Is Impotence on the Rise in Opioid Users?

According to a recent study, long-acting opioids are nearly five times more likely to suppress testosterone levels than short-acting opioids.

Over the last few years, we’ve seen a surge in data that couples opioid use with lowered male testosterone levels. We know the use of opioids can lead to hypogonadism, a condition of lowered sex hormone production. In males, lowered testosterone levels can lead to fatigue, depression, and even osteoporosis and obesity. Some studies suggest this hypogonadism is also associated with lowered pain tolerance.

In previous studies, opioid users were lumped together, but this recent study compared the testosterone levels of patients taking long-acting opioids with patients taking short acting opioids.

Dr. Andrea Rubinstein presented her information at the annual American Academy of Pain Medicine meeting. Her study compared 81 male patients taking opioids for at least three months. Those in the long-acting opioid group included patients prescribed methadone, buprenorphine (Subutex, Suboxone), sustained-release medications in patch form, such as morphine and fentanyl, and sustained-release medications like OxyContin (taken whole as intended with the coating not removed). These patients were compared with those on short acting opioid like immediate-release oxycodone and hydrocodone.

The patients on the long acting opioid were nearly five times more likely to have low testosterone levels than patients on the short acting opioids. The age of the patient and the total daily dose did not appear to affect the risk of low testosterone.

It’s possible that short acting opioids give more fluctuation in serum opioid levels, and thus less likely to suppress hormonal function.

This is not great news for those of us who treat opioid addiction. We use long-acting opioids like methadone and buprenorphine precisely because they are long-acting, and give a steady blood levels. Their long action in the body means they can be dosed once a day (usually) and still relieve all opioid withdrawal symptoms. The relief from opioid withdrawal frees the patient to focus on making important life changes. With short-acting opioids, most addicts feel a euphoric high, followed several hours later by withdrawal. This drives them to seek opioid drugs as often as every six hours. It’s hard to maintain a normal life when seeking pursuing opioids three or four times per day. Simply staying out of withdrawal becomes the opioid addict’s full time job. Short acting opioids may be better for my patients’ testosterone levels, but not good for their disease off addiction.

So what should I do with this data about hypogonadism in my practices?

I think I should be more diligent about monitoring my patients for symptoms of low libido. It’s important to ask male patients about sexual difficulties because sometimes they are embarrassed to mention them. If patients have no symptoms of hypogonadism, they probably don’t need further testing. If  patients do have symptoms, I’ll ask them to see their family doctors for a work-up, because that’s something that can’t be treated at the opioid treatment programs where I work. Testosterone can be supplemented with gel or intramuscular injections, and testosterone levels need to be monitored, as well as cholesterol levels.

I’ve had previous patients who object to testosterone supplementation because they felt they were treating a side effect from one medication with a second medication. While this is true, the only other option is tapering off methadone or buprenorphine, or cutting down their dose. This also has risks, as opioid addiction is a life-threatening illness. If a patient wants completely off medication, he should have an inpatient treatment lined up as soon as his dose is low enough for admission.

What about women on medication-assisted treatments with low sex drive? Women weren’t included in this study, but yes, we know their hormones are also affected by opioids.  Testosterone may help women recover their sex drive, but it has serious side effects and hasn’t been proven to be safe in the long term for women. For females who report sexual dysfunction on long-acting opioids, I will continue to refer them to their gynecologists.

As usual, the benefits of long-acting opioids must be balanced against their risks.

 

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19 responses to this post.

  1. Posted by dbc1823417993312314 on April 20, 2012 at 2:35 pm

    I actually judge the degree to which I’m medicated through … ermm, this mechanism. Everything else is pretty subjective, except perhaps your GI tract (which has too much lag time).

    Reply

    • You mentioned for men with low T to consider the gel. That’s the Androgel which comes with very fine print black box warning that it could cause prostate cancer. Why didn’t your article, while dispensing information, not mention that men on this “gel” need to get their PSA monitored very often… every 2 months.. at least. I was on this gel and my PSA went from 1.0 and when it went up to 3 or 4 the doctor said that it was normal with this treatment. when it went to 6.0 he said “get a bioopsy for cancer” Yes, the androgel gave me an aggressive prostate cancer.. the biopsy showed 3 out of twelve samples with aggressive cancer. thank you drug company for nearly killing me.
      one other thing from the real world… floroquinolone antibiotics do something that shrinks the pituitary. That was the initial cause of my low testosterone… I was given Levaquin for 10 days for an infection. if you google levaquin and low testosterone, there is now research that scientifically shows this connection. Men with low T should always be asked if they ever had a floroquinolone antibiotic and a human study of wide proportions needs to be done and patients warned of this possible devastating effect on their bodies. take an antibiotic and be hypogonadal with other medications that kill you. great western medicine. great FDA keep up the good work drug companies from hiding the truth from doctors and patients.

