(OPIAD) Opioid-induced androgen deficiency

[sk8phaze (OP)]

(OPIAD)

http://www.ncbi.nlm.nih.gov/pubmed/22786453

Abstract

Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD).

    This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression.

    Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken.

     Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation.

     Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males.

**I've been searching on and off for 2 years for the name of the medical condition, and every symptom on that list that applies to males, I have. Except one. The only symptom that i don't have there on that list any lack in hair growing. Quite the opposite actually, i've always had to get haircuts more regularly then before i started using, but even if i spend 20 min shaving my face after a shower/bath and get it smooth as a babys ass with once of those super overpriced razors that "Now come with 25 BLADES each!" (Said in that cheesy infomercial voice) "But wait...! There's more!!!!"

    Obviously I was being sarcastic about the # of blades per razor, but I'll go from a smooth shaved baby-face to a 80 grit sandpaper face by 5pm. My barber I used when I was in my late teens/early 20's told me that hair is the body's way of getting rid of the harder substances in the body. The ones that you cant or don't excrete thru Stool or Urine, or sweat.**

    I can tell a large, No...Huge difference between IV'ing and smoking H or whatever my current  DOC is, and when i dont take opiates(blasphemy! lol)i'll come back to normal in a months time roughly.

   Narcotic long term usage really took the blinders off on how much time,effort, and Money I put into sex. Showing me how I had let some of my past girls especially the gold digger types walk all over me and control me. Now that i'm on long term bupe maintenance its taking much longer to bounce back to my full ravenous sexual appitite which i've experienced on Bupe before.
   
Having this OPIAD condition has its benefits if your a optimistic type of glass half full kinda bloke like me, I tryto always see a silver lining in everything yada yada yada. Seriously though, now I don't mind being single and I've found that saying "No" to a girl causes a very unusual  phenomena to happen Immediately:

*Piss her off(in a good way)!!!! The 1st time I tried this my girl at the time was on top of me in a hot tub, both nude, sitting right on top of my dick, she tried to slide down & when I told her "no, you have to wait and earn it..."
*Telling her a word that she rarely if not ever is used to hearing, she'll assume your joking, then once you make it known that your for real, she'll be surprised almost stunned, then the surprised effects turn to anger (now: there could be a number of reasons why the female was denied my 'sweet sweet lovin' =P, but it doesn't matter, you've now not only got a girl that feels rejected but also confused & denied even though she knows its only temporary, translation. Everyone wants what they cant have, so now you've got a cutie on pins & needles waiting for "The Night", I usually will get the deal done 3-4 days later but I've made a girl wait for 3 weeks before BUT she said it was by far the best sex she ever had and had been thinking about me nightly in the bathtub til the special night arrived, allowing time to get to know someone before being lovers makes for such wonderful intimacy. 

*Congrats, you showed her something that goes against everything she thought she knew about guys(aka-'There are guys that aren't just tryin' to fuck me, bullshit, no f'ing way, cuz all girls are convinced that all men are fuckboi's/players.BAM!  mind  blown, ) Then a phenomenon happens. 
* 1.) She doesnt know why you said to wait, is there another girl, is he gay, did i fuck it up...?
   2.) This drives the girl crazy, Cuz NOBODY makes her wait, ever. She been conditioned to being cat called holla'd at and putting little to no effort into finding a good guy, let alone a meaningful relationships cuz, why would they? They have the All Mighty Vagina.
   3.) So now this girl is bothered by your telling them no...it'll be less then 30 days, Let them know its not forever, it might be tomorrow or in a month, and that if she has a problem with that, explain that you dont wanna be with a girl that you barely know, or that you simply just dont fuck on the 1st date.
*This makes a delightful craving causing their desire for you to go up, plus their not feeling slutty with someone u just met.
* Your done! Now, you have killed many birds with just one stone!

