Suboxone, Methadone, and Testosterone

I've been doing some investigation into the testosterone issue raised by a member. I will share things as I find them. We do know, by the way, that ALL opiates have the potential to reduce testosterone in men; my primary point in my earlier response was that we must be careful to avoid making assumptions based on individual experiences, as that can lead to confusion and 'scientific rumors' that have real influence on the choices people make. I do realize that this IS a forum, and I am grateful for all of the sharing that people do, including the post that raised the testosterone issue.

Here is an article abstract that people will find interesting. For people not used to reading scientific abstracts, the info is divided into several sections-- Abstract, Introduction, Methods, Results, and Conclusions (or Discussion). That is the standard format that you will see in pretty much every scientific publication. The quick way is to read the intro and conclusion; if a person is truly drawing conclusions, though, it becomes important to read the other parts, and in the actual article, not just the abstract. I don't have time for that this afternoon, and I don't know if I can get access to the full article of this particular journal... but the abstract will at least provide people with the conclusions made by the people who did the study.

Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment.
Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, Attia J. Journal of Sexual Medicine. 5(3):684-92, 2008 Mar.

INTRODUCTION: Use of opiates/opioids is associated with hypoactive sexual desire, erectile and orgasmic dysfunction. AIM: To determine prevalence and investigate etiology of sexual dysfunction in men on methadone or buprenorphine maintenance treatment (MMT, BMT).
MAIN OUTCOME MEASURES: International Index of Erectile Function (IIEF), hormone assays, Beck Depression Inventory.
METHODS: A total of 103 men (mean age 37.6 +/- 7.9) on MMT (N = 84) or BMT (N = 19) were evaluated using the IIEF, hormone assays, Beck Depression Inventory, body mass index (BMI), demographic, and other substance use measures.
RESULTS: Mean total IIEF scores for partnered men were lower for MMT (50.4 +/- 18.2; N = 53) than reference groups (61.4 +/- 16.8; N = 415; P < 0.0001) or BMT (61.4 +/- 7.0; N = 14; P = 0.048). Among partnered men on MMT, 53% had erectile dysfunction (ED) compared with 24% of reference groups; 26% had moderate to severe ED, 12.1% in under 40s and 40.0% among those 40+ years. On multiple regression, depression, older age, and lower total testosterone were associated with lower IIEF and EF domain; on multivariate analysis, there were no significant associations between IIEF or EF and free testosterone, opioid dose, cannabis or other substance use, viral hepatitis, or BMI. Total testosterone accounted for 16% of IIEF and 15% of EF variance. Men without sexual partners had lower Desire and Erection Confidence scores and less recent sexual activity, suggesting potentially higher prevalence of sexual dysfunction in this group.
CONCLUSION: Men on MMT, but not BMT, have high prevalence of ED, related to hypogonadism and depression. Practitioners should screen for sexual dysfunction in men receiving opioid replacement treatment. Future studies of sexual dysfunction in opioid-treated men should examine the potential benefits of dose reduction, androgen replacement, treatment of depression, and choice of opioid.

And another one:
Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence.
Bliesener, Niclaas. Albrecht, Susanne. Schwager, Andra. Weckbecker, Klaus. Lichtermann, Dirk. Klingmuller, Dietrich.
Journal of Clinical Endocrinology & Metabolism. 90(1):203-6, 2005 Jan.

The abstract:
High-dose methadone is well known to cause testosterone deficiency and sexual dysfunction in opioid-dependent men. Buprenorphine is a new drug for the pharmacotherapy of opioid dependence. Its influence on the gonadal axis has not been investigated to date. We therefore assayed testosterone, free testosterone, estradiol, SHBG, LH, FSH, and prolactin in 17 men treated with buprenorphine. Thirty-seven men treated with high-dose methadone and 51 healthy blood donors served as controls. Sexual function and depression were assessed using a self-rating sexual function questionnaire and the Beck Depression Inventory. Patients treated with buprenorphine had a significantly higher testosterone level [5.1 +/- 1.2 ng/ml (17.7 +/- 4.2 nmol/liter) vs. 2.8 +/- 1.2 ng/ml (9.7 +/- 4.2 nmol/liter); P < 0.0001] and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. The testosterone level of buprenorphine-treated patients did not differ from that of healthy controls. In conclusion, we demonstrated for the first time that buprenorphine, in contrast with high-dose methadone, seems not to suppress plasma testosterone in heroin-addicted men. To this effect, buprenorphine was less frequently related to sexual side effects. Buprenorphine might therefore be favored in the treatment of opioid dependence to prevent patients from the clinical consequences of methadone-induced hypogonadism.