      Reply

      • I’m sorry this happened to you. Your experience illustrates that all medications have side effects. It’s always about weighing risks and benefits. It’s also a reminder for doctors not to prescribe antibiotics unless necessary.

  2. I will be reading your blog. Let me say first that I hope I find informative info, and not a blog trying to push the notion that places such as methadone clinics are good for our society. I can tell you that I know first hand that they are not. I have been a subject at one of these so-called clinics for over 5 years now. I have been detoxing myself 5mgs every 2 weeks now for the better part of a year. I say myself because I recieve no encouragement or suggestions as to vitamins/exercise/diet I should employ during this difficult time. I have been keeping a log on my daily symptoms as well as my thoughts and feelings as I detox. I am set to be completely clean in roughly 2 months, and it will be at that time that I will decide what to do with the info I have compiled.
    In closing, I will simply say this: I know these methadone clinics are a bad thing because I see the blank faces every week. I was one for a very long time. There is something wrong with a place hell-bent on keeping a person loaded with methadone while at the same time NEVER offering encouragement of abstinance. I really hope you are not another one of them. If you are not, I appologize for sounding rude. Call it PTSD from a methadone clinic attempting to beat my soul into submission through years of no-end-in-sight medicating. I guarantee you though, they never counted on me.

    Reply

    • I’m sorry you’ve had a bad experience at your clinic. Not all methadone clinics are created equal, and I am very much in favor of good methadone clinics. They have saved many lives over the past 40+ years.
      I’m glad you are successfully tapering. Many clinics don’t encourage tapers because of the studies that show patients who leave treatment have death rates about 8 times higher than patients who stay in treatment. However, patients are different. If your plan to to taper completely off medication, you need to get as much counseling now as you can, particularly about relapse prevention. If you can’t get this at your clinic, you can always go to Narcotics Anonymous. It’s free, it’s widely available, and it works. You will meet opioid addicts who are now living completely clean and can learn from them how they did it.
      Best wishes.

      Reply

  3. I have had a terrible experience and the bad thing is…I’m one of the better patients. In the way that I have held down a full time job (same one), have a wife, kids,mortgage, etc. Have failed 1 UA in the time I’ve been there. Thing is ma’am, why do I think it’s terrible? Because I was the exact same person I was 5 years ago + 50lbs heavier. My health has been in the toilet, and only once in all those years did anyone suggest getting clean. It was a guest doctor there last April (doing my yearly physical) who I plan on looking up once this nightmare is over, so that I may thank him. He scared me to death, but you know what, he got me thinking. To keep people locked on this stuff that is so much worse in my opinion than what I was taking before (oxy’s), is just wrong. I have written about it and the similarities between them and a corner drug dealer. I just feel that at this critical time in my life, at the very least, they (my clinic) should be suggesting I see and talk with the doctor that signs my prescription for methadone. Where is all the help now that I’m detoxing? It is stark raving obvious that this place cares nothing but the money. Cash money because they accept nothing else. And I find it really hard to believe it is much different at most of the other clinics across this country. People are getting fat cat rich on the backs of people who are duped from the moment they walk through the door.
    Funny thing is, I am actually for methadone being available as a short term detox only. Give a clinic a certain amount of time whereby they must have that patient detoxing. I also think it’s funny that all the people pro-methadone clinics as they are, refuse to call it what it is-detoxification. Taper sounds better I guess, but I won’t call it that. I’m getting this toxic mess out of me, and I call it the way I feel it…literally.
    If you are a doctor, I do have a few questions for you because it’s hard to get anything concrete out of the clinic I go to. First is, once I pick-up my last weeks worth of methadone, if I request my records/file, are they required to give that to me then? Second, you said that methadone patients that detox are 8 X more likely to die than those that stay-why is this?
    Last thing is this, when you said “my plan to taper (detox)”, don’t you find it a little strange that the clinics don’t have plans for people to detox? It’s almost as if there is a rule at my clinic, that there is to be no mention of detox whatsoever. At any rate, I do appreciate you taking the time to dialogue with me, as my clinic does not.

