Plasma Testosterone and Sexual Function in Men Receiving Buprenorphine Maintenance for Opioid Dependence

Abstract

High-dose methadone is well known to cause testosterone deficiency and sexual dysfunction in opioid-dependent men. Buprenorphine is a new drug for the pharmacotherapy of opioid dependence. Its influence on the gonadal axis has not been investigated to date. We therefore assayed testosterone, free testosterone, estradiol, SHBG, LH, FSH, and prolactin in 17 men treated with buprenorphine. Thirty-seven men treated with high-dose methadone and 51 healthy blood donors served as controls. Sexual function and depression were assessed using a self-rating sexual function questionnaire and the Beck Depression Inventory. Patients treated with buprenorphine had a significantly higher testosterone level [5.1 +/- 1.2 ng/ml (17.7 +/- 4.2 nmol/liter) vs. 2.8 +/- 1.2 ng/ml (9.7 +/- 4.2 nmol/liter); P < 0.0001] and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. The testosterone level of buprenorphine-treated patients did not differ from that of healthy controls. In conclusion, we demonstrated for the first time that buprenorphine, in contrast with high-dose methadone, seems not to suppress plasma testosterone in heroin-addicted men. To this effect, buprenorphine was less frequently related to sexual side effects. Buprenorphine might therefore be favored in the treatment of opioid dependence to prevent patients from the clinical consequences of methadone-induced hypogonadism.

Depression in male patients on methadone maintenance therapy

“…Hallinan et al (2008) and Brown et al (2005) used the Beck Depression Inventory (BDI) to measure the presence of depression in methadone patients and reported significant association with erectile dysfunction. Contrary to Bliesener et al (2005), who used a two-question self-rating scale for sexual function, depression as measured by BDI was not associated with erectile dysfunction in neither methadone nor buprenorphine groups. This present study aimed to examine the factors associated with depressive symptoms among men on MMT.…”

High-Dose Methadone Maintenance in Rats: Effects on Cocaine Self-Administration and Behavioral Side Effects

“…Likewise, after the introduction of the female, male rats maintained on methadone showed no species-specific behaviors necessary for copulation such as pursue and mounting (Pfaus et al, 1990). Although this experiment did not identify the mechanism(s) by which methadone maintenance produced these impairments (Agmo and Paredes, 1988;Band and Hull, 1990;Ceccarelli et al, 2006;Cicero et al, 1975Cicero et al, , 1976Pfaus and Gorzalka, 1987;Rodriguez-Manzo et al, 2002;Tokunaga et al, 1977), the data clearly indicate that sexual dysfunctions observed in methadone-maintained individuals (Daniell, 2002b;Fischer et al, 2002) can result from a direct pharmacological effect of methadone (Bliesener et al, 2005;Daniell, 2002a;de la Rosa and Hennessey, 1996).…”

Opioids in chronic noncancer pain

“…The hormonal effects of opioid usage in both men and women have been documented during oral consumption [89,[91][92][93][94][95], transdermal [92][93][94][95][96][97], intravenous [98][99][100][101] and intrathecal [102,103] administration. Opioid endocrinopathy has also been documented in illicit drug users where serum hormone levels return to normal following withdrawal from the drug [93,98].…”