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    Old 02-15-2008, 08:53 PM   #1
    forginon
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    Narcotics and Hormone Levels

    I just want to alert the guys to a problem I have encountered and that may affect others who frequent the Pain Management section of HealthBoards.

    I have just learned that my testosterone (T) level is critically low. Apparently the "normal" range is between 200 - 1,000. Mine is 66. I am now learning why I have had certain symptoms for so long. This needs to be treated seriously as T levels can dictate elements of both physical and mental health.

    Although it's not an established scientific fact, yet, there's strong evidence to support the idea that chronic use of opioids contributes to lower T levels. I have been suffering from major depression for many years, seasonal affective disorder for the last few years, lethargy, apathy, low to non-existent libido, weight loss, muscle loss, loss of strength and endurance, inability to concentrate, etc.

    Reading many of the threads on the Men's Health board, I am learning how many of these symptoms are consistent with low T. I am currently being tested for levels of other hormones and body chemicals to determine other potential causes for the low T, besides the opioids. Shortly, my GP may be referring me to an Endocrinologist for the best treatment.

    If you are interested in learning more about the symptoms of low T, I encourage you to read the relevant posts in the Men's Health forum. One specifically appropriate thread is entitled "Symptoms of Low Testosterone," or something real close to that.

    From what I've read so far in the Men's Health section, it's very encouraging to learn how many lives have been dramatically changed by Testosterone Replacement Therapy, or other therapies to jump start one's body to again start producing appropriate levels of T.

    Please don't be concerned that doctors will discontinue opioid therapy to treat low T levels. That's not how to solve this problem, and I don't believe that anyone is theorizing that opioids is ever the only cause of low T, but just one of possibly many causes.

    Best of Luck to all!

    steve

     
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    Old 02-16-2008, 01:23 PM   #2
    forginon
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    Re: Narcotics and Hormone Levels

    I'm glad you posted.

    I care so much for everyone here, and I strongly believe that some of the symptoms we can suffer from with low T, like feelings of depression, lethargy, and such can be dramatically improved through testosterone replacement therapy (TRT), if warranted.

    We are often quick to assume that the depression we feel is the natural result of long-term pain, which it might well be, but there's also the possibility that T levels have been affected by the opioids causing similar symptoms. When I read the success stories in the Men's Health section and how wonderful they feel with TRT, I get very excited at the possibility that I could be feeling much better again. And I want to share that with my friends here. I won't turn this into a soapbox thing, I just want to get the word out.

    I will document my progress with brief posts here and hopefully some will find it helpful. I know this is a sensitive issue and I don't want to make anyone uncomfortable, so I'll keep my progress very brief and to the point.

    steve

     
    Old 02-16-2008, 02:12 PM   #3
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    Re: Narcotics and Hormone Levels

    You.re absolutely correct Steve, My Pm group actually added this info to the new PM contract we sign every year about 2 years ago. I've taken androgel off and on for the last 4 years depending on which med I'm using. Methadone was a major labido killer which is just one effect of low T levels. Morphine was never a problem for me, not oral or IT, But when they switched me to IT dilaudid, I instantly knew my levels had dropped and was retested and put back on androgel.

    We have to realize we are the first control group for extended opiate use. Prior to the invention of OxyC in 96, only terminal patients used high potency meds around the clock. Whether or not they could function sexually or felt like beatng their chest was of little concern in managing hospice care.

    There may not be confirmed studies about opiate effects on hormones, but my docs been doing it long enough to include it in his PM contracts which I see as nothing more than an elaborate informed consent form.

    I'm glad he uses them and I'm glad he's informing people of the risks asoctated with prolonged opiate use. There are several people on the forum using androgel, getting injections or using the patches. Even women need to be aware of the efect opiates have on their hormone system. Your doc is doing the right thing by first confirming it's not a problem with your pituitary gland or caused by something better known, but this is a well known subject amongst PM docs and part of the reason I have a pet peeve about GP's playing PM doc, shrink or giving surgical opinions. They aren't PM's, They shouldn't be giving surgical opinions and they have no biz treating psych problems with meds they just learned about from the rep.

    Sorry your having problems, but the topical "androgel" is very effective, just ask my wife.
    Take care, Dave

    Last edited by Shoreline; 02-16-2008 at 02:22 PM.

     
    Old 02-16-2008, 03:37 PM   #4
    forginon
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    Re: Narcotics and Hormone Levels

    Dave,

    Thanks so much for posting! I have great respect for you and your knowledge and I'm glad you think I'm doing the right thing. Of course, my wife is right there with me wanting this resolved.

