Opioid-induced hypogonadism in palliative care. Does it matter? Report on four patients treated with hormone substitution

Emma Roantree; Zbigniew Zylicz

Vol 8, No 2 (2009)

Case reports

Published online: 2009-03-30

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Opioid-induced hypogonadism in palliative care. Does it matter? Report on four patients treated with hormone substitution

Emma Roantree, Zbigniew Zylicz

Advances in Palliative Medicine 2009;8(2):69-74.

Vol 8, No 2 (2009)

Case reports

Published online: 2009-03-30

Abstract

Many patients treated for a long time with opioids develop hypogonadotrophic hypogonadism with deficiencies in dehydroepiandrosterone sulphate (DHEA-S) and testosterone. It is thought that hypogonadism results in the symptoms of fatigue, depressed mood, slower cognition, increased pain sensitivity, amenorhoea and loss of libido. It is debatable but quite possible that hypogonadism may also be one of the reasons of opioid tolerance. Substitution of the hormones; testosterone and/or DHEA may potentially break this vicious cycle, restore pain sensitivity to opioids and improve other symptoms improving patient's quality of life. In this article we describe four patients with intractable pain treated compassionately with either DHEA or testosterone. From the observations done by us, it is clear that substitution of those hormones has potentially a profound effect on opioid activity, both aimed and adverse effects. Suggestions for future studies are made.