Hypogonadism associated with long-term opioid therapy: A systematic review

Pravardhan Birthi, Vittal R. Nagar, Robert Nickerson, Paul A. Sloan

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Sexual dysfunction and Opioid-Induced Sexual Hormone Deficiency (OPISHD) have been associated with patients on long-term opioid pain therapy. There have been few comprehensive reviews to establish a relation between hypogonadism with chronic opioid pain management. The OPISHD is often not treated and literature guiding this topic is scarce. Objective: To investigate hypogonadism associated with long-term opioid therapy based on qualitative data analysis of the available literature. Study design: Systematic review. Interventions: The review included relevant literature identified through searches of PubMed, Cochrane, Clinical Trials, US National Guideline Clearinghouse, and EMBASE, for the years 1960 to September 2013. The quality assessment and clinical relevance criteria used were the Cochrane Musculoskeletal Review Group Criteria for randomized control trials and the Newcastle-Ottawa Scale Criteria for observational studies. The level of evidence was classified as good, fair, and poor, based on the quality of evidence. Main outcome measures: The primary outcome measures were clinical symptoms and laboratory markers of hypogonadism. Secondary outcome measure was management of OPISHD. Results: Thirty-one studies were identified, of which 14 studies met inclusion criteria. There were no randomized control trials and eight of 14 studies were of moderate quality. The remaining studies were of poor quality. Four studies report most patients on long-term oral opioid therapy have associated hypogonadism and three studies of patients receiving intrathecal opioid therapy suggest that hypogonadism is common. Conclusions: There is lack of high-quality studies to associate chronic opioid pain management with hypogonadism. At present, there is fair evidence to associate hypogonadism with chronic opioid pain management, and only limited evidence for treatment of OPISHD.

Original languageEnglish
Pages (from-to)255-278
Number of pages24
JournalJournal of Opioid Management
Issue number3
StatePublished - May 1 2015

Bibliographical note

Publisher Copyright:
© 2015 Journal of Opioid Management, All Rights Reserved.


  • Chronic nonmalignant pain
  • Chronic pain
  • Hypogonadism
  • Hypogonadism treatment
  • Long-term opioid therapy
  • Opioids

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Hypogonadism associated with long-term opioid therapy: A systematic review'. Together they form a unique fingerprint.

Cite this