Testosterone is the primary male hormone released by the brain. Higher levels of testosterone are found in men than women, but it is found in both sexes. It plays a central role in reproduction and muscle and bone mass. But testosterone plays a role in people managing chronic pain. When a person is experiencing chronic pain, the brain is consistently releasing stress inducing chemicals. These chemicals are released by the brain to signify the area of the body that needs attention. Its a primal response, with ramifications. The hyper-arousal of the hypothalamic-pituitary gland means cortisol and testosterone became severely diminished. Testosterone and cortisol are integral to pain relief, and without it, the pain the body experiences is enhanced.
Testosterone has shown to make the use of opioids for chronic pain patients more effective, allowing for patients to even lower their dosages. In addition to this benefit, testosterone also helps bind the chemical release of opioids to pain receptors in the body. This provides faster relief for the pain, and less stress induced chemicals to be released into the body. The Catch-22 of pain management and low testosterone is that sometimes, (non-cancer) patients using opioids long term can also lower testosterone. The regular use of opioids has been associated with opioid induced androgen deficiency (OPIAD) making the pain seem worse. So what do we do? Is it a damned if we do, damned if we don’t? It does not have to be. Chronic pain is typically managed with some type of opioid regimen and physical therapy. The pain needs to be addressed by opioid, and thus the lowered testosterone needs to addressed with hormone therapy. What has been lost previously is the lack of hormone treatment for patients experiencing chronic pain. The progressive track has led to patients having these concerns voiced. It is important for both physicians and patients to advocate for a full treatment course. All aspect of a patient’s wellness must be considered.
Low testosterone can effect both men and women. Hormone therapy should only be incorporated under the guidance of a physician with extensive knowledge of pain management. The physician will be able to accurately determine a highly specific regimen of care, per patient. For example, a man and a woman using the same opioid, at the same dosage, will be effected by hormones differently. And their hormone needs would have to be addressed in specialized ways. Introducing testosterone therapy with pain management regimens and regenerative medicine is still fairly new, but is emerging as a crucial aspect of patient care.
