Can patients who require pain medications such as hydrocodone and oxycodone for chronic pain benefit from testosterone therapy?
If you review the study below, you will find that the answer is a definite YES. At Tri-Cities Health, we have noted that a large percentage of patients who experience chronic pain end up with low testosterone levels and could benefit from Testosterone Therapy. The low testosterone levels result not only from the medication, but frequently from the onset of the pain itself. Many of the side effects of the medication are alleviated by treatment geared toward regaining appropriate testosterone levels.
At Tri-Cities Health, we have witnessed the following changes in our patients who have received Testosterone Therapy: Energy levels increase. Sex drive returns. Erectile dysfunction frequently improves. Quality of sleep improves. Muscle mass returns with appropriate exercise. Mental health symptoms improve. An overall improved sense of well-being occurs in most patients.
At the very least, chronic pain patients should know their numbers. Labs that need to be assessed include: testosterone total, estradiol level, SHBG, prolactin, FSH/LH, PSA, CBC, CMP, TSH, Hgb A1C, and Vit D.
Read the abstract from the study below:
Pain. 2015 Feb; 156(2):280-8. doi: 10.1097/01.j.pain.0000460308.86819.aa.
Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial.
Basaria S1, Travison TG, Alford D, Knapp PE, Teeter K, Cahalan C, Eder R, Lakshman K, Bachman E, Mensing G, Martel MO, Le D, Stroh H, Bhasin S, Wasan AD, Edwards RR.
Symptomatic androgen deficiency is common in patients taking opioid analgesics, as these drugs potently suppress the hypothalamic-pituitary-gonadal axis. However, the efficacy of testosterone replacement in this setting remains unclear. The objective of this trial was to evaluate the efficacy of testosterone replacement on pain perception and other androgen-dependent outcomes in men with opioid-induced androgen deficiency. We conducted a randomized, double-blind, parallel placebo-controlled trial at an outpatient academic research center. Participants were men aged 18 to 64 years on opioid analgesics for chronic noncancer pain, and total testosterone levels were <350 ng/dL. Participants were randomly assigned to 14 weeks of daily transdermal gel that contained 5 g of testosterone or placebo. Primary outcomes were changes in self-reported clinical pain and objectively assessed pain sensitivity. Sexual function, quality of life, and body composition were also assessed. The mean age was 49 years. The median total and free testosterone levels at baseline were 243 ng/dL and 47 pg/mL and 251 ng/dL and 43 pg/mL in the testosterone and placebo arm, respectively. Of the 84 randomized participants, 65 had follow-up data on efficacy outcomes. Compared with men assigned to the placebo arm, those assigned to testosterone replacement experienced greater improvements in pressure and mechanical hyperalgesia, sexual desire, and role limitation due to emotional problems. Testosterone administration was also associated with an improvement in body composition. There were no between-group differences in changes in self-reported pain. In conclusion, in men with opioid-induced androgen deficiency, testosterone administration improved pain sensitivity, sexual desire, body composition, and aspects of quality of life.