency in female results in menstrual abnormalities, decreased menstrual flow, infertility, and cognitive symptoms such as mood changes, anxiety and depression.3 These symptoms are often observed among women who are taking opioids for prolonged period of time.3

What Triggers a Low Testosterone?

Low testosterone level is more often seen in long acting opioids than short acting opioids. Deficiency of gonadotropins like follicle stimulating hormone and luteinizing hormone causes inadequate production of testosterone sex hormones in men.

What is the Normal Testosterone Level in Male?

Normal testosterone levels in young healthy male patient is about 300 and 800 nanograms per deciliter (ng/dL).

What is the Testosterone Level in Male Hypogonadism?

Patient is considered suffering with hypogonadism or low testosterone disease when level of testosterone is below 200 ng/dL.

Are Erectile Dysfunction and Other Sexual Dysfunctions Common in Opioid Treatment?

Erectile dysfunction in male and infertility in female is less common when short acting opioids are taken for short period of time. Long acting opioids and prolonged treatment with either short or long acting opioid causes more often hypogonadism leading to erectile dysfunction in men and infertility in female patents.

What are the Symptoms of Male Hypogonadism?

  • Cognitive Symptoms - Mood Changes, Anxiety and Depression.
  • Decreased Libido or Lack of Sexual Drive.
  • Male and Female Infertility.
  • Erectile Dysfunction5.
  • Hypotonic Muscle Mass.
  • Fatigue.
  • Hot Flashes.

What are the Physical Findings or Signs of Hypogonadism?

Is Osteopenia and Osteoporosis Reversible if Opioid Treatment is Discontinued?

Untreated hypogonadism may lead to severe bone diseases like osteoporosis or osteopenia. Opioid induced androgen deficiency (OPIAD) is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. Osteopenia and osteoporosis is reversible if recognized earlier and treated.

What is the Treatment for Opioid Induced Low Testosterone?

The study published in the Journal of Pain by Daniel H.W in the year 2006 suggests testosterone patch was effective in treating opioid induced testosterone deficiency. Patients were treated with initial dosage of testosterone patch of 5 mg/day for first 12 weeks and increased to 7.5 mg for next 12 weeks. The testosterone patches were generally well tolerated. Testosterone patch therapy at a dose of 7.5 mg/day normalizes hormone levels and appears to improve a number of quality of life parameters (e.g., sexual function, well-being, mood) in men with opioid induced androgen deficiency (OPIAD).

What is the Treatment of Opioid Induced Female Hypogonadism?

Opioid induced androgen deficiency syndrome (OPIAD Syndrome) is diagnosed after multiple blood biochemical studies and treatment is androgen replacement therapy. Options of treatment include testosterone preparations for males and dehydroepiandrosterone (DHEA) supplementation for females.

How is Testosterone Prescribed?

Testosterone is available as topical, oral buccal absorption pills and as a liquid for injection. Look for side effects of testosterone and DHEA. Consult your physician in case of any complications.


  1. Opioid-induced androgen deficiency (OPIAD).

    Smith HS, Elliott JA.

    Pain Physician. 2012 Jul;15(3 Suppl):ES145-56.

    Albany Medical College, Albany, NY, USA.

  2. Opioid analgesics suppress male gonadal function but opioid use in males and females does not correlate with symptoms of sexual dysfunction.

    Wong D, Gray DP, Simmonds M, Rashiq S, Sobolev I, Morrish DW.

    Pain Res Manag. 2011 Sep-Oct;16(5):311-6. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

  3. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain.

    Daniell HW.

    J Pain. 2008 Jan;9(1):28-36. Epub 2007 Nov 1.

    Department of Family Practice, University of California Davis Medical School, Redding, California, USA.

  4. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain.

    Daniell HW.

    J Pain. 2008 Jan;9(1):28-36. Epub 2007 Nov 1.

    Department of Family Practice, University of California Davis Medical School, Redding, California, USA.

  5. Erectile dysfunction in opioid users: lack of association with serum testosterone.

    Cioe PA, Friedmann PD, Stein MD.

    J Addict Dis. 2010 Oct;29(4):455-60. doi: 10.1080/10550887.2010.509279.

    Rhode Island Hospital, Providence, RI, USA.

  6. Open-label pilot study of testosterone patch therapy in men with opioid-induced androgen deficiency.

    Daniell HW, Lentz R, Mazer NA.

    J Pain. 2006 Mar;7(3):200-10.

    Department of Family Practice, University of California Davis Medical School, Redding, California, USA.

Written, Edited or Reviewed By:


Last Modified On: July 19, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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