    I was the one to request testing because of my ongoing symptoms, and real limited knowledge of opiates and T levels. Since my GP writes all my scripts he's the one who said yes to the testing. My first test came back a 66, and the follow-up a 78, so the problem is confirmed. He did give me a prescription for an AndroGel pump dispenser and you rub the contents on your skin. I'm very lucky to have this GP, as I've been going to this practice since 1964, and he picked right up when my previous GP retired. He's been really good to me and really listens. And he's the first to admit that as a GP he defers to the specialists on many occasions (e.g. my PM doc).

    I want to know why I'm low and rule out tumors and such. I actually printed some posts from the Men's Health section and reviewed them with my GP. He was very interested and consented to more thorough testing. When the results come back I'll probably request a referral to an endocrinologist.

    Dave - thanks again for posting.

    steve

     
    Old 02-16-2008, 08:48 PM   #5
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    Re: Narcotics and Hormone Levels

    Hey Steve, Most likely they will do a MRI of your brain, The good thing is that ost P tumors are benign. The interesting thing about low T levels isn't just how they effect you performance wise "trying to be delicate" but the it really wasn't a performance issue, it was a labido issue. I just didn't care which is so out of caracter. Even meds like cialis or vuiagra are made to solve a vascular problem, they don't restore labido. I really felt the difference and literally felt like chest thumpin once my leevels were back to normal. As far as the numbers, 80 is low, I tested at 102 and 98 after 3 months of % mgs a day my numbers where mid 200. The endo actually has a chart for age and i'm sure there are plenmnty of 18 year olds pushing 1000 , but that's not normal for somoen over 35. I ask about an increase and had done some research about issues like prostate cancer, Hypogonadsim, etc etc and although risky, I felt so much better physically and mentally I ask about an increase and the Endo said I was right where I should be and the goal wasn't to create an artificial high especially do to the risk. I How it made me feel, I would have loved to double the dose, but again, we have to way the risk Vs the benefit.

    Good luck and I hope you're feeligng better soon. Androgel works within weeks or days and the change quite remarkable.

    Take care, Dave

     
    Old 02-16-2008, 10:11 PM   #6
    forginon
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    Re: Narcotics and Hormone Levels

    Dave,

    You are right on the money, as usual.

    I do hope for an MRI since I have a good friend whose pituitary was smashed by a benign tumor, and among other things, he was put on HCG which kick-starts your testes to start producing T again. I'd like to know now if there are any tumors so I can get treatment ASAP.

    Like you, my problem has been libido. I just haven't cared. And that needs to be fixed.

    I do look forward to feeling better. And I am so excited about stories like yours. I wonder if it will help with the pain? Not as an analgesic, but in my ability to deal with it - the attitude.

    Do you happen to know if any of the narcotics are less hard on T than others? I expect they're all equally tough, but I have to ask.

    Thanks again!

    steve

     
    Old 02-17-2008, 04:21 AM   #7
    badoldback
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    Re: Narcotics and Hormone Levels

    One thing you need to watch out for. They will read off the chart and say normal T levels are from 200 to 1000, you are at 205 so you should be OK. These charts are ranges including 8 year old boys and 95 year old men. My own experience is that while taking meds I need to be at about 450ng/dc to be fully functional.

     
    Old 02-17-2008, 07:45 PM   #8
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    Re: Narcotics and Hormone Levels

    Steve, I suffer from adhesive arachnoiditis and am on fairly heavy pain meds. Noticed incrementally increasing loss of libido over many months. Read in a handbook for intractable pain survival that lowT can have profound effects. Asked my doc to do blood test about 5 weeks ago, and sure enough, Tlevel at 120. He prescribed Androgel and after having to pressure my ins. co. and doc sending lab results to them, I finally started on it about two weeks ago. Haven't noticed any profound changes yet, but am very hopeful. We do have to be our own advocate at times and I hope this thread can help others. Besides libido and mood, lowT can lead to osteoporosis IIRC.

    Ernie

     
    Old 02-18-2008, 04:33 AM   #9
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    Re: Narcotics and Hormone Levels

    Hey Steve, I didn't notice a problem untill they put me on methadone. After a while and feeling really wrotten, They referred me to an endo, my first two test were low and I started at 5mgs a day and then moved to 10 mgs a day. Things stabalized and I felt better with methadone and androgel but my insurance changed and I was able to switch back to morphine/r Kadian. I continued taking the same dose of androgel while on morphine for about 3 months before retesting and my level had skyrocketed just from the switch back to morphine. My leel shot up so high after switching to morphine I was able to completely stop the androgel and still remain within normal ranges for someone my age.

