BACKGROUND: Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.OBJECTIVE: To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.METHODS: A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone-binding globulin, progesterone, luteinizing hormone and follicle-stimulating hormone, and estradiol) were obtained.RESULTS: In men, a low FT level was more common in opioid users (20/26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32/47) and controls (13/18; P=0.75), and also did not relate to any hormone abnormality.DISCUSSION: Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.CONCLUSION: Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.

中文翻译：

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阿片类镇痛药可抑制男性性腺功能，但男女使用阿片类药物与性功能障碍的症状不相关

背景：阿片类镇痛可削弱男性和女性的性腺功能，但与性腺功能减退的症状和激素测量之间的相关性尚不明确。目的：确定使用阿片类药物治疗慢性疼痛的男女性腺功能受损的频率方法：对在多学科疼痛诊所就诊的患者进行了一项前瞻性研究。总共招募了65名女性（47名阿片类药物使用者和18名非阿片类药物镇痛对照）和32名男性（26名阿片类药物使用者和6名对照）。性功能障碍和荷尔蒙检查的历史（男人：总睾丸激素[TT]，游离睾丸激素[FT]，催乳素和促黄体生成激素；妇女：FT，TT，催乳素，硫酸脱氢表雄酮，性激素结合球蛋白，孕酮，结果：获得黄体生成素，促卵泡激素和雌二醇的结果。在男性中，阿片类药物使用者较低的FT水平更为普遍（20/26； P = 0.04）。在荷尔蒙水平异常的男性中，性功能障碍的发生频率与荷尔蒙水平正常的男性没有差异，阿片类药物与非阿片类药物的使用频率也没有差异。在女性中，阿片类药物使用者的FT水平较低（P = 0.02）。仅在更年期组中，阿片类药物的女性中硫酸氢脱氢表雄酮含量较低（P = 0.03）。绝经前更频繁服用阿片类药物的妇女的TT水平较低（P = 0.03）。阿片类药物使用者（32/47）和对照组（13/18; P = 0.75）的女性性功能障碍发生率相同，并且与任何激素异常无关。服用阿片类药物的男性的FT较低，催乳素水平较高，服用阿片类药物的女性的FT含量较低。结论：阿片类药物经常导致男性的FT值低，但异常激素水平与性功能障碍的症状之间没有关系。因此，应该对所有男性进行低FT水平筛查。服用阿片类药物的妇女的FT水平较低，但这与性功能障碍症状没有关系。因此，FT或其他激素的测量被认为对女性没有帮助。但激素水平异常与性功能障碍的症状之间没有关系。因此，应该对所有男性进行低FT水平筛查。服用阿片类药物的妇女的FT水平较低，但这与性功能障碍症状没有关系。因此，FT或其他激素的测量被认为对女性没有帮助。但激素水平异常与性功能障碍的症状之间没有关系。因此，应该对所有男性进行低FT水平筛查。服用阿片类药物的妇女的FT水平较低，但这与性功能障碍症状没有关系。因此，FT或其他激素的测量被认为对女性没有帮助。