I believe these studies. My sex drive on suboxone is crazy. I have no problem with ED at all. My problem is PE (premature ejaculation) It got a lot better since I talked about this here though. Also, orgasm on suboxone are extremely more intense. Every time. I'm also back in the gym and had no problem putting the muscle back on that I had. I will be getting a testosterone check in the next 6 weeks and I'll let you know the results.

I've never had problems while on Sub maintenance, I do however remember that when I was using I had very little interest in sex. The times I suffered pretty severe withdrawal I noticed that my sex drive returned full force. So that was fun after all what could be worse than feeling like you want to die (while in withdrawal I mean) ? Having an extremely powerful sex drive after my girlfriend had finally given up on me because of my using....... I'm really glad I'm not using anymore withdrawal was horrible in so many ways...as I'm sure we are all aware.
_________________
"Am I not destroying my enemies when I make friends of them?"
-Abraham Lincoln

Immediately after I went on Suboxone, my sex drive all but disappeared. Orgasms became very difficult to reach, and when I did have them they were very painful. However, now that I have been on almost 5 months of continuing Sub treatment, my normal sex drive is returning, and orgasm has become normal/pleasurable again. It's like my body has adjusted enough to the buprenorphine that it has "overridden" the sex-drive effects. Whoo-hoo!
JD

Ok......big admission and somewhat embarassing...I can obtain erect...but only for awhile...I can have ejaculation but not fully erect......so I use Cialis 20mg when I know I am goingto be intimate. This cost me the true love of my life......she just wsouldn't understand...she was in AA but not opiate addicted. I think of her often......but know that my life is better on sub...just too late. better to have loved...and man did I love her..but I couldn't satisfy sometimes even on Cialis. Some day I will be ready.....but I can't live in the past..she is gone. Love is a hurting thing........

ReRaise,
Wow, I'm very sorry you lost a girl you really loved...that must have been a very hurtful and frustrating experience. I've had similar experiences because since the age of 17 I have had to also be on multiple antidepressants and mood stabilizers. Drugs like that just obliterate the sex drive. In effect I've never had a normal sex drive, and I sometimes suspect that taking antidepressants and abusing opioids from such an early age permanently altered my sexual functioning. Even when my sex drive is so-called "normal" for me, it is much lower than most of my past sexual partners. Some of them have been understanding, some have not. What I would say about the girl you loved who left you over unsatisfying sex: true love isn't based solely on the physical, and there are plenty of other ways to satisfy besides 'traditional' intercourse. And there's absolutely nothing for you or any other guy to be ashamed of for using Cialis and other ED drugs. It's just another medical condition that is treated with medication. It doesn't mean you're not man enough, or other bullsh*t. You're one hell of a man because you did not sacrifice your Recovery for the success of a romantic relationship, even though at the time you might have been really, really tempted. Intimate/romantic relationships are a classic way for many newly clean addicts to relapse. But you didn't! The way I see it, you have taken a major step in your Recovery: you actually have subjected yourself to significant emotional suffering because you are determined to stay clean. I'm proud of you, ReRaise! And don't worry, you are going to meet a woman who is going to value you and your Recovery, and who will be more than willing to work with you to find a solution as a couple for both of your physical needs. You are the man!

I also have problems with sexual desire and relations. I was on methadone for many yrs before switching to Suboxone. I can say I now have a little more interest in sex but it is far from normal. The lack of sex was a major factor in my ex wife divorcing me. We were married for twenty four yrs and she felt my low sex drive was related to methadone and partially because I wasn't attracted to her. The latter was not true. This was frustrating and extremely disappointing for both of us. Even though I am down to 1/2 mg of subs I still am not fully functional... I plan to ask my dr to prescribe Cialis and see if that helps. I tried Viagra several yrs ago and although it did help with longer erection... it did nothing with regards to my libido.

Does anyone know if Cialis is different than Viagra? I am mostly interested in how/if it works on libido... if at all?

Thanks for the info!

What concerns me most about this data is not the erectile issue- understandably, it seems that most male posters are concerned with the sexual function aspects of altered testosterone levels.

I live with hypogonadism, pretty darn profound hypogonadism and my sex life is completely normal. I do find that I am easily stressed, exhausted, and moody. I do not produce sperm. I cannot make another child with my wife.

To me, this is very very distressing. I don't give a crap about keeping it up, my concern is what is hypogonadism brought on by sub like for most men?

The people with low sex drive should get a testosterone blood work up done.

