Long-Term Opioid Use: How It Affects Hormones and Sexual Function

When you’re on opioids for long-term pain, the focus is usually on whether they’re working - not on what they’re doing to your body underneath. But here’s the truth: long-term opioid use doesn’t just dull pain. It quietly rewires your hormones, and that changes everything - including your sex life, energy, mood, and even how you feel about yourself.

What’s Really Happening Inside Your Body?

Opioids like oxycodone, hydrocodone, fentanyl, and morphine don’t just bind to pain receptors. They also slam the brakes on your hypothalamic-pituitary-gonadal (HPG) axis - the system that controls testosterone, estrogen, cortisol, and other key hormones. This isn’t a rare side effect. It’s the rule.

Studies show that 63% of men on chronic opioid therapy develop biochemical hypogonadism - meaning their testosterone levels drop below 300 ng/dL. That’s not just low. That’s clinically significant. For many, this happens within just 30 days of starting daily use. By six months, nearly two out of three men are in the red zone.

Women aren’t spared. While estrogen levels often stay normal, testosterone drops. That’s enough to wreck libido, cause vaginal dryness, and trigger menstrual chaos. Up to 87% of premenopausal women on long-term opioids experience irregular periods. Nearly one in five stop getting their period entirely. And because these symptoms are often dismissed as ‘just stress’ or ‘aging,’ many women suffer in silence for years.

Why Do Opioids Do This?

It starts in the brain. Opioids suppress the release of gonadotropin-releasing hormone (GnRH). No GnRH means no luteinizing hormone (LH) from the pituitary. No LH means your testes or ovaries stop producing sex hormones. It’s a domino effect - and once it starts, it doesn’t reverse on its own.

Dose matters. Even 60 morphine milligram equivalents (MME) per day - about two 30 mg oxycodone pills - can trigger hormonal disruption. At 120 MME or higher, the drop in testosterone becomes severe. That’s not a high dose for someone with chronic pain. It’s standard.

And it’s not just testosterone. Cortisol - your body’s main stress hormone - also drops in many users. That means fatigue, brain fog, and trouble handling stress. Combine that with low libido and depression, and it’s no surprise so many people on long-term opioids feel like they’re barely hanging on.

How Bad Is the Sexual Impact?

For men: erectile dysfunction hits 70-80%. Libido plummets. Orgasms feel flat or disappear. One Reddit user, ChronicPainWarrior87, wrote: ‘After two years on oxycodone, my testosterone was 180. My doctor didn’t test it until I asked. Took six months to get help.’ He’s not alone.

For women: sex becomes painful or unappealing. Vaginal dryness, lack of arousal, and loss of interest are common. A 2021 survey of 342 women found 78% lost interest in sex. 41% said their depression got worse. And again - doctors often didn’t connect the dots.

It’s not just physical. The emotional toll is heavy. Many men feel emasculated. Many women feel broken. Partners notice. Relationships strain. Yet, in a 2023 JAMA study, only 38% of primary care doctors routinely screen for these issues.

What About Other Pain Medications?

Not all painkillers are equal. NSAIDs like ibuprofen or acetaminophen might cause mild sexual side effects in 5-15% of users - but nothing like opioids. Gabapentinoids like pregabalin affect testosterone in only 12% of men - a fraction of the opioid rate.

That’s why guidelines from the American Pain Society and the CDC now say: don’t start opioids for chronic non-cancer pain unless everything else has failed. Physical therapy, cognitive behavioral therapy, antidepressants like duloxetine, and even acupuncture have better long-term outcomes - without wrecking your hormones.

What Can You Do About It?

First: get tested. If you’ve been on opioids for more than 90 days, ask for a blood test for total testosterone (men) and a full hormone panel (women). Don’t wait for your doctor to bring it up. Most won’t.

For men: testosterone replacement therapy (TRT) works. Studies show 70-85% of men see major improvements in libido, erections, and energy once levels are restored. TRT comes as gels, patches, or injections. But it’s not risk-free - it can raise red blood cell counts, so monitoring is required.

For women: options are limited. There’s no FDA-approved treatment for opioid-induced low libido in women. Some doctors use low-dose testosterone patches (1-2 mg daily) off-label, with 50-60% reporting improved desire. Others try adjusting opioid doses or switching to buprenorphine, which causes 40% less hormone disruption.

And here’s a game-changer: low-dose naltrexone. In a 2024 Cleveland Clinic study, combining a tiny dose of naltrexone with reduced opioid use improved testosterone levels by 25-35% in 68% of patients - without losing pain control. It’s not magic, but it’s promising.

Stopping Opioids Isn’t Easy - But It Can Be Done Safely

Some people think the only solution is quitting opioids cold turkey. That’s dangerous. Withdrawal can be brutal - nausea, sweating, anxiety, insomnia - and 73% of people who try it alone end up back on their old dose within 90 days.

Successful tapering needs structure. Work with a pain specialist and an endocrinologist. Slow, supervised reductions - often over months - can help your body start making hormones again. Some patients regain normal testosterone levels within 3-6 months after stopping. Others need ongoing TRT. Either way, you don’t have to suffer in silence.

The Bigger Picture

This isn’t just about sex. It’s about quality of life. When your hormones are off, you’re not just less interested in intimacy - you’re more tired, more irritable, more depressed. You lose motivation. You pull away from friends. You stop exercising. It’s a downward spiral.

And the system is failing. The Endocrine Society says failing to test for opioid-induced hypogonadism is ‘substandard care.’ Yet most clinics don’t even check. The FDA now requires warning labels on opioid packaging. But patients still aren’t being told.

There’s hope. The non-opioid pain market is growing fast - projected to hit $59 billion by 2027. New treatments are emerging. More doctors are learning. But until you speak up, you’re at risk.

What to Ask Your Doctor

If you’re on long-term opioids, here’s what to say next time you see your provider:

• ‘Could my low energy or loss of sex drive be from my opioids?’
• ‘Can you test my testosterone level?’ (men)
• ‘Are my periods normal? Should I be worried about missed cycles?’ (women)
• ‘Are there alternatives to this dose or this drug?’
• ‘Could low-dose naltrexone or switching to buprenorphine help?’

You have the right to ask. And you deserve to feel like yourself again.