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The effects of opioids on the endocrine system: an overview
  1. Koddus Ali1,
  2. Jon Raphael1,2,
  3. Salim Khan1,
  4. Mourad Labib3,
  5. Rui Duarte4
  1. 1Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
  2. 2Department of Pain Management, Russells Hall Hospital, Dudley, UK
  3. 3Department of Biochemistry, Russells Hall Hospital, Dudley, UK
  4. 4Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Koddus Ali, Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Ravensbury House, Birmingham B15 3TN, UK; koddus.ali{at}


Opioids commonly used for pain relief may lead to hypogonadism, which is characterised by suppression of production of the gonadotropin-releasing hormone (GnRH) resulting in inadequate production of sex hormones. The aim of this narrative review was to highlight the effects of opioids on the endocrine system and the development of hypogonadism. MEDLINE, EMBASE and Cochrane Library were searched for relevant articles investigating hypogonadism in patients undertaking opioid therapy by using a combination of both indexing and free-text terms. The suppression of GnRH leading to a decrease in sex hormones has been described as the principal mechanism of opioid-induced hypogonadism. However, there is no consensus on the threshold for the clinical diagnosis of hypogonadism. Evidence indicates that chronic opioid use can lead to hypogonadism. Clinicians should be aware of symptomatology associated with hypogonadism and should regularly monitor patients with appropriate laboratory investigations.

  • opioids
  • hypogonadism
  • chronic pain
  • testosterone
  • testosterone replacement therapy

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  • Contributors KA authored the manuscript with significant input from ML and RD. All authors commented on the manuscript and approved the final version of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.