    Atfter 6 months I was quickly aproaching my max script benefit so I switched back to methadone and within a month I was back in the low 100's as far as T level and back on ansdriogel. Then I had the pump put in,and started with morphine and felt better again, we retested and I was well above normal again so I discontinued the A-gel again and stabalized out within normal ranges again. Later they switched me to dilaudid to prevent granulomas from the less soluable morphine and surprise surprise, Dialaudid had the same effect that methadone did. The feeling wasn't as profound but we tested levels and started back on the Agel. I only require half the dose on dilaudid that I need while on methadone but That's not enough info to draw an absolute conclusion and pass it on.

    I do think it was pretty obviously that methadone had the most negative impact and morphine had virtually no impact where dilaudid had about half the impact that methadone did on me. Of course were all different, I'm sure there is a coralation between doses, but in my experience meth wa a much greater problem than any other med. The problem though is the risk involved with testosterone suplements. Prostate cancer is no joke, Hypogonadism is a nice medical term for your jewels shrinking which is something I would like to avoid and my doc isn't going to create an artificially high level just because it makes me feel better due to those risks. Basically it's not reasonable to expect a 40 year old to have the same levels as a 20 year old, I'm sure we would feel beter, but the risk outweighs the benefit. Another thing that helps is excercise, but I certainly didn't have the motivation to do that with the T levels of a young girl. LOL Once my levels had been corected excercise has been a daily part of how I manage pain.

    Good luck and I hope they get things all sorted out. Take care, Dave

     
    Old 02-18-2008, 11:42 AM   #10
    forginon
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    Re: Narcotics and Hormone Levels

    Dave,

    Again, all good info.

    I had a feeling that it was the methadone with me too. Before that I had used the fentanyl patch then switched to Avinza, and I don't recall any issues then compared to the period during and after methadone treatment. I was on the methadone for a few years up to 80mg/day. Now I'm back on morphine, with MS Contin, and liquid oxycodone for BT pain, but there's been no reversal of the low T symptoms. Of course, I have not yet begun T replacement therapy.

    Thanks for the well wishes and I'll post progress as it comes.

    Ernie,

    I appreciate the added info about osteoporosis. I wasn't aware of that.

    Thanks Again,

    steve

     
    Old 02-18-2008, 03:18 PM   #11
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    Re: Narcotics and Hormone Levels

    Oh man,
    Another thing for me to worry about. Maybe that explains my depression and lethargy. I know some of it is from side effects, dealing with living alone again, trying to live clean and sober, among my other health problems. But I may just have my doctor test me next time I am in. I have a friend who just turned 50 and he is on the T therapy. I learn something new everyday.

    Brian

     
    Old 02-18-2008, 06:17 PM   #12
    forginon
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    Re: Narcotics and Hormone Levels

    Brian,

    You may not have to worry.

    You haven't used methadone, right? So far we've seen a probable link with low T and methadone. And Shoreline wrote that going on Dilaudid also brought down his T level. You haven't used hydromorphone either, right. As far as I know I was OK on the fentanyl patch, so, from experience, we know of no issues with that either.

    So try not to worry yet.

    Heck, so long as no tumors show up I'm kinda excited. There's a very good chance I may soon be feeling better than I have in years. Maybe my exhaustion, tiredness, apathy, feelings of depression, etc may all be due to exceptionally low T. And I just have to believe that feeling better will help me deal with the pain better.

    If you do get tested, please let me know how it goes, if you feel comfortable with sharing this kind of info.

    Remember "don't worry, be happy."

    steve

     
    Old 02-19-2008, 05:24 PM   #13
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    Re: Narcotics and Hormone Levels

    I stumbled upon the issue on the internet one day about a year or so ago....Asked my PM Doc, and he confirmed that most men who take chronic opiates end up on T replacement. Got a simple blood test from my GP, T came back incredibly low....Was referred to a Urologist.

    The Uro confirmed everything, and started me on Androgel, which is a cream applied once a day. T levels shot up...Feel much better, depression went a way, and my manhood was restored, almost overnight.

    From what I've been able to research (includes my consultation with my Uro), pain meds effect the Pit. Gland....Which is turned off by the pain meds or at the very least, slowed way down. The Pit gland sends a signal to the brain to signal the Testes to make T. Pain meds turn this mechanism off, or slow it waaayyy down. Thus, the signal from the brain to the testes (to make T) is missing. Therefore, you need supplementation. Proper T is CRITICAL to preventing heart disease, and many other important functions (besides the basics).

    I would highly encourage anyone on pain meds to have their T checked....EVEN women. Women make T also, just less of it. T supplementation is very safe and the goal of such is to get you to the "average" percentile. This isn't anywhere near what bodybuilders or athletes take, which is very damaging.

    Last edited by Executor; 02-19-2008 at 05:27 PM. Reason: spelling

     
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