The relationship of salivary testosterone and male sexual dysfunction in opioid-associated androgen deficiency (OPIAD)

<p><i>Background</i>: Opioids are an effective treatment for chronic non-malignant pain (CNP). Long-term use risks and side effects such as opioid-induced androgen deficiency (OPIAD) exist. This could be measured by saliva testosterone (Sal-T).</p> <p><i>Objectives</i>: To evaluate OPIAD in long-term opioid use in CNP patients.</p> <p><i>Methods</i>: A cross-sectional study included CNP male outpatients under opioid treatment. Total-Testosterone (Total-T), Free-Testosterone (Free-T), Bio-Testosterone (Bio-T) and Sal-T were measured. Correlations were calculated by Spearman’s rho (SPSS 20).</p> <p><i>Results</i>: From 2012 to 2014, 134 from 249 (54%) consecutive male outpatients reported erectile dysfunction (ED), 37% of them related to opioids and 19% evidenced OPIAD. A total of 120 subjects (94 cases and 26 matched-controls) were included. A significantly lower luteinizing hormone, Total-T and Free-T were found, as well as, a significant correlation between Sal-T and Total-T (<i>r</i> = 0.234, <i>p</i> = 0.039), Bio-T (<i>r</i> = 0.241, <i>p</i> = 0.039), IIEF (<i>r</i> = 0.363, <i>p</i> = 0.003) and HAD-anxiety (<i>r </i>= −0.414, <i>p</i> = 0.012) in OPIAD patients. Sal-T levels were significantly lower in patients with severe–moderate ED versus mild ED (<i>p</i> = 0.045) and in patients with severe ED versus moderate–mild ED (<i>p</i> = 0.036).</p> <p><i>Conclusions</i>: These data demonstrate the high prevalence of ED in long-term use of opioids, part of this is associated to OPIAD, which can be tested by Sal-T as a non-invasive approach.</p>