Sexual dysfunction in tramadol hydrochloride use disorder male patients: a case-control study

Abstract

Evidence suggests that opioids can modulate gonadal function, with consequent decreased release of sex hormones. We attempted to investigate the sexual function of males using tramadol hydrochloride (HCL) and its relationship to levels of free testosterone, luteinizing hormone, and follicle stimulating hormone, and to compare them with heroin use disorder patients and healthy controls. Our sample consisted of 60 opiate use disorder patients (assessed by Structured Clinical Interview for DSM-IV Axis I) (30 heroin and 30 tramadol) and 30 healthy controls. Sexual dysfunction was assessed using the International Index of Erectile Function. Free testosterone, follicle stimulating hormone, and luteinizing hormone levels were measured in morning blood samples using enzyme-linked immunosorbent assay (ELISA). Results showed that there was a decrease of luteinizing hormone and free testosterone levels in opiate use disorder patients compared with healthy controls, with heroin-dependent patients having significantly lower levels than those using tramadol. Opiates’ effect on follicle stimulating hormone had mixed results. Opioid-dependent patients (both tramadol HCL and heroin using patients) developed sexual dysfunction more than healthy controls, which was generalized, with erectile dysfunction being the most affected domain. These findings are of ultimate importance, considering the fact that people use opioids to enhance their sexual performance in many countries.

Antioxidants (selenium and garlic) alleviated the adverse effects of tramadol on the reproductive system and oxidative stress markers in male rabbits

“…Furthermore, tramadol increased pro-apoptotic Bax expression as well as levels of tumor necrosis factor-, interleukin-1, and nuclear factor kappa B, while decreasing anti-apoptotic Bcl-2 expression and causing histological degenerative changes in the testes 11 , 12 . Also, tramadol lowered serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone in rats and humans in another research 13 , 14 . Degenerative changes in the seminiferous tubules were also seen, and Leydig cells in the testes of rats had euchromatic nuclei and dilated smooth endoplasmic reticulum 13 .…”

Drugs of Abuse and Sexual Function: What Is New?

“…Although the risk of abuse is lesser than with other opioids, it is not negligible and chronic use for this indication is controversial 55 . Two recent studies in Egyptian communities, where tramadol dependence is an increasing problem, report a dose-dependent association between the use of tramadol and both decreased libido and ED, correlating to a significant decrease in serum testosterone level and increase in serum prolactin level 33,37 …”

“…55 Two recent studies in Egyptian communities, where tramadol dependence is an increasing problem, report a dosedependent association between the use of tramadol and both decreased libido and ED, correlating to a significant decrease in serum testosterone level and increase in serum prolactin level. 33,37 Cocaine…”

Opioid-Induced Sexual Dysfunction in Cancer Patients

“…In a case–control study, Hashim et al [ 56 ] compared sexual function in a group of opioid addicts in tramadol, heroin, and control groups of 30 patients each. The mean scores on the IIEF-5 scale regarding erection were 8.6, 15, and 29.9, respectively, and the differences between the groups were statistically significant ( p < 0.001).…”