  You now have the power to call any time of any day, and within 30 min tops she be there. Wet n ready.
Cause hey, everybody wants what they cant have, more importantly. Every girl knows all guys are only after sex Duh! dont you watch LifeTime movies?
"a guy would never say no to sex with a girl unless he was gay or a serial killer."

   To the ladies reading this post im talking about this condition for men thats like having menopause for us, younger Junkies like me, im 32. This seldom occurred to me even on long oxy/H runs, on Bupe maintenance my hormonal levels always went back to 100%.
 I've been on Bupe for 8 months, chipping on H once every week or two, so 2-4 times a month but never consecutive days back to back, i like keeping a lil bupe in my system so im not sick while awaiting my next dose of bupe, but if i wanna do some Full Mu agonists i still have some receptors free to cling to.

     Ultimately, since there is not much data on this newly known subject I was wondering about going to the doctor to see if i can get some blood tests done to see what going on, i'm burning up everywhere i go, i have a low sex drive when thats NEVER been the case, lack of motivation, i'm lonely, but i can barely put the effort into going to work everyday, let alone having to please someone else while paying for everything. and LA girls will remind you daily that if you cant provide her every-need, there are guys on the regular that would KILL to be with them, and that I should be so lucky...ugh.

   So i wanna shout out some Thanks:
*thanks for reading this whole post
*thanks to saving money by not wasting it on gold diggers
*thanks to opiates for making me more picky who i sleep with, no more $5 Holla's behind the 7-11 from the resident trap house skank(lol, kidding)
*I think its the only reason i had unprotected sex with random girls not on birth control, and not getting any off them pregnant.

   Ultimately, now that I just finished my first week at my new 1st Career, 1st salary job, and more money at my disposal then i feel comfortable with. I like this new job and I want a good girl to look forward to seeing nights/weekends. But I don't want her to do drugs, only pot & booze. I need a positive influence to balance out my bad boyish nature, while simultaneously keeping me a good boy,  Either i stay strong on Bupe Maitinence, or I give in and have a decent sum of savings, with a newly acquired low tolerance, thats the ultimate recipe for your average OD story.

   I'll wrap this up the way i should have started, I would like to make these side effects go away, I miss my personality, my sex-drive, my CONFIDENCE for sure!!!! And just overall i want my sense of self back. Been told on several occasions i was smart as well, Normal Sk8Phaze is a happy go lucky, smooth talking, decent looking, charismatic guy with a dirty but funny sense of humor. I've had 2 or 3 situations where a girl wanted to fuck and my dick was more unresponsive then an OD'd freshly out of rehab coppin' a bundle and shoots it all at once. Very embarrassing. But tbh, they weren't my type and i know for a fact its saved me from hooking up with a blonde girl with herpes.
 
   Sorry for the long post, this condition is incredibly annoying as i wake up in w/d's
 even if i took my PM dose right before sleep, , i have no urge to masturbate but if i dont it'll cause a wet dream so i gotta get it out whether i want to or not, & i still wake up with watery eyes, goosebumps, depression, lack of motivation until 45-60 min. passed and the bupe + Diazepam  is working.

    This weekend even if i did have $20k in spending money, i have no interest in going out and doing new things like i used to. The longer I continue this homebody cycle of enjoying isolation the more it consumes me. My monthly schedule is work,  come home, watch youtube, and drink/smoke weed, maybe eat. The few girls that call still i dont answer 60% of the time.
   
    Thats not the real me! This never happened on Buprenorphine before. I mean i felt normal and energetic and horny for a couple months last year about 1 month after voluntarily switched from bth to Subs. Then it came back again. @candy and the others here in the medical field, do you have any advice on how to return my endocrinopathic system back to normal. In simple, I need to increase my testosterone levels back to normal. I've tried expensive GNC bottles of Ultra Testosterone Boosters with the flashly labels and the sky high price with minimal to zero results, I've heard or read that in order to really make a difference you must get a RX'd topical Cream or they give iv/im injections.
     I would just walk to the hospital and wait in the ER or Urgent Care center and have them refer me to a specialist or order blood work/lab tests, but in order to do so I'll have to tell them that this is caused by Long Term Opioid Maintinence, some legal, some not.

