This study was designed to determine male sex hormone affection in patients with tramadol dependence
In this study, the patients group included 25 male patients with tramadol dependence. Five patients (20%) have serum testosterone level lower than those of the control group. This is in agreement with [8], which reported that opioid-induced androgen deficiency has become one of the most common causes of testosterone deficiency among men in many communities.
Also, 3 patients out of 25 (12%) have serum FSH and LH levels lower than control. This is also in agreement with [9] in their study of opioid-induced endocrinopathy.
In normal physiologic condition, it is expected that as the level of sex hormones decrease, a negative feedback mechanism should trigger the hypothalamus to increase production of GnRH (FSH and LH).
It is noted in the present study that there is a reduction in sex hormones without an adequate increase in gonadotropins; this is in contrast to [10].
Our results suggest marked central inhibition of the hypothalamic-pituitary-gonadal axis, i.e., the occurrence of significantly reduced testosterone levels during tramadol administration has largely been attributed to the inhibitory action of tramadol on GnRH secretion in the hypothalamus.
In this work, there was statistically significant correlation between the severity of male sex hormone reduction with the duration and high doses of tramadol intake which is also correlated with high addiction severity scale, and this is in agreement with [11] in their study of opioid-induced hypogonadism.
In the present study, the mean value of male sex hormone levels showed statistically significant decrease in patient groups of tramadol dependence when compared to the control group.
Another study done by [12] found symptomatic hypogonadism in male with chronic exposure to opioids.
In the current study, it is noted that low levels in sexual satisfaction scale is correlated with high Addiction Severity Index as these patients have spent most time in searching for tramadol and work more to earn more money to buy tramadol so they are not interested in sexual activity with other partners.
Despite that many patients have started tramadol use as a sexual enhancer and as a treatment for premature ejaculation, yet the prolonged use of tramadol decrease sexual capacity that could be attributed to its effect on sex hormones.
Limitations of the study
Limitations of the study include the following:
- 1-
The relatively small number of patients.
- 2-
The effects of several other comorbidities as the age that is associated with androgen deficiency, also hyperlipidemia, hypertension, and diabetes mellitus, may affect the quality of sexual performance and thus may affect the scores of the Sexual Satisfaction Scale.
Further larger-scale studies are needed to assess the current results.