During a press conference here at ENDO 2013,Shehzad S. Basaria, MD, medical director of the section of men’s health, aging and metabolism at Brigham and Women’s Hospital, Harvard Medical School, said testosterone therapy administered to men with opioid-induced androgen deficiency led to a decrease in pain perception on Quantitative Pain Testing (QST) in the pain laboratory.

Basaria and colleagues randomly assigned 65 men (mean age, 49 years; BMI: 33 kg/m²) with an androgen deficiency to 5 g transdermal testosterone gel (n=36) or placebo (n=29) for 14 weeks. Abstract data indicate baseline total testosterone (228 ng/dL) and free serum testosterone levels (44 pg/mL) increased significantly among those assigned to testosterone.

At 12 weeks, patients randomly assigned to testosterone displayed significant improvements to pressure pain thresholds (P<.031), mechanical pain intensity (P=.049) and cold pain after-sensations (P=.08), according to data.

Clinical pain perception, as measured by a validated questionnaire, was not different between the two groups, Basaria said.

“Previous data suggest that improvement in pain perception and tolerance on QST testing generally precedes improvement in clinical pain. A longer study might have shown improvement in clinical pain as well,” Basaria said.

These findings suggest that testosterone therapy administered to men with opioid-induced androgen deficiency led to a greater reduction in pain sensitivity compared with placebo. However, further trials examining the anti-nociceptive role of testosterone are warranted. In an interview with Endocrine Today, Basaria said that the most important message to clinicians would be not to initiate testosterone treatment solely for the treatment of pain. He and colleagues are currently looking at longer term studies that may examine improvements in clinical pain perception as well.

“Clinicians should become more aware of this condition called opioid-induced androgen deficiency. Many clinicians do not appreciate that testosterone levels are reduced in a significant number of men who are on opioid analgesics. In some men, testosterone levels are suppressed in castrate range,” Basaria said. “It’s important for clinicians when they have patients in their clinic on opioids to pay attention to complaints of sexual dysfunction, fatigue or decreased energy. Testosterone levels should be checked as these men might benefit from testosterone therapy.” – by Samantha Costa

Source: Endocrine today