  Will they put in my profile that I was an illict IV narcotic user? And not give me the quality and devotion to fixing this hormonal imbalance, or will they just say, "quit drugs and you'll be normal in 6 months tops" while making sure i never get RX'd even a tylenol3 ever again?

   I just want to have my energy back, so I can go out and meet new friends, which in turn eventually leads to meetig a girl. So on the bright side of things at least i got time to work it out. Sorry this thread seemed to have two topics merged together but its really one big question, how do i raise my testosterone without becoming some 'roid rage asshole with a high pitch voice.

                                                                                                                         Sk8Phaze

 

[theSWPK]

Step one: go to your doctor and have blood work done. Tell them you are concerned about your hormone levels and specifically ask for a testosterone panel. If your test is low, you'll be prescribed the cream/patch/injections.

Step 2: that's it man...

[sk8phaze (OP)]

Step 3: Thank u SWPK! i cant even shoot up anymore cuz my blood will clot if i dont get it first time perfectly, it jams up the rig, and no matter how much water i drink i have darker urine then i believe is healthy and my heart has to work extra harder to circulate this thick blood, and even worst, the 1st thing they'll want is a blood test, which is what i want, but i seriously dont have any spots to draw from. Once that finished i dont mind any other tests done.

[Zoops]

Yeah man, what The SWPK said. You don't need to tell them you're on bupe maintenance therapy, or your history as an IV opiates user. Just say you've been reading up on your symptoms and suspect you're suffering from low T and you want to get it checked.

It's probably low (I just knew mine was low as shit - and it was VERY low as the doctor said), and if so, you'll get Rx'd some T replacement therapy. Injections are cheapest, and most effective. Topical T gel works but it's sort of a pain in the ass compared to a shot in the buttocks once a week.

If the doc Rx's shots, he will probably tell you to do X amount ever two weeks. I recommend cutting that amount in half and doing a shot once a week. You'll get smoother blood levels that way. Less pronounced peaks and troughs.

[DeadCat]

Because of the recent "Low T" advertising, GP's have had more  than a few men come in SURE that they needed testosterone becasue like the commercial said; They lst muscle mass, energy, libido and that "old get up and go"...ie;  Waking up limp. WIt doesn't take a rocket scientist to figure out that waking up limp is your body's way of telling you that the Earth doesn't want any more copies of you, you fucking loser.

The thing is being overweigh or obese (30% of the USA) will produce the same symptoms as will a depression and malaise that comes from working pointless jobs with no imrovement in sight, only bills and god old "mid-life crisis" (Yup  you past 40 and you will never retire on a yacht in the islands)  and depression is a normal healthy reacion to livingin a deoressing world (Thanks ,Woody Allan).


Therefore it isn't unusual to dismiss a patient who is sure they have "ow T" because the TV told them so. So they tell the patientto go for walk every day, have "date nights" with the wife, exercise more, eat less, get hobby, take a vacation , etc.

But if you have realistic reasons to believe you have low testosterone (Regular opiod use, injury, whatever that is interfering with your endocrine system that is reponsible for regualting hormones, tissue function, sleep, libido, mood and other ambiguous ways of "not feeling like yourself" ... Then ask (or insist) on getting an appointment with an endocrinologist who will take a much deeper and nuanced look at your "complaints" and blood tests and will be the MD who convinces your insurance company you have hypogonadism (balls don't work) and have a legitimate need for testosterone replacemnt therapy.

TL/DR See an endocrinologist, not a GP if you really believe you have Low T.

Today's trivia fact: There are only 2 countries in the world that allow drug manufacurers to advertise thier drugs directly to th public (aka "push" advertising) they are the are (you guessed it) the United States and who knows why but the other is New Zealand.