    Reply

  4. I’m sorry, I do see that you are in fact a doctor. Now I don’t even know if me calling you ma’am was rude. If it was, please insert Dr. I have read several of your posts and it does seem to me that you may be the exception rather than the rule where clinics are concerned (in my experience). As I said though, thank you for the dialogue.

    Reply

    • You need information. First of all, you need to read NIDA’s website which may answer some of your questions:

      http://international.drugabuse.gov/educational-opportunities/certificate-programs/methadone-research-web-guide

      As for specific data about patients who leave methadone treatment – I got my statistics wrong. Patients leaving treatment have a death rate 63 times that of controls, while it was the patients maintained on methadone that had the eight time higher death rate compared to people without addiction:

      Gronbladh L, Ohlund LS, Gunne LM, Mortality in heroin addiction: Impact of methadone treatment, Acta Psychiatrica Scandinavica Volume 82(3)223-227. Treatment of heroin addicts with methadone maintenance resulted in a significant drop in mortality compared to untreated heroin addicts. Untreated addicts had a death rate 63 times expected for their age and gender; heroin addicts maintained on methadone had a death rate of 8 times expected, and most of that mortality was from diseases acquired prior to treatment with methadone.

      Here are summaries of related stuies. I give the specific article references so you can read them yourself if you wish.
      Goldstein A, Herrera J, Heroin addicts and methadone treatment in Albuquerque: a year follow-up. Drug and Alcohol Dependence 1995 Dec;40(2): 139-150. A group of heroin addicts were followed over 20 years. One-third died within that time, and of the survivors, 48% were on a methadone maintenance program. The author concluded that heroin addiction is a chronic disease with a high fatality rate, and methadone maintenance offered a significant benefit.

      Zanis D, Woody G; One-year mortality rates following methadone treatment discharge. Drug and Alcohol Dependence, 1998: vol.52 (3) 257-260. Five hundred and seven patients in a methadone maintenance program were followed for one year. In that time, 110 patients were discharged and were not in treatment anywhere. Of these patients, 8.2% were dead, mostly from heroin overdose. Of the patients retained in treatment, only 1% died. The authors conclude that even if patients enrolled in methadone maintenance treatment have a less-than-desired response to treatment, given the high death rate for heroin addicts not in treatment, these addicts should not be kicked out of the methadone clinic.

      Scherbaum N, Specka M, et.al., Does maintenance treatment reduce the mortality rate of opioid addicts? Fortschr Neurol Psychiatr, 2002, 70(9):455-461. Opioid addicts in continuous treatment with methadone had a much lower mortality rate (1.6% per year) than opioid addicts who left treatment (8.1% per year).

      Sees KL, Delucchi KL, et.al. “Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence” Journal of the American Medical Association, 2000, 283:1303-1310. Compared the outcomes of opioid addicted patients randomized to methadone maintenance or to180-day detoxification using methadone, with extra psychosocial counseling. Results showed better outcomes in patients on maintenance. Patients on methadone maintenance showed greater retention in treatment and less heroin use than the patients on the 180 day taper. There were no differences between the groups in family functioning or employment, but maintenance patients had lower severity legal problems than the patients on taper.

      Gruber VA, Delucchi KL, Kielstein A, Batki SL; A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug and Alcohol Dependence, 2008 94(1-3) 199-206. The authors found that six months of treatment with methadone treatment reduced heroin use more than 21-day methadone detoxification. The addition of increased counseling in one of the six-month groups didn’t seem to improve outcomes any more than minimal counseling.

      Metzger DS, Woody GE, McLellan AT, et. al. Human immunodeficiency virus seroconversion amoung intravenous drug users in- and out- of- treatment: an 18-month prospective follow up. Journal of Acquired Immune Deficiency Syndrome 1993;6:1049-1056. Patients not enrolled in methadone maintenance treatment converted to HIV positivity at a rate of 22%, versus a rate of 3.5% of patients in methadone maintenance treatment.

