Assessing men with opioid use disorder for testosterone deficiency after the development of symptoms

Abstract

Objective

Individuals with opioid use disorder (OUD) have reduced life expectancy and inferior outcomes when treated for depression, diabetes, and fractures. Their elevated risk of testosterone deficiency may contribute to all of these relationships, however few individuals prescribed opioids are evaluated with testosterone assays. The purpose of this study is to determine whether patients with opioid use disorder are evaluated for testosterone deficiency after development of a symptom that may merit investigation, such as erectile dysfunction (ED).

Method

We conducted a retrospective longitudinal cohort study that utilized data from a national database called TriNetX. Patients were eligible for inclusion if they were 20 to 90 years of age, male, and diagnosed with erectile dysfunction. We utilized descriptive statistics and logistic regression to address study aims.

Results

Testosterone testing was uncommon for all patients with ED. Among 20,658 patients, it was assessed in 11.2% with OUD and 15.1% without OUD. Among those screened, 40% individuals with OUD and ED had testosterone deficiency. Odds of screening those with OUD were lower than matched controls (RR 0.74).

Conclusions

Individuals with OUD are at increased risk of testosterone deficiency than the general population, but nearly 90% are not evaluated for this condition even after development symptoms. That 40% of individuals assessed were classified as testosterone deficient suggests endocrine disorders may be contributing to increased fracture risk, chronic pain, and severe depression commonly encountered in patients with OUD. Addressing this care gap may reduce morbidity and mortality associated with opioid use disorder.

Keywords:

• Opioid use disorder
• OUD
• opioid
• erectile dysfunction
• ED
• testosterone
• testosterone deficiency
• hypogonadism
• endocrine
• endocrinopathy
• sex hormone
• screening

Authors’ contributions

Bhavna Bali: Substantial contributions to the conception, design, and drafting the content. Wen Jan Tuan:Contributed to the acquisition, analysis, and interpretation of data for the work and drafting the work. Alyssa Scott MD: Contributed to the acquisition, analysis, and interpretation of data for the work and drafting the work. Pooja Bollampally MPH: Interpretation of data for the work and reviewing for important intellectual content. Destin Groff BA: Interpretation of data for the work and Drafting the work. Shou Ling Leong MD: Interpretation of data for the work and reviewing for important intellectual. Van L. King MD: Interpretation of data for the work and reviewing for important intellectual content. Curtis Bone MD MHS: Substantial contributions to the conception or design of the work, interpretation of data for the work, drafting the work, and reviewing for important intellectual content. All authors provided final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

This project was supported by the Health Resources and Services Administration (HRSA) and the U.S. Department of Health and Human Services (HHS) under grant number T0BHP30010. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.