[Griffin]

***Sorry for the long ass post most of it is me ranting about my doc not putting me on testosterone and me having to goto a clinic that only takes cash no insurance to be put on it***

http://forum.drugs-and-users.org/index.php/topic,2344.msg29035.html#msg29035

If you have the time read the last few pages of the is your doctor a moron thread, I posted quite a bit about this going on with me. I am 25 had my testosterone levels finally tested in May, after feeling like shit for the past year or so. My levels weren't under the "normal" range they have which is like 250-1100. Mine were 360 and my free T levels are 4.5. My doc said that it's because of the methadone and I need to get off of it and it will probably go back to normal, and when I have been off for 2 months he would test me again to see if it went up any.

It was extremely annoying because I have had all these symptoms for the last year, and all the males in my family have low t and I am the only druggie, so I knew that this was probably the reason I have been feeling horrible.

So I went to my mmt doc after my primary care dr said no because I take methadone, and my mmt dr said its really common and that he will see if medicaid would cover it for me and if they do he would prescribe the cream for me. That was the 2nd week of may, and he said that I will probably have to do a full prostate exam with a bunch of other stuff to get approved and even then it might not happen. They sent back one letter asking for my info which he sent in a month ago no word back yet.

So I went to a Low T clinic in my area that doesn't take insurance, and what seemed to me like a pill mill for testosterone and dietary supplements, and paid them $120 for 4 weeks of shots. They are 200 mg each, and I am starting to noticeably feel a little bit better. I have worked out, been able to focus better at school, have had more energy, and sleeping better. I have also been hungry as fuck for meat idk why, Haven;t really ate much meat the last 18 months and I've already had 3 whoppers and 2 jimmy johns gargantuan sammiches this week.

My first shot was on the 17th but I am an idiot, and never IM'd before and have zero muscle on my ass, and couldn't really reach it so I pulled out of the muscle on accident when injecting and when I pulled the syringe out most of the testosterone came out with it. So I switched to my thigh on Friday and I have done more in the past 2 weeks than the past 3-4 months probably. I had zero motivation, energy, libido, I always felt weak and tired, unable to focus, and unable to muster up the motivation to get out of bed to the point where I was putting off taking a piss.

It hasn't been like a super shot cure all, but I have felt a little bit better all around, and like I said I've worked out a few times already, and I remember laying in bed so much this last year hating myself for being fat and trying to muster up the motivation to do 10 measly pushups or anything and never doing it.

Besides going to the clinic, grocery store, and school I didn't exist. My sex drive is coming back a bit, and its hard to explain about the motivation and energy I just have actually done stuff this past week that weren't an absolute necessity which hasn't happened in a LONG time.

So get tested the worse they can tell you is your levels are fine and that it may be something else, or you might have low levels try it and it may or may not help with what your going through. I will update you if you want if I feel any better significantly over the next few months, because I could of convinced myself of a placebo effect or something and this last week was just a mind over matter placebo.

http://menshealth.rockymountainmensclinic.com/low-t/?matchtype=b&network=g&device=c&creative=80614478472&keyword=%2Blow%20%2Bt%20%2Bdenver&placement=&target=&random=5948898129386458863&aceid=&adposition=1t1&gclid=Cj0KEQjwncO7BRC06snzrdSJyKEBEiQAsUaRjLgcXkWIdwr8deaO1_Fcuprhmu5FBSdaEBNkZanEYOkaAnEH8P8HAQ


The place I went to was like this one there are a ton that are cash only, and as long as you pay and don't have high levels you will get it. Unfortunately I was to worried of being judged or not getting to try it to see if would help that I didn't tell the doctor about taking methadone. I am praying that it helps me feel normal and lose the weight I have been trying to for the past 2 yrs so that I can have a tiny bit of confidence.


My doc said she wants me to get my levels to at least 700-800 so double what mine is at and said I will probably stay on it as long as I want to to maintain the levels that I want to and feel good at.. She said I should feel better than normal when I am stable, extra energy, confidence, moivation I thought she was trying to sell me on it by how good she made it sound when I get to her "normal". I get another blood test in 3 weeks to see if it has gone up. let me know if you have any specific questions on how it went for me.

