10 Nov Methadone Treatment Reduces Testosterone in Men, Study Finds
Most treatments come with potential side effects, and medicines designed to help people overcome addiction are no different. Methadone is a widely used substitute opioid, prescribed to help people overcome heroin addiction (and as a pain reliever), but it may lead to other issues in men, according to the results of a recent study. Previous research has shown that methadone treatment can reduce testosterone in men, but a new piece of research has suggested that the reduction is larger than previously thought. The authors suggest this should be considered before prescribing men methadone or other opioid therapy, but other experts point out flaws in the study and suggest that this may not be necessary. Finding out more about the research gives you the full story on what was found and what it means for the treatment of opioid-addicted men.
Comparing Testosterone Levels
To conduct the study, the researchers recruited 231 patients (56.7 percent were men) with opioid dependence from methadone clinics across Ontario in the latter half of 2011. These were matched with 783 non opioid using adults (the “control” group) recruited from primary care in Ontario, and all participants had demographic characteristics, substance use history, psychiatric history, blood samples and urine samples taken. The research was cross-sectional, so it looked only at methadone-using status and testosterone levels at one point in time — meaning the authors could not follow a patient before and after starting methadone treatment to establish any change in testosterone levels after treatment started. Instead, it only allowed them to establish a correlation between methadone use and low testosterone, which may mean there is causation but also may not — there is no way to tell from this type of study.
Methadone’s Effect on Testosterone Levels
The authors found that testosterone levels in men in methadone treatment were significantly lower than those in the control group, with testosterone levels falling as the methadone was increased. For women, no such association was observed, and the researchers also checked for a difference depending on the women’s menstrual cycles, but this turned up no difference either.
The researchers comment that, “Our results have confirmed the suppressive effect of methadone on testosterone in men undergoing methadone treatment. This sex-specific difference … is indicative of a distinct biological mechanism between men and women.” The authors suggest that, while opioids such as methadone suppress sex hormones in men by affecting the gonads, they may primarily suppress B-estradiol in women and testosterone only as a secondary androgen.
An issue identified by the authors is that the number of women receiving methadone treatment in the study was quite low, so while it didn’t have enough power to find a significant association, it may be useful to establish the likely size and direction of the effect. They believe that, despite this limitation for the female sample, the finding may be able to assist clinical decision-making for men struggling with opioid addiction, specifically by encouraging screening for testosterone deficiencies (with a simple blood test) and enabling continual monitoring. They argue that this could improve quality of life for patients and may even improve treatment outcomes overall.
Limitations of the Study
As mentioned earlier, the cross-sectional design of the study makes it difficult to know whether the low testosterone observed was really due to methadone or some other reason. Additionally, Dr. Roger Chou (of Oregon Health and Science University in Portland, who was not involved with the study) noted that the control group did not include addicted individuals, but it could be that opioid addiction itself is associated with these effects on sex hormones rather than methadone. He suggests that, while the finding does agree with previous research, better evidence is needed before it can be taken as a basis for clinical practice or a justification for further (and possibly unnecessary) testing.
He added, “I think it’s more important to assess the patient clinically. This means if somebody isn’t having any sexual dysfunction or other things that might signal testosterone deficiency, I personally don’t think there’s any reason to check their testosterone level.”
The issues with the study notwithstanding, the findings do indicate that opioid use in the form of methadone appears to have a notable impact on testosterone levels in men. This can have many impacts on the individual (including loss of sex drive, erectile dysfunction and depression), so if further research confirms this effect, it may lead to improved care for men addicted to opioids.
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