      Sells SB, Simpson DD (eds). The Effectiveness of Drug Abuse Treatment. Cambridge, MA: Ballinger, 1976: This was an analysis of information from DARP, the Drug Abuse Reporting Program, which followed patients entering three types of treatment from 1969 – 1972 and showed that methadone maintenance was effective at reducing illicit drug use and criminal activity. This study also demonstrated that addicts showed more improvement the longer they were in treatment.

      Reply

      • We may have some differing opinions, but I can always respect someone who is doing what they are doing because they genuinely want to help people. You have convinced me that you are one of them. It would serve a great purpose for every clinic to have someone such as yourself “available”. I have literally felt as if I am all alone in this, where the clinic is concerned. As much money as I have given them, I don’t deserve that. At first I won’t lie, it hurt… hell, it still hurts, but I have learned to channel that energy and make it work for me. At any rate, I want you to know that I admire your willingness to first, allow my post to be viewed, and second, take the time to give me some valuable information. It is much appreciated-truly.

      • Those numbers are all well and good, but I think we both know that they are only numbers to support your viewpoint. I plan on researching the numbers too, and I am sure I will be able to find some that support what I believe too; which is that most of the clinics, as they are today, are no different than drug dealers. I don’t need a degree in medicine to know that that is exactly the way I, and many people view them. I felt no different, and probably worse dealing with the counselors at my clinic as I did with drug dealers. For these clinics to have a patient come in, and never suggest anything other than MMT is just wrong. You know as well as I that there are very few doctors that agree with MMT. I’m not suggesting they are all right, but why are there so few of you, and a legion of them? I think I know the reason, and when you translate it, it reads like this: 2000pts at my clinic X $15/day X 4 weeks = $840,000.00 cash money every four weeks. That’s just about $1million cash money/month. I’m a republican all for business, but I’m not for this. Somebody is making pot loads of money, and they don’t want their cash flow interrupted. That’s the way I feel, after being treated the way I have by those people. They made me feel that way, I didn’t. You may be right, short term detox may not be best, but what they are doing at these places isn’t either. As I said, I can’t speak to your place (clinic), but the ones I know of, are fly traps there to teach an addict one thing and one thing only: submission. I’ll leave things alone now, but I hope you post this (which I’m sure you will), because people should know both sides.

    • Please see my reply to your last post for some solid information. Yes, clinics do try to retain people in treatment based on the data that shows bad outcomes for patients who leave. However, if you look at the NIDA web guide on methadone treatment you’ll see that the best clinics also evaluate each person as an individual. for example, if you have a 5-year history of opioid addiction but managed to stay clean from all opioids for a year during that time, meaning your history of dependence was interrupted, you probably will be able to successfully taper off and stay clean because you did it before. But your clinic must work on relapse prevention before you’re off methadone.

      And you are right – many methadone clinics are owned by large, for-profit companies. Does that make them bad clinics? Not necessarily – it depends on how they are run. If clinic owners pressure the people working on the front lines to “keep the numbers up,” meaning keep making us profits, that’s bad. Ideally, non-physicians shouldn’t control the practice of medicine. Is that the way it is in real life? Sadly, no, at least not in this field, as I’ve learned from unpleasant experience.

      I’ve worked at 12 clinics over the past 11 years (one place had 8 locations). I’ve worked at for-profit and non-profit, and the non-profit did not deliver the best care of all. The best clinic is one where I’m working now, Stepping Stone of Boone. I’m allowed complete authority to do what I do best – be a doctor. But this is a very unusual clinic in that its owners are all people who live in the Boone community and who have a passion for helping addicted people regain their lives. That may mean staying on methadone or buprenorphine permanently, or it may not. Obviously, the patient is the one who makes the decision. If a patient wants to taper, we talk, and we discuss the best way to do it, taking into account physical/mental health issues, other drug use, how much counseling they have they had, etc. We have an adequate number of counselors for the number of patients (very important) and we also offer buprenorphine, though it does cost more than methadone. We’ve had some buprenorphine patients do so well that I switched them to my “X” number and write Suboxone prescriptions for them, which makes life so much more convenient for them.

      The bottom line – vote with your feet. if you aren’t getting good care, look for another clinic. The big problem is that there tend not to be very many clinics in many areas, leaving patients with only one choice.

      Also, be honest with yourself – have you asked to see the doctor? Have you done your part to get counseling? In many clinics, if the patient seems disinterested in doing anything except getting the daily dose, the counselor may not make an extra effort to talk with you. Some patients even get angry if counselors push them to have sessions! Your counselor isn’t going to work harder than you do at your recovery.

