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Bawor M, Dennis BB, Samaan MC, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Coote M, Pare G, Thabane L, Samaan Z. Methadone induces testosterone suppression in patients with opioid addiction. Sci Rep 2014; 4:6189. [PMID: 25155550 PMCID: PMC4143768 DOI: 10.1038/srep06189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022] Open
Abstract
Sex hormones may have a role in the pathophysiology of substance use disorders, as demonstrated by the association between testosterone and addictive behaviour in opioid dependence. Although opioid use has been found to suppress testosterone levels in men and women, the extent of this effect and how it relates to methadone treatment for opioid dependence is unclear. The present multi-centre cross-sectional study consecutively recruited 231 patients with opioid dependence from methadone clinics across Ontario, Canada between June and December of 2011. We obtained demographic details, substance use, psychiatric history, and blood and urine samples from enrolled subjects. The control group included 783 non-opioid using adults recruited from a primary care setting in Ontario, Canada. Average testosterone level in men receiving methadone treatment was significantly lower than controls. No effect of opioids including methadone on testosterone level in women was found and testosterone did not fluctuate significantly between menstrual cycle phases. In methadone patients, testosterone level was significantly associated with methadone dose in men only. We recommend that testosterone levels be checked in men prior and during methadone and other opioid therapy, in order to detect and treat testosterone deficiency associated with opioids and lead to successful methadone treatment outcomes.
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Affiliation(s)
- Monica Bawor
- 1] MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON [2] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Brittany B Dennis
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Health Research Methodology Graduate Program, McMaster University, Hamilton, ON [3] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - M Constantine Samaan
- Division of Pediatric Endocrinology, Department of Pediatrics, McMaster University, Hamilton, ON
| | | | - Andrew Worster
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Department of Medicine, McMaster University, Hamilton, ON
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres, Ontario, Canada
| | - David C Marsh
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Northern Ontario School of Medicine, Sudbury, ON
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Meir Steiner
- 1] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON [2] Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON [3] Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Rebecca Anglin
- 1] Department of Medicine, McMaster University, Hamilton, ON [2] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Margaret Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON
| | - Guillaume Pare
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Lehana Thabane
- 1] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [2] Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada
| | - Zainab Samaan
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [3] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
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Depression, Testosterone concentration, sexual dysfunction and methadone use among men with hypogonadism and HIV Infection. AIDS Behav 2012; 16:2236-43. [PMID: 22722881 DOI: 10.1007/s10461-012-0234-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Low testosterone levels are associated with depression and impaired sexual performance. We examined the association between hypogonadism, sexual function and depression among men with HIV infection in Shiraz, Iran. A total of 237 male HIV-positive patients referred to voluntary counseling centers were recruited based on convenience sampling from May to October 2010. All patients provided informed consent and completed the Beck Depression Inventory (BDI-II) and Brief Male Sexual Function Inventory (BMSFI). Blood samples were collected after an overnight fast to measure free testosterone (FT) concentration. Hypogonadism was found in 68 % of the participants, and about 68.8 % had moderate and severe depression. Serum FT levels were significantly lower in patients with depression and a direct association was found between the risk of hypogonadism and increased BDI-II score. Among methadone nonusers and nondepressed patients, an inverse association was found between hypogonadal and eugonadal men in the sexual drive, erectile and ejaculatory function domains of the BMSFI. However, there was no significant association between methadone user status and depression. Depression and hypogonadism had a reciprocal effect. Depression and methadone use were associated with hypogonadism and had a significant effect on sexual function.
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Sharma A, Flom PL, Weedon J, Klein RS. Prospective study of bone mineral density changes in aging men with or at risk for HIV infection. AIDS 2010; 24:2337-45. [PMID: 20683316 PMCID: PMC2936812 DOI: 10.1097/qad.0b013e32833d7da7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate rates and predictors of change in bone mineral density (BMD) in a cohort of aging men with or at risk for HIV infection. DESIGN A prospective cohort study among 230 HIV-infected and 159 HIV-uninfected men aged at least 49 years. METHODS Longitudinal analyses of annual change in BMD at the femoral neck, total hip, and lumbar spine. RESULTS At baseline, 46% of men had normal BMD, 42% had osteopenia, and 12% had osteoporosis. Of those men with normal BMD, 14% progressed to osteopenia and 86% continued to have normal BMD. Of the men initially with osteopenia, 12% progressed to osteoporosis and 83% continued to have osteopenia. Osteopenia incidence per 100 person-years at risk was 2.6 for HIV-uninfected men and 7.2 for HIV-infected men; osteoporosis incidence was 2.2 per 100 person-years at risk among men with osteopenia, regardless of HIV status. In multivariable analysis of annual change in BMD at the femoral neck, we found a significant interaction between heroin use and AIDS diagnosis, such that the greatest bone loss occurred with both AIDS and heroin use (adjusted predicted mean annual bone loss 0.0196 g/cm). Hepatitis C virus seropositivity was also associated with femoral neck bone loss (P = 0.04). The interaction between AIDS and heroin use also was associated with bone loss at the total hip, as was current methadone use (P < 0.01). CONCLUSION We found an association of heroin use and AIDS with BMD change, suggesting that heroin users with AIDS may be at particular risk for bone loss.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
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Dobs A. Role of testosterone in maintaining lean body mass and bone density in HIV-infected patients. Int J Impot Res 2003; 15 Suppl 4:S21-5. [PMID: 12934047 DOI: 10.1038/sj.ijir.3901032] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Low testosterone levels are common in both men and women with human immunodeficiency virus (HIV) infection and may contribute to loss of lean body mass and AIDS wasting. Causes of low testosterone levels are complex and may include chronic illness, HIV infection and its complications, medications used to treat HIV and opportunistic diseases, and normal aging-related declines. In the majority of studies addressing the use of testosterone treatment in HIV-infected patients, testosterone has been found to help prevent loss of lean body and muscle mass. Whether the combination of exercise and testosterone is more effective in preventing loss of lean body mass than either therapy alone is not yet clear and warrants further study. In addition to its effects on body composition, testosterone treatment results in improved mood and libido in HIV-infected women and increased bone mineral density in HIV-infected men. Testosterone may thus make a valuable contribution to the treatment of HIV-infected individuals. International Journal of Impotence Research (2003) 15, Suppl 4, S21-S25. doi:10.1038/sj.ijir.3901032
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Affiliation(s)
- A Dobs
- Division of Endocrinology & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Abstract
HIV infection is associated with a number of adverse consequences, including metabolic disorders. This article reviews disorders such as wasting, lipid metabolism disorders (including fat redistribution or dyslipidemia), glucose abnormalities, bone disease, and endocrine disorders such as hypogonadism in the presence of HIV infection and/or drug abuse. The issues covered are current estimations of prevalence, risk factors, underlying pathophysiology, diagnosis, and interventions (prevention and treatment) for metabolic complications of HIV and drug abuse.
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Affiliation(s)
- Adrian Dobs
- The John Hopkins University School of Medicine, Baltimore, Maryland, USA.
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