A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy

Abstract

Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.