      If you don’t have an available doctor, that’s a problem. Each clinic should have a medical director. I think it would be unusual if the doctor wasn’t there nearly daily for a clinic of that size. At Stepping Stone, we have 130 patients, and I’m there in person at least 5 hours per week, and always available to staff by phone. I spend a few more hours per week looking at patient data, talking with staff, looking at how our policies/protocols are working. I’d think you’d have a doctor at a minimum of one day per week, surely.

      Reply

  5. See, that’s what I’m talking about. A clinic like what you are describing above is wonderful. Because it is truly there doing what is best for the patient-the individual. I have a good feeling, if I were one of your patients, I would have had the nerve to do what I’m doing now long ago. I also believe that we probably would have remained friends for many years after, because I have a keen sniffer with people. I’m not always right, but I tend to be pretty spot on with my first impressions. I feel really sorry (for my rants) sometimes after reading a bit more about what you have written because I know you’re not one of the bad ones. However, just as in today at my clinic (I decreased to 25mgs)…the nurse who served me asked me, “so how’s you’re detox going?” just a cavalier question as if what I was going through were just another ordinary day. Like I had just been bitten by a mosquito that had festered, but now was getting better. I just told my wife this morning (when I got home), that I had been thinking and I haven’t had my physical for this year. In years past (when I was maintaining), they would have disallowed my take-homes if I had missed my physical. Now that I’m detoxing, and getting close to being off, they don’t even feel the need to do physicals anymore. I have questions I could have asked him, but I guess since I’m no longer going to be there, they no longer feel the need to waste money on my physicals. Dr, you have to know that this is not right. If you get one thing out of what I am telling you, please know that the people at the clinic I go to, are not happy people. I should know because I was one of them. And furthermore, I would be willing to prove to you everything that I am saying. I would have no problem releasing my med records to you so that you can in fact see that I am what I say I am, and not some lunatic railing against a random cause. I would personally walk in there and give them the okay to fax you all my records. That probably sounds crazy, but after years of going to that clinic and talking to people that never remember half of what you say, or your face even (and I’m kinda cute :), I have just come to the conclusion that they must just not believe anything that comes out of anyone’s mouth. I figure they must think, “why pay attention”. But hell, if you can help guide this plane that is my life in online, I’d be more than happy…I’m definitely not getting anything from them. I know I’m not one of your patients, but I don’t have to be for you to tell me what the heck I should be doing. Or, if I’m doing good, and to just stay on track. And btw, I’m not some cheapo just trying to get something for free. If you need me to pay some, I do have a job, and insurance even, but I want you to know something; I have a goal, and that goal is to walk out of that clinic the same way I walked in. There will be no rapid detox, or subu…whatever the stuff is-not interested. Anyway, I also have a blog where I’ve been keeping track of my symptoms and such if that’s all you would need to give me some advice. It’s at ismelltherain.me under my “daily symptoms log” category. If you have the time that is, and if not well, I’ve probably pissed you off. At that, I probably wouldn’t blame you, but hey, you see what I’ve been dealing with. Btw, you can just delete this post if you wish cause I guess it’s more personal than the other stuff, but whatever you think.

    Reply

    • You do not have to prove your clinic is doing a poor job. I know there are clinics out there like that, and I don’t defend them.
      They give the other, better-run clinics a bad name and bad reputation. I wish that weren’t true. It sounds like you live in a place with only one clinic around, if you’re driving and hour to get there.

