Altered Sexual Function and Decreased Testosterone in Patients Receiving Intraspinal Opioids

Altered sexual function has been reported in individuals addicted to opioids or on methadone maintenance, yet little literature is available regarding the effect of intraspinal opioids on libido or sex hormone levels. We evaluated sexual function and plasma sex hormone levels in six men treated with chronic intraspinal opioids. All patients had some reduction in libido and four patients had difficulty obtaining or maintaining an erection. These changes were noted within 1 month of beginning intraspinal opioid therapy. Serum testosterone levels ranged from 26 to 367 ng/dL (normal, 350-1500 ng/dL); the mean serum level was 197.7 ng/dL (SD = 119.8). Serum testosterone levels and other sex hormones, including follicle-stimulating hormone, luteinizing hormone, sex-hormone-binding globulin, and prolactin, should be measured prior to and at various points during intraspinal opioid therapy. Patients should be queried regarding sexual function and should be cautioned regarding the possibility of these adverse effects prior to initiating spinal opioids. Supplemental testosterone should be considered to treat this dysfunction.