Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Pain Res Manag. 2011 Sep-Oct;16(5):311-6. doi: 10.1155/2011/807123.
Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.
To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.
A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone- binding globulin, progesterone, luteinizing hormone and follicle- stimulating hormone, and estradiol) were obtained.
In men, a low FT level was more common in opioid users (20⁄26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32⁄47) and controls (13⁄18; P=0.75), and also did not relate to any hormone abnormality.
Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.
Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.
阿片类镇痛药会损害男性和女性的性腺功能，但与性腺功能减退症的症状和激素测量值之间的相关性尚未得到很好的确立。
确定使用阿片类药物治疗慢性疼痛的男性和女性性腺功能障碍的频率，并确定症状与性腺功能的激素测量值之间的相关性。
对参加多学科疼痛诊所的患者进行了前瞻性研究。共纳入 65 名女性（47 名阿片类药物使用者和 18 名非阿片类镇痛药对照者）和 32 名男性（26 名阿片类药物使用者和 6 名对照者）。获取了性功能障碍史和激素检测（男性：总睾酮[TT]、游离睾酮[FT]、催乳素和促黄体生成激素；女性：FT、TT、催乳素、脱氢表雄酮硫酸盐、性激素结合球蛋白、孕酮、促黄体生成激素和卵泡刺激素以及雌二醇）。
在男性中，阿片类药物使用者中 FT 水平较低更为常见（20/26；P=0.04）。在激素水平异常的男性中，性功能障碍的发生频率与激素水平正常的男性无差异，且阿片类药物与非阿片类药物的使用频率也无差异。在女性中，阿片类药物使用者的 FT 水平较低（P=0.02）。仅在绝经期组（P=0.046）中，阿片类药物使用者的脱氢表雄酮硫酸盐水平较低更为常见（P=0.03）。服用阿片类药物的绝经前女性 TT 水平较低的频率更高（P=0.03）。阿片类药物使用者（32/47）和对照组（13/18）女性性功能障碍的发生频率相同（P=0.75），也与任何激素异常无关。
服用阿片类药物的男性 FT 和催乳素水平较低，而服用阿片类药物的女性 FT 水平较低。服用阿片类药物的男性和女性的性功能障碍频率与激素水平均无相关性。
阿片类药物经常导致男性 FT 水平降低，但激素水平异常与性功能障碍症状之间没有关系。因此，所有男性都应筛查 FT 水平降低。服用阿片类药物的女性 FT 水平较低，但这与性功能障碍症状无关。因此，FT 或其他激素的测量值在女性中被认为没有用处。