      It’s not good medical practice to treat people without face to face contact, so I can’t give you any advice for you personally. However, I can tell you what I tell other patients – listen to your body, and remember that the dose change you make today may not affect you for about five days, due to the long action of methadone. Also remember that when you get to doses less than 40mg, each milligram is a bigger percent of the whole, so most people slow to 2mg per week or so. Some texts say the taper, or detox as you call it, should be no faster than 10% per week, but people are so different in the way they tolerate withdrawal. I also recommend:
      -plenty of fluids
      -ibuprofen for body aches
      -hot baths do help with muscle and joint aches, but not for long
      -aerobic exercise each day, but don’t overdo it. Pick something you enjoy doing if possible
      -eat plenty of fruits and vegetables, and if you don’t, consider starting a once-daily multi-vitamin. It doesn’t have to be fancy or expensive; brands like One A Day or Centrum are fine. Men should take those without iron.
      -as you get to doses less than 20mg, ask your clinic doctor to give you a prescription for clonidine, a blood pressure medication that blocks many of the nervous system withdrawal symptoms like anxiety, sweating & chills, diarrhea, tremor, and nausea. It’s mildly to moderately helpful.
      -don’t neglect your spiritual health. I define spiritual as anything that helps you improve relationships with yourself, with other people, and a Higher Power. Surround yourself with positive and supportive people. It should go without saying that you can’t be around people who are using drugs. Consider going to 12-step meetings. If you have something that nurtures your spiritual self, indulge in that. It could be meetings or church or volunteering to help someone else…actually your blog may be a great way to help others and connect with them
      -avoid relapse triggers when possible. The big 3 are strong negative emotion, being around people who have drugs, and medical situations. Some of those things you have some control over, and some you don’t. Have a plan for how you’d handle medical situtations before they ever happen.

      I have seen many people taper off methadone and be successful. It isn’t easy, but it is do-able. The biggest mistake I see my patients make are that they get down to 15mg or so, get impatient and just stop dosing. Most people will do better if they come all the way down to 0mg. Look at it like this…you’ve come so far, you do not want to fumble at the one-yard line. You are almost there. Getting down to 25mg is wonderful. But if you don’t feel great, there’s nothing wrong with staying at that dose until you become more accustomed to it. Unless you have a certain deadline that you have to meet for some reason.

      I think you are doing great – probably better than you realize. I’m sorry your clinic isn’t giving you the support you need. I’m not going to defend a clinic that’s not doing a good job, but know there are clinics and counselors and doctors who care a great deal for their patients. Many would love to see a patient doing as well as you are. I guess sometimes you have to give yourself the encouragement you wish others would give.

      Reply

      • Thank you-thank you very much. Why couldn’t they just tell me this? I have been doing almost all of that to a tee, Centrum included. I read somewhere that your body is starved for nutrients from years of drug abuse. I feel as though I don’t need much, but I wish they would tell me every once in a while that they know I can do it. I don’t have to be in the medical field to know how dangerous what I am doing can be. I know i have rambled, but my emotions are scrambled see, and I’m going to leave you alone now. I will remember you and what you are doing here (which is good) 🙂
        A

  6. Posted by Mrs.A on March 8, 2016 at 10:57 am

    Hi, Doctor!
    I thank you and the gentlemen below “ismelltherain” for your dialogue. It has done much to help me discern on whether it would be a good idea for my husband to “detox” or “taper” off bupenorphine. Of course, that is what the GP says, but he is not an addiction specialist. I am a social work student considering specialization in addiction, inspired by my husband’s battle and my high level of empathy for people experiencing life situations so “nightmarish,” that they feel they need to self-medicate in order to survive.
    If I have not stated earlier, my dear husband (DH) was diagnosed by the GP with hypogonadism. He is 29 years old and I tell you, it has been extremely difficult to get doctors (even the addiction specialist) to listen to my concerns even to the point where I had to ask the nurse to put in the blood panel a free tester one test. Out of an average 200 range, he is a 9 – single digits. It has affected everything including mood, energy, libido, scrotum size, erectile dysfunction (I suspect), etc. My concerns are not selfish as I have abstained from sexual contact with my husband -per his non-gentle request- for the last 4 years. I also have not cheated whatsoever and been completely faithful.
    Here is my question/concern: His affect, I believe, has changed him dramatically with his antisocial behavior. He doesn’t want to go out, see anyone, or make new friends and this has been ongoing. Although his mood has improved in the last year, I fear it is situational (our living situation has improved) and if my house of cards falls, so will his good mood. I know too, that he has no desire to change or to detox as our friend here “ismelltherain,” which scares me considering he’s almost 30 and has been addicted or on treatment since before our marriage in 2011. Not to judge, but his addiction was never very severe and he even hid it very effectively from me until our 2nd year of marriage. However, his urges are very strong and he relapsed once in Feb 2013 before being put on suboxone. As we get into child-rearing age, he expresses a very high interest in reading interest (even more than I) and talks about “when we have babies” every single day.
    He is eager, which concerns me more, considering the hypogonadism. I fear if he doesn’t “taper” now or soon, he may never be able to have his own children – which he said he wants to try before considering adoption (which I am the opposite because I also have PCOS). We’re a fertility doctor’s worst nightmare, but I honestly don’t care. What I care about is how the situation will affect his mood. Will he be suicidal? Will he have another nervous breakdown? My biggest concern is that he has not hit rock-bottom emotionally, like I suspect our friend “ismelltherain” has, which could help him in seeking counseling and the like. He has no interest in NA, outpatient treatment, counseling, etc. I don’t want him to hit rock-bottom because I care about his emotions, but I think he may need it.
    As for the hypogonadism, it has largely gone untreated or uncontrolled. He does androgel since 2014 but the clinical symptoms (specially regarding scrotum size) have gotten worse and he doesn’t care at all. He is so far gone, that he doesn’t even miss sexual contact. He doesn’t even think it is something that should be missed and that it is but an “add-on” or “luxury” in marriage, not a natural, healthy ingredient. He politely disregards all my thoughts, cares, concerns, and emotions which would bother me if he wasn’t sick, but he is, so it worries me even more.