I basically got tired of my doctor not putting me on it even though I have been asking about it and bringing it up since December and it took me basically forcing him to give me the test to get it done. He believes all my problems are because I am on methadone and that I need off of it immediately. So I went and found a place that would since technically my free T level is the only level that is under the threshold of normal.
Sucks paying out of pocket but its so much worse feeling like shit 24/7, Sleeping 16 hours a day, and unable to work or goto school because you can't force yourself to.

[DeadCat]

GRIFFIN, my friend,

Every time I read your posts and hear how difficult your life has been lately the thought that come to mind is: "The Universe is telling you to GTFO of Colorado." And I am not one who generally things the Universe tells people shit.

I dont know what your actual ties, legal and otherise but it sounds like you cant catch a break there. There are clincs everywhere not all of them greedy, controlling SOBs but some are just better than others, Yu might even get your peobation moved out os state or terminated if you can get a job offer.

Life just doesn't have to be that hard.

[limerence]

im 25 on poppy seeds. i can hardly get it up, let alone cum. its been like 2 weeks and i live with my beautiful girl, she is upset. are there any herbals like maca or horny goat weed that help? been thinking of quitting or getting on sub since i like her more than opiates but i still really love opiates lol. anything other than trt? and if not, whatts a good diy trt guide? i cant afford drs. the clinic i go to will tell me to just stop the tea

when we met i was on h and my sex drive was on overdrive

[Griffin]

**off subject complaint about my life unnecessary to read and has nothing to do with topic at hand**

Yeah dc I have been trying to leave for the past 2 years and even though I was homeless, jobless, knew no one in this state, and had nothing but the clothes on my back, I couldn't get my probation transferred out of state, then when I had 4 weeks of probation left, I got arrested again for something that also isn't transferrable through interstate compact, fucking fuckbags.

I really like CO, but damn they are fucking with my chi, especially since I can't even smoke weed and don't really want to since I haven't in so long its no fun the past few times I have tried it it has been so strong that I ended up being anxious for the high to end. I want to leave until I visit Oklahoma where I am from and where all my friends and family are and I am reminded I don't want to be there either and why I left. I want to live on the east coast but I really doubt I'd be able to stay clean with ecp and the availability but who knows.

I want to travel to another country and see how that goes but naturally that is terrifying and hard to do. I hate that the world doesn't like me here cause CO its pretty awesome, the mountains, the laws, the people, but it seems that I am destined to have shit constantly go wrong. I kind of wonder what would of happened if I didn't move, if I would of gotten arrested or if I would of gone to prison, but what ifs are generally a waste of time.

Did I mention they are leveling my house to make a parking lot in 4 weeks and it's impossible to find affordable housing here? So my options right now are move in with my landlord in a room smaller than a jail cell, which would suck ass or move in with my ex(who helped me get arrested the first time, took my shit and so on and so forth) and her husband if I can't find a place before the 24th of next month.

My exhaust pipe finally broke off completely while driving down the road last week I finally got it all put back in place so that it would be alright until I could afford to fix it, but it was cracked worse than I thought, it as cracked pretty much almost all the way through and I hit a bump and it broke all the way through and fell in the middle of the road right in front of a cop. I am just glad I wasn't on the highway when it happened cause it could of killed someone and I probably would of had to goto prison for vehicular manslaughter or some shit.

 I am trying to finish my community service so I can send in a motion to end my probation early but they probably wont even though they won't lose money if they let me off but I have a much higher chance of fucking up and having to pay them more money if they keep me on. Since I transferred to a private probation company they don't get the $50 fee each month for supervising me so that incentive to keep me on is gone which is ultimately why I wasn't let off early the first time which would of prevented the second arrest because they wouldn't of been able to search me with out reason and wouldn't of found the methadone and given me a DUI because they knew i took it.

Limerance idk about anything to help the sex drive I felt the same way mine is coming back though.