I also have hypogonadism and take testosterone shots. Sometimes he works well and sometimes he doesn't. It sucks. I take a very large dose of methadone and accept the fact i produce NO test. Its embarrassing and was very difficult to explain to my GF. Most don't get it. The key is finding someone that is mature and can take the good with the bad..f everybody else.

also im only 29. I want to applaud everyone that has the nutz to talk about ED, hypogonadism, anything related, viagra, lost loves, ....all those post hit home...if not for the people on the thread i wouldn't have said anything-so thankyou!

this is my last post on this thread LOL
to those that might seek testosterone replacement therapy; testosterone can be addicting in it's own right. It can cause positive and negative effects. negative effects if taken in too large dose..eg. bodybuilders, it can enlarge the prostate, cause gyno (bitch tits), water retention, estrogenic side-effects
It can be addicting because of drawing it up with a needle and injecting, increased sex drive, massive strength gains, pain loss, increased energy and stamina..all causes to increase a 'therapeutic' dose
just remember as addicts..always do what the instructions say...i always liked 'to play doctor'-that's what got me into trouble among others

I just tested in the very low range for free testosterone. I have an appointment in 3 weeks to see the doctor about treatment. Does anyone have any experiences with testosterone patches or gels, rather than getting injections? One of my issues is that I don't drive, so I can't go to the doc very often for shots. How often, generally, do you need the shots? I've read it takes 2-3 months of treatment to see good results of a raised testosterone level....is that true? Any guys with experience with this issue, please respond. My symptoms are loss of muscle tone, loss of strength, extreme fatigue, moodiness, weight gain, and no sex drive whatsoever. I also had many of these symptoms before the Suboxone, and had always suspected I had low testosterone from opioid and polydrug abuse in general, so I think this is a long-term problem for me.
james

I went to see my Sub doc about getting treated for this low Testosterone issue that has probably been caused by my use of Suboxone. He prescribed Adrogel, and now I'm waiting on my insurance company for special approval (which f-ing sucks, b/c they should just suck it up and pay for the damn stuff).
Anyway, my Sub doc is pretty young, and has been prescribing Sub for about 6 years. He stays very current with the literature and etc., and he is very knowledgeable. He says about one-fourth of his male patients suffer from testosterone deficiency so severe that it requires hormone replacement therapy directly most likely because of the Suboxone.

For me when I first started Suboxone I was like a marathon runner, most likely for the decreased sensitivity. It would take me an hour plus to ejaculated. At first, my partner didn't mind at all..Actually, she loved it...After a while it became a little annoying though. Now though, everything has evened out and I'm back to my normal two minute man self. Well, atleast with myself since I'm on quite the dry streak. Hey! at least I'm sober though!

Hey -

I read through the information that Dr. Junig posted about low testosterone.

I decided that since I had messed around with opiates for 8+ years before I started suboxone, perhaps my testosterone was low. I had most of the symptoms, and without blaming suboxone for this (I believe my case was carry-over from long term use), I went in for a blood test.

What was interesting was that the response was "I was in the normal range...." so I asked for a copy of the blood test. I was normal - for the mean and median of an average 80 year old man. It takes some digging to find research publications about American men's average total and free testosterone levels. But, I did find them.

When I visited with my doctor with my chart from a study done over a decade ago - he said that the big deal is that overall American men are decreasing in their testosterone level in the general population. In short, what a 46 year old male's testosterone level 20 years ago - compared with today - would be lower. There is no conclusive evidence why this is happening. We laughed that maybe it is in the water.

He wasn't worried for me - that it was caused by opiates or suboxone - rather that I was 46 and my testosterone was in the lower 5 percentile.

That was a few weeks ago. We decided that it was worth a try with Androgel. The entry level dose. Everything I read says this is a 3 month process to really see the results.

I'm into it a couple weeks - and the first thing I noticed was within a week or so, I suddenly had more energy after work. Nothing drastic, but I could do that 'one more thing.'

I'm not sure that this is 100% related to testosterone or not. It may be psychological as I know I am doing 'something' to help. In my little myopic world, though, that is OK. If I get more energy, more interest in sex, easier time with erections, etc. it is worth it. That is as long as I don't get the side effects.

I guess what I am saying is that for some men who have lost interest or have issues that may be attributed to low testosterone, what does it hurt to have the test? I honestly think that suboxone has not made my case much worse, I just CARE MORE now that I am clear headed. Don't know if that makes sense.

Well --- that's my update. Don't know if anyone cares Smile

--LD

After 6 months of Suboxone treatment (average of 8 mg and now 5 mg a day), my testosterone got down to nothing. My level one month ago was 52. That's next to nothing! I had gotten to feeling so bad, tired, and gained so much weight that I just wanted to die. After I started Androgel 5 g packets eight days ago, I can already feel my energy coming back. BUT I will have to see the doctor in 5 weeks to get my T levels checked, and he said I'll probably have to go on the 10 g Androgel pump. Anyway, what I want to know is this: I'm not going to stop taking Suboxone, so does that mean I'll always have to take Androgel? Because that's not going to be financially feasable at some point.
James