A patient receiving chronic opioid therapy or abusing opioids can develop hypogonadism.
Manifestations in males:
(1) erectile dysfunction and/or impotence
(2) loss of muscle mass and strength
(3) flushing and sweating
(4) loss of libido
(5) infertility
(6) low energy levels
(7) mood disturbances
(8) osteoporosis
(9) low serum testosterone
(10) reduced serum LH and FSH
Manifestations in females:
(1) menstrual dysfunction (irregular, oligomenorrhea, amenorrhea)
(2) flushing and sweating
(3) loss of libido
(4) infertility
(5) low energy levels
(6) mood disturbances
(7) osteoporosis
(8) reduced serum estradiol
(9) reduced serum LH and FSH
The diagnosis requires:
(1) chronic exposure to opioids or opioid agonists
(2) exclusion of other causes of hypogonadism (although mixed causation possible)
