ENDO 2013: The Endocrine Society 95th Annual Meeting & Expo:

Testosterone Replacement Improves Pain Sensitivity and Quality of Life in Men on Opioids

Testosterone replacement therapy in men is prescribed to treat androgen deficiency. Common symptoms of androgen deficiency include reduced sex drive, decreased energy, and depression. Furthermore, a healthy testosterone level in men is necessary "…for cellular growth, healing, maintenance of muscle mass and bone, and central nervous system maintenance of opioid receptors, blood-brain barrier, and dopamine-norepinephrine activity."1 Testosterone replacement is an important treatment consideration in men who take opioids for chronic pain.

During The Endocrine Society's 95th Annual Meeting (ENDO 2013), Shehzad S. Basaria, MD presented results from a small, but important randomized clinical trial about opioid-induced androgen deficiency. Dr. Basaria is the Director, Androgen Clinical Research Unit and Associate Professor of Medicine in the department of Medicine Endocrinology, Diabetes and Nutrition at Boston University School of Medicine in Boston, MA.

The objective of the trial was to determine if testosterone replacement improves pain perception and tolerance, as well as quality of life in men diagnosed with opioid-induced androgen deficiency.

Eighty-four men age 18 to 64 years with opioid-induced androgen deficiency participated in this 14-week trial. Participants were randomized to either 5 gm of transdermal testosterone gel or placebo. Sixty-five men completed the study; 36 in the testosterone group and 29 in the placebo group.

At Baseline
Standard Deviation
33 kg/m2
Total testosterone
228 ng/dl
Free testosterone
44 pg/ml

 Pain perception was measured using the Brief Pain Inventory (BPI) questionnaire. Pain threshold and tolerance were measured using Quantitative Sensory Testing (QST). Quality of life was measured by the SF-36 questionnaire. Outcomes were measured at baseline and at week 12. Liquid chromatography/mass spectrometry measured total testosterone, and free testosterone was calculated.


At 12-weeks
The men randomized to testosterone exhibited significant improvement in:

  • Pressure pain threshold
  • Mechanical pain intensity
  • Cold presser pain
  • Mood (emotional)
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