Opioids, Testosterone and Suicide
Opioid use disorder and suicidal behaviour are major public health problems in many countries. Individuals who use opioids are much more likely than those who do not consume opioids to die by suicide.
Opioid use disorder is associated with a rise of 40% to 60% in the risk of suicidal ideation. Individuals using opioids frequently twice as likely to attempt suicide as individuals who do not consume opioids.
In the United States, opioid use disorder is associated with more than doubled risk of suicide among females and elevated suicide risk among males by one-third.
Clinicians and researchers believe that some cases of death among opioid users regarded as accidental overdoses or ‘undetermined’ are in fact suicides. It means that there may be more suicides among opioid users than reported.
In this commentary, I propose that inhibition of testosterone production by opioids may contribute to the pathophysiology of suicidal behaviour among male opioid users.
The inhibitory impacts of opioid substances on the hypothalamic–pituitary– gonadal axis have been recognized for several decades.
All opioids reduce testosterone production because they hamper secretion of hypothalamic gonadotropin- releasing hormone and disrupt its normal pulsatility.
Opioid use decreases levels of testosterone in men regardless of the route of administration
…
It is reasonable to hypothesize that testosterone-reducing effects of opioids may contribute to suicidal behaviour among opioid users. Probably, blood testosterone levels should be examined in individuals taking opioids. Male opioid users who have low testosterone levels should be evaluated for suicidality.
It is important to note that many factors including obesity, alcohol abuse, cigarette smoking, excessive caffeine intake and environmental pollution may reduce testosterone levels in men in Western countries.
Research studies are needed to find out whether testosterone supplementation may reduce suicidal behaviour among male opioid users. Testosterone supplementation may be an effective treatment intervention in men who use opioids and who are also at high risk of suicide.
Sher L. Opioids, testosterone and suicide [published online ahead of print, 2020 Jul 1]. Aust N Z J Psychiatry. 2020;4867420937807. doi:10.1177/0004867420937807 https://journals.sagepub.com/doi/10.1177/0004867420937807
Opioid use disorder and suicidal behaviour are major public health problems in many countries. Individuals who use opioids are much more likely than those who do not consume opioids to die by suicide.
Opioid use disorder is associated with a rise of 40% to 60% in the risk of suicidal ideation. Individuals using opioids frequently twice as likely to attempt suicide as individuals who do not consume opioids.
In the United States, opioid use disorder is associated with more than doubled risk of suicide among females and elevated suicide risk among males by one-third.
Clinicians and researchers believe that some cases of death among opioid users regarded as accidental overdoses or ‘undetermined’ are in fact suicides. It means that there may be more suicides among opioid users than reported.
In this commentary, I propose that inhibition of testosterone production by opioids may contribute to the pathophysiology of suicidal behaviour among male opioid users.
The inhibitory impacts of opioid substances on the hypothalamic–pituitary– gonadal axis have been recognized for several decades.
All opioids reduce testosterone production because they hamper secretion of hypothalamic gonadotropin- releasing hormone and disrupt its normal pulsatility.
Opioid use decreases levels of testosterone in men regardless of the route of administration
…
It is reasonable to hypothesize that testosterone-reducing effects of opioids may contribute to suicidal behaviour among opioid users. Probably, blood testosterone levels should be examined in individuals taking opioids. Male opioid users who have low testosterone levels should be evaluated for suicidality.
It is important to note that many factors including obesity, alcohol abuse, cigarette smoking, excessive caffeine intake and environmental pollution may reduce testosterone levels in men in Western countries.
Research studies are needed to find out whether testosterone supplementation may reduce suicidal behaviour among male opioid users. Testosterone supplementation may be an effective treatment intervention in men who use opioids and who are also at high risk of suicide.
Sher L. Opioids, testosterone and suicide [published online ahead of print, 2020 Jul 1]. Aust N Z J Psychiatry. 2020;4867420937807. doi:10.1177/0004867420937807 https://journals.sagepub.com/doi/10.1177/0004867420937807
