Screening for Opioid-Related Low Testosterone Underused
Rates of screening, treatment for low testosterone higher for prolonged versus short-term opioid users
THURSDAY, Sept. 12, 2019 (HealthDay News) -- More men with long-term opioid use are screened for low testosterone than men taking opioids for a short period of time; however, given the known link between opioid use and low testosterone, these rates were still lower than expected, according to a study published in the September issue of Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
Jacques Baillargeon, Ph.D., from the University of Texas Medical Branch in Galveston, and colleagues used data from a large commercial insurance database to identify 53,888 men (aged ≥20 years) who had 90 or more days of opioid prescriptions in a single 12-month period (2010 through 2017) and no history of hypogonadism or testosterone therapy in the preceding 12 months. These men were matched to 53,888 men with ≤14 days of opioid prescriptions based on age, opioid initiation date, and opioid indication.
The researchers found the incidence of serum testosterone screening at five years of follow-up was 11.55 percent among short-term opioid users and 17.15 percent among prolonged opioid users. After adjustment for age, year of opioid initiation, region, comorbid disease, glucocorticoid use, and health care utilization, compared with short-term opioid users, prolonged opioid users had an increased incidence of serum testosterone screening at five years (hazard ratio [HR], 1.46). Furthermore, prolonged users had an increased incidence of hypogonadism diagnosis (hazard ratio, 1.74) and receipt of testosterone therapy (hazard ratio, 2.41). These findings persisted across multiple sensitivity analyses.
"This finding suggests a wide underscreening of opioid-induced low-testosterone, but it's not clear what factors drove this low rate," Baillargeon said in a statement. "It may reflect a lack of awareness among some clinicians or a reluctance to screen for conditions that would require additional medications in patients who already have complex conditions and treatment plans."
Baillargeon disclosed financial ties to AbbVie, Auxilium Pharmaceuticals, GlaxoSmithKline, and Endo Pharmaceuticals.