What is opioid-induced androgen deficiency and what symptoms may arise?

• A. Hypogonadism from chronic opioid suppression of HPA axis; fatigue, decreased libido, decreased muscle mass
• B. Adrenal fatigue with fatigue only
• C. Increased testosterone causing aggression
• D. Hyperprolactinemia causing galactorrhea

Answer: (A)

Opioid-induced androgen deficiency happens because chronic opioid use suppresses the hypothalamic release of GnRH, which lowers pituitary LH/FSH and ultimately reduces testosterone production. This central suppression leads to a form of secondary hypogonadism, with the typical symptoms reflecting low testosterone: fatigue, decreased libido, and loss of lean muscle mass. In practice, men on long-term opioids may also experience mood changes, erectile difficulties, and reduced bone density over time. The other options don’t fit because they describe unrelated or incomplete mechanisms (adrenal fatigue; increased testosterone; hyperprolactinemia–galactorrhea) that don’t capture the central deficiency and its common symptom cluster.