    Reply

    • I think there’s a good chance he would feel better if his doctor could get his testosterone level back to normal. Also, has your husband talked to his doctor about depression? Loss of interest in usual activities, isolation…those could be symptoms of depression.
      but if your husband doesn’t want help, you can’t force him.

      Reply

      • Posted by Mrs.A on March 8, 2016 at 3:23 pm

        I’m sorry for the novel, Doctor. Lol.
        I’m relieved to hear you think so too. That it’ll help him.
        Yes, in 2013 when he first sought treatment for the addiction I took him to 1 doctor who was an MD addiction specialist & another doctor who was just a psychiatrist & a LCSW for therapy. We went regularly and after a year of therapy + Paxil/Prozac he felt better. He’s doing much better than before but is still pretty antisocial. I have to drag him to even visit family that live 3 blocks away. After over a year he decided that he didn’t want to do any more pharmaceuticals except bupenorphine and I let him. He stopped everything else, but then this hypogonadism started getting worse and even Prozac couldn’t help him regain interest in old hobbies.

        He does have sort of interest in getting better, but not really. This morning I spoke to him about you and our friend “ismelltherain’s” journey with “tapering” and he just shrugged, said ok, and that I was very cute for doing all this. Commenting and reading up on it. When I told him I noticed it was getting worse, not better on TRT, he just said he doesn’t notice the difference and confessed that perhaps the reason he’s not responding to TRT is because he “takes days off.”
        Do you think I should run with his apathy and set up appointments with specialists and therapy and everything to help him or should I wait for it to come from him?
        I’m fearful that although he’s apathetic now, as the going gets tough, he’ll grow to hate the appointments and grow to resent me for pushing him to go to them.
        Also, about “tapering” he had no reaction. I told him the pros and cons and risks and “ismelltherain’s” story and he had nothing to say. He has a childhood/adolescence history of Fear of Failure too from an overbearing mother (his words, not mine. She was very emotionally abusive to him) so I think he could honestly do it if he had more of an attitude similar to “ismelltherain’s.”
        What do you think I should do?

      • I don’t think I can offer advice about what you should do. I do know that you can’t make someone do something they don’t want to do. And I do know addiction is a family disease. Some family members seek therapy for themselves, to help them decide what to do in difficult situations, like what you describe above. I think therapy for you can help you decide how much you want to try to push him or not push him.
        Also, consider Alanon, a 12-step meeting for friends and family of alcoholics and addicts, whether those alcoholics and addicts are in recovery or not. Alanon talks a lot about boundaries, taking care of yourself, etc. At those meetings you can talk to other people in similar situations, see what results they’ve had, and make up your own mind about what’s right for you in your relationship.
        best wishes!

  7. levaquin and cipro cause low testosterone, then patient is given Androgel, then patient gets prostate cancer, then patient gets pain medications for two tendon ruptures from Levaquin and is on methodone for neuropathic pain 24/7 from Levaquin and methodone interacts with testosterone implants and patient becomes suicidal with effects of low testosterone that goes up and down like roller coaster. at 48 years old life is finished for patient from being given Levaquin and a domino effect of drugs and illness and cancer and depression and fatigue and no job follow. to be continued. Last chapter not written yet. who will write it? a doctor or a drug company rep?

    Reply

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