Organiczne substancje psychoaktywne oddziałujące na receptory opioidowe.
Więcej informacji: Opioidy w Narkopedii [H]yperreala
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This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. (...). While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized.
https://www.ncbi.nlm.nih.gov/pubmed/22786453
Long-acting opioid use carries risks of addiction, tolerance, and systemic side effects including hypogonadotropic hypogonadism with consequent testosterone depletion leading to multiple central and peripheral effects. Hypogonadism is induced through direct inhibitory action of opioids on receptors within the hypothalamic-pituitary-gonadal (HPG) and hypothalamic-pituitary-adrenal (HPA) axes as well as testosterone production within the testes. Few studies have systematically investigated hormonal changes induced by long-term opioid administration or the effects of testosterone replacement therapy (TRT) in patients with OPIAD. Clomiphene citrate, a selective estrogen receptor modulator (SERM), is a testosterone enhancement treatment which upregulates endogenous hypothalamic function. This review will focus on the pathophysiology, diagnosis, and management of OPIAD, including summary of literature evaluating OPIAD treatment with TRT, and areas of future investigation.
https://www.ncbi.nlm.nih.gov/pubmed/27586511

OPIAD mechanisms
Opioids exert their activity by binding to the mu opioid receptor, which is expressed in the central nervous system (CNS), peripheral nervous system (PNS), and other areas such as the hypothalamus and pituitary gland.3 Opioids indirectly inhibit secretion of GnRH by the hypothalamus, thereby reducing downstream production of gonadal hormones in both sexes.3 Conversely, the mu-receptor antagonist naloxone increases LH and gonadal hormone secretion.5,6 Therefore, OPIAD is considered a form of secondary (hypogonadotropic) hypogonadism.1,3,5
Opioids may also cause adrenal insufficiency, reducing androgen production by the adrenal glands. Deficiency in dehydroepiandrosterone (DHEA), an adrenal precursor to testosterone production, was documented in patients on opioid therapy.7 Opioids were also found to induce apoptosis of leydig cells, which is thought to directly inhibit testosterone synthesis.8
It is thought that down-regulation of noradrenergic neurons and up-regulation of GABAergic neurons plays a role in transmitting the indirect effects of opioids on GnRH neurons in the hypothalamus. One study found that morphine could interact with a neuropeptide called Kisspeptin, which in turn down-regulates the HPG axis.9
Another possible mechanism is increased production of sex hormone-binding globulin, which reduces the levels of free testosterone. Studies in rats have found that morphine increased the conversion of testosterone to estradiol and dihydrotestosterone (DHT) by increasing aromatase and 5-alpha-reductase mRNA production.3
OPIAD Incidence
Various studies have reported rates of hypogonadism between 54% and 64% in men using chronic opioids.2 Hypogonadism with opioid use is dose-dependent and occurs quickly. Patients receiving 100 mg to 200 mg of morphine equivalent for 1 month are 50% to 100% likely to develop some degree of OPIAD.3 In one study, HPG axis suppression was found to occur as soon as 1 week after opioid use and was sustained for 12 weeks.5 However, hypogonadism associated with opioid use is generally considered reversible.3,5 It should be noted that both sexes are affected, as females also experience hypogonadism and may have decreased libido when taking opioids.1,2,3
https://www.pharmacytimes.com/contribut ... ing-points


Coś o czym od dawna wiadomo, ale teraz w formie prac naukowych ;) Czyli obniżka hormonów płciowych u osób chronicznie zażywających opioidy...
Uwaga! Użytkownik GG Allin nie jest już aktywny na hyperrealu. Nie odpowie na próbę kontaktu, ani nie przeczyta odpowiedzi na post.
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