’ m quite an ‘ expert patient ’ when it comes to methadone maintenance therapy ( MMT ) and opioid substitution therapy ( OST ). I ’ ve been on various forms of OST / MMT for the past 22 years and , when my story begins , I was taking a dose of 100ml methadone daily . This worked brilliantly in silencing the nagging voices of craving that were ever present when I was on a dose of 40ml and it helped me create a more stable life with my then partner and our rescue cat , Honey . On the outside things looked pretty good for me and my partner , who I ’ ll call Kika . We were both working – I was an advocate for drug users using local treatment services . I ’ ve struggled with depression throughout my life and I ’ m also a survivor of a few traumatic attacks , so I was used to trying to deal with low mood . Nonetheless , I was feeling more depressed and very sluggish with low energy . Our sex life which was great at the start had dwindled to nothing for a few years , and for this I had a nagging sense of guilt . I ’ d read about opioid-induced androgen deficiency ( OPIAD ), a condition which affects men and women who ’ ve been taking opiates / opioids for some time and causes a dramatic drop in the production of testosterone . I learnt that testosterone is vital for us to feel energised and motivated for all aspects of life , not just sex .

At this time my treatment was under the care of my GP . I ’ ve been very lucky to have all three of my GPs happy to treat me , but my longstanding and much-loved GP had just retired and it took me some time to convince my new GP to test my testosterone levels as he believed I was dealing with depression . When he did , the test

demonstrated that my testosterone levels were on the floor – or at castration levels , as the research says . He started my testosterone replacement treatment but sadly my long-term relationship with Kika was already on the rocks and it was too late to row back , despite my libido returning . Thankfully we remained very close friends .

Now I ’ m certainly not claiming that testosterone replacement is some sort of magic bullet . My contract had ended and my mum had died . I ’ m not going to claim that having a libido back as a 50-year-old shortish jobless man was always easy . It was other aspects of having my hormones right that have been , ultimately , a game changer for me . Having more energy helped me take up the offer of a gym partnership from another long-term friend who ’ s now in abstinence-based recovery . Alongside a short local run which I do most days , this has helped me fight off the low mood which dogged me .

The reason I wanted to write this article is because I ’ ve found that knowledge of OPIAD is lacking among many doctors and drug workers . People who are on longterm opioid treatment , either for pain or drug dependency , are having the symptoms of an androgen deficiency misdiagnosed as being purely related to their mental health . They are much more likely to be treated with antidepressants than have their blood tested for abnormally low testosterone .

Even less well known is the vital function of

testosterone in women , and the impact that this can have on women either suffering from OPIAD or living through the menopause . The level of testosterone in women is about one tenth to one twelfth of its level in healthy men , but it still has a vital role .

One last but significant point is that when myself and Kika first started seeing each other I was on a high dose of buprenorphine which , for me , didn ’ t seem to have the same impact on my sex drive . More thorough research than this anecdotal report would obviously be needed to establish whether buprenorphine has the same effect on testosterone production .

For a fully referenced research paper on OPIAD visit https :// www . painphysicianjournal . com / current / pdf ? article = MTcxMg % 3D % 3D & jo urnal = 68

People on longterm opioid treatment ... are much more likely to be treated with antidepressants than have their blood tested for abnormally low testosterone .

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