[Zoops]

im 25 on poppy seeds. i can hardly get it up, let alone cum. its been like 2 weeks and i live with my beautiful girl, she is upset. are there any herbals like maca or horny goat weed that help? been thinking of quitting or getting on sub since i like her more than opiates but i still really love opiates lol. anything other than trt? and if not, whatts a good diy trt guide? i cant afford drs. the clinic i go to will tell me to just stop the tea

when we met i was on h and my sex drive was on overdrive

Limerence, I PROMISE you that if you skip dosing seeds for ONE day, just until the w/d starts to barely kick in, your sex drive will bounce right back sky-high. And you'll also cum at the drop of a hat.

@DeadCat - I agree that being overweight can produce the same symptoms as low T. But the thing is, that syndrome is responsive to T therapy, even if T is normal (which is probably in the low end of the range of normal  in cases of frank obesity). Just like non-ADD people respond to therapy with psychostimulants - increased ability to concentrate and all that. Testosterone is the same way. Even if you don't actually "need" it, it will improve your body composition, libido, energy, confidence and all the rest of that shit.

Only to a certain extent of course.

[DeadCat]

Limerence, I PROMISE you that if you skip dosing seeds for ONE day, just until the w/d starts to barely kick in, your sex drive will bounce right back sky-high. And you'll also cum at the drop of a hat.

@DeadCat - I agree that being overweight can produce the same symptoms as low T. But the thing is, that syndrome is responsive to T therapy, even if T is normal (which is probably in the low end of the range of normal  in cases of frank obesity). Just like non-ADD people respond to therapy with psychostimulants - increased ability to concentrate and all that. Testosterone is the same way. Even if you don't actually "need" it, it will improve your body composition, libido, energy, confidence and all the rest of that shit.

Only to a certain extent of course.

Right, I was just trying to offer an explanation of why GPs may  discount a patien't self-diagnosis of "Low T" because once Anfdogel got approved the maker saturated TV with ads aimed at middle-aged men who just though if they got the product they'd be 19 again.

[Lucy cat]

I have experienced the same but additional symptoms of depression anxiety no euphoria no pain control thirsty ringing in ears. I have read it is the opposite effect after chronic opioid use for years.

[Chip]

Step 3: Thank u SWPK! i cant even shoot up anymore cuz my blood will clot if i dont get it first time perfectly, it jams up the rig, and no matter how much water i drink i have darker urine then i believe is healthy and my heart has to work extra harder to circulate this thick blood, and even worst, the 1st thing they'll want is a blood test, which is what i want, but i seriously dont have any spots to draw from. Once that finished i dont mind any other tests done.

i recently heard how well taking a low dose Aspirin tablet works as a blood thinner.

[Zoops]

WOOHOO!! 1600th POST!! YAY!!

^^I'm not sure how well "thick" blood caused by too many erythrocytes will respond to aspirin therapy. Aspirin works with platelets and clotting factors and that stuff, while he's complaining of blood that's simply too "thick," which is quite literal in cases of erythrocythemia (hematocrit too high, caused by too many RBCs)

But it's definitely worth a try. Go for it. And they way you described it, I'd go straight for 1 regular-strength aspirin tablet each day (325mg), not that baby shit (81mg - why is it 81mg anyway? 1/4 strength would be 324mg)

@sk8phaze - you know, they can draw all the blood they need from that one time. If it's such an ordeal to get blood taken, then just tell them to run all the tests you want right then, at that time. And for real? No place? No place at all? Shit, homie, I thought I was all out of veins, but I recently have discovered a whole slew of 'em, in fingers, the palm of my hand (ouch!), and a big FAT one that runs along the front of my shoulders! That one is fucking SWEET!

[Griffin]

My doc said having thicker blood was a common side effect of being on testosterone, and that if I was ever having a problem I should just go give blood and would be fine. Unfortunately I can't give blood because I am on MMT, so that wouldn't work for me. Would you get high from getting a transfusion from someone on MMT?