What do opioids do to testosterone + estrogen?

Opioid use disorder (OUD) takes a toll both mentally and physically, contributing to all kinds of issues, from infections and poor oral health to an increased risk of depression and anxiety. More recent research has further flagged the effect that prescription and illicit opioids have on the body's hormones. Do opioids lower testosterone and estrogen hormone levels? Read on to find out.

The role of testosterone + estrogen in male + female bodies

Hormones are your body's chemical message carriers, coordinating a variety of functions, from your sleep-wake cycle to your mood and sexual function. Your body's endocrine system produces hormones. The endocrine system includes multiple glands like the pituitary gland, located at the base of the brain; the thyroid gland, set at the front part of the lower neck; and the testes (part of the male genitals) and ovaries (part of the female genitals).

Scientists have identified more than 50 hormones in the human body, including testosterone and estrogen. Men and women have both hormones, which influence much more than sexual and reproductive functions.

The testes produce testosterone in men. Testosterone is responsible for sexual development in adolescence, sperm production, and sex drive. However, it also has other roles, like promoting muscle size and bone growth. The ovaries and adrenal glands produce testosterone in women. The hormone influences things like bone strength, ovarian function, and libido. In general, women have much lower levels of testosterone than men.

On the other hand, women tend to have higher levels of estrogen than men. The ovaries primarily produce estrogen in women. The hormone causes breasts to develop during adolescence while also influencing the menstrual cycle, fertility, and pregnancy. In men, testosterone can be converted into estradiol (a type of estrogen). Men's bodies rely on estradiol for things like regulating sex drive and achieving erections. For men and women alike, estrogen also influences cholesterol levels, bone density, muscle mass, mood, skin, and more.

Opioid effect on hormones

One common question when it comes to opioids and endocrine health is, "Do opiates affect testosterone?" In short, yes, it's known that opioids reduce testosterone levels. And that isn't the only impact they have on endocrine health. They can also impact estrogen production.

These influences on the body's hormones come with numerous health implications. In 2024, the Endocrine Society — a global community of physicians and scientists in endocrinology — published a scientific statement giving an overview of how opioids disrupt endocrine system function¹. This builds on a body of research discussing a range of hormone health risks linked to opioid use.

Sexual health

Estrogen and testosterone are widely known as hormones impacting sexual health. It's long been known that opioids lower testosterone levels, for example, which can contribute to challenges like fatigue, low mood, and sexual dysfunction¹ .

Meanwhile, the impact of opioids on estrogen levels can result in altered menstrual flow and, researchers theorize, probable reduced fertility². It's further suggested that long-term opioid use can bring on early menopause, result in primary ovarian insufficiency, and cause infertility³.

Bone density

Research indicates that there are three ways⁴ long-term opioid use can increase the risk of bone fractures, including:

• Opioids cause a direct change in how bones build and rebuild
• Hypogonadism (aka low testosterone) from chronic opioid use
• Central nervous system (CNS) effects (sleepiness, wooziness) from opioid use

One analysis of insurance claims in patients with fractures aged 17 to 64 showed a link between opioid use and increased risk of bone fracture⁵.

Muscle mass

Opioid use suppresses a part of the endocrine system known as the hypothalamic-pituitary-gonadal axis (HPG axis), leading to low estrogen and low testosterone levels. 

Hypogonadism can cause issues in both men and women, including fatigue and decreased muscle mass⁶. Losing muscle might not seem like a huge deal, but it can affect your health. Especially as people get older, loss of muscle mass can mean loss of strength and function and an increased risk of falls.

Cognitive health + emotional/mental regulation

The hormone imbalances related to OUD might also have implications for cognitive function. Hormonal imbalances can be associated with issues like slow mental processing, difficulty concentrating, and memory loss. Declining estrogen is associated with brain fog⁷.

Hormone imbalances can also influence emotional well-being, impacting mental regulation. Research suggests that one in three people with OUD also has symptoms of anxiety — a common condition individuals experience at the same time as OUD. OUD can also occur at the same time as other mental health conditions, like PTSD and depression. 

Skin + hair health

Opioids can also influence outward physical characteristics, like skin and hair. For instance, opioid-induced low testosterone refers to a syndrome in which low levels of gonadotropins, a type of hormone, result in reduced testosterone production. Among the implications is reduced facial and body hair⁸ for men. Low estrogen and thyroid disruptions can cause dry skin.

Speaking of skin, numerous studies suggest that opioid use can hinder wound healing. This is likely because opioids reduce immune activation, which is necessary for promoting healing⁹. Estrogen is known to accelerate wound healing, so lowered estrogen levels might be one possible reason for this link¹⁰.

How OUD treatment can influence hormones

Given the varied ways chronic opioid use impacts endocrine health, there is a renewed call among healthcare professionals to discuss these implications with patients with OUD. Patients in OUD treatment for more than three months must be told about the risk of hypogonadism and asked about side effects⁴. 

It's also necessary to understand the effects of care options for OUD so patients can make informed decisions on their treatment journey. One popular OUD treatment is Suboxone®, considered the "gold standard" of OUD care (important safety information). Suboxone is a combination medication composed of naloxone and buprenorphine that helps reduce withdrawal symptoms and cravings.

While it's safe and effective, Suboxone also carries a risk of side effects because it is in a similar class of medications to prescription full agonist opioids. However, the side effects while taking Suboxone are generally much milder/less common due to the buprenorphine. The partial opioid receptor agonist is linked to milder effects on the hypothalamic-pituitary-gonadal system⁴. Suboxone does have side effects. Long-term Suboxone use can result in a variety of side effects, including:

• Constipation
• Gastrointestinal issues
• Blood pressure changes
• Dental problems
• Anxiety
• Depression
• Drowsiness and sleep disruptions

When it comes to sexual side effects during OUD treatment, individuals might have a lower sex drive and struggle to achieve orgasm. Men might also experience issues like erectile dysfunction (ED) and premature ejaculation. Meanwhile, women might experience unique issues of their own, like irregular periods.

Finding OUD care that works for you

There are solutions available to address OUD, like medications for addiction treatment (MAT). MAT combines the use of prescriptions like Suboxone with mental health support, like one-on-one and group therapy. In this way, it helps address both the physical and mental components of addiction.

Ophelia makes MAT accessible remotely, removing geographic barriers to care. Eligible patients can have a Suboxone prescription called into a local pharmacy and then visit with their care teams online, getting ongoing support on their treatment journey. Find out how it works and if you might be eligible.