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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168024/
8.2 Management of mixed hypogonadism due to opiates
Chronic opiate therapy can result in low testosterone levels because opiates suppress the hypothalamus-pituitary-gonadal axis in a dose dependent manner to reduce testosterone production. Patients with a history of chronic opiate use and who present with symptoms of hypogonadism should be evaluated. Other causes should be excluded and opiate induced hypogonadism may be the diagnosis if there are no other causes of hypogonadism [155,156]. The patient should be referred to a pain clinic and behavioral therapies to help wean the subject off opiates. If this effort is not successful, then the patient may be offered testosterone replacement therapy. If fertility is a concern, then medications that inhibit negative feedback of estrogen (e.g., clomiphene citrate) can be tried even though there are limited data on their effectiveness.
8.2 Management of mixed hypogonadism due to opiates
Chronic opiate therapy can result in low testosterone levels because opiates suppress the hypothalamus-pituitary-gonadal axis in a dose dependent manner to reduce testosterone production. Patients with a history of chronic opiate use and who present with symptoms of hypogonadism should be evaluated. Other causes should be excluded and opiate induced hypogonadism may be the diagnosis if there are no other causes of hypogonadism [155,156]. The patient should be referred to a pain clinic and behavioral therapies to help wean the subject off opiates. If this effort is not successful, then the patient may be offered testosterone replacement therapy. If fertility is a concern, then medications that inhibit negative feedback of estrogen (e.g., clomiphene citrate) can be tried even though there are limited data on their effectiveness.