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PostPosted: Mon May 22, 2017 12:21 pm 
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Hey gang,

I thought this might warrant a new thread. This concerns the often contentious discussion of bupe and testosterone levels. This is the same post (below )I added to the now longish thread concerning a young man's difficulties in this area. While we're all different human beings with different physiologies, and I don't question individual experience, I hope this study...perhaps the same one Dr. Junig recently cited, offers encouragement.


https://www.ncbi.nlm.nih.gov/pubmed/15483091

Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence.

Bliesener N1, Albrecht S, Schwager A, Weckbecker K, Lichtermann D, Klingm├╝ller D.
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Abstract
High-dose methadone is well known to cause testosterone deficiency and sexual dysfunction in opioid-dependent men. Buprenorphine is a new drug for the pharmacotherapy of opioid dependence. Its influence on the gonadal axis has not been investigated to date. We therefore assayed testosterone, free testosterone, estradiol, SHBG, LH, FSH, and prolactin in 17 men treated with buprenorphine. Thirty-seven men treated with high-dose methadone and 51 healthy blood donors served as controls. Sexual function and depression were assessed using a self-rating sexual function questionnaire and the Beck Depression Inventory. Patients treated with buprenorphine had a significantly higher testosterone level [5.1 +/- 1.2 ng/ml (17.7 +/- 4.2 nmol/liter) vs. 2.8 +/- 1.2 ng/ml (9.7 +/- 4.2 nmol/liter); P < 0.0001] and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. The testosterone level of buprenorphine-treated patients did not differ from that of healthy controls. In conclusion, we demonstrated for the first time that buprenorphine, in contrast with high-dose methadone, seems not to suppress plasma testosterone in heroin-addicted men. To this effect, buprenorphine was less frequently related to sexual side effects. Buprenorphine might therefore be favored in the treatment of opioid dependence to prevent patients from the clinical consequences of methadone-induced hypogonadism.


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PostPosted: Tue May 23, 2017 9:29 am 
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Thank you for ur information Godfrey!!

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PostPosted: Tue May 23, 2017 10:39 am 
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I was on the phone tonight with a woman who said she hasn't had an orgasm since she started Suboxone 2 months ago. And prior she was an incredibly sexual woman. Insanely so. She says she feels "dead down below".

Type in testosterone, sex or libido in the forum search and you'll see countless complaints over the years.

Here's another study that showed T reductions across both methadone and Buprenorphine compared to controls. Thankfully was less for buprenorphine.

https://www.ncbi.nlm.nih.gov/pubmed/17971165

I'm not saying everybody experiences this side effect, but I don't think we should invalidate the experiences of those who do.


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PostPosted: Tue May 23, 2017 11:38 pm 
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Teejay, the study you attached does not report lower testosterone levels in buprenorphine patients. I am a peer reviewer for a couple good journals, and I don't know anything about the acceptance rate for the 'International Journal of Andrology', where this article is from. But the abstract is convoluted and difficult to read. The report compares findings to 'expected values', without listing those actual values. There is no mention of the p-values for the comment about comparisons with 'reference groups'. And 'reference groups' are not the same as 'controls'.

But even with those problems, the study concludes that 'Men on MMT have high prevalence of hypogonadotrophic hypogonadism. The extent of hormonal changes associated with buprenorphine needs to be explored further in larger studies.' In other words, the study concludes that methadone has an impact, but makes no claim about the impact of buprenorphine.

I have access to the full article from my office, and I'm not there now. But the abstract does not make any claims about buprenorphine. The lab values for methadone and buprenorphine patients are combined, and clearly the methadone results pull all of the results downward: 'Overall 54% of men (methadone 65%; buprenorphine 28%) had total testosterone (TT) <12.0 nm; 34% (methadone 39%; buprenorphine 11%) had TT <8.0 nm.'

Look at those numbers--- only 11% of buprenorphine patients had the lowest free T levels, compared to 39% of methadone patients. And only 28% of buprenorphine patients were in the middle group, compared to 65% of methadone patients. That leaves 72% of buprenorphine patients in the normal range for testosterone levels, not making any adjustments for age-- compared to 35% of the methadone patients. In other words, twice as many buprenorphine patients had normal testosterone levels than methadone patients.

Studies are hard to interpret, and poor studiies are very hard to interpret. This abstract reports the results in a confusing way, which usually occurs when the authors aren't able to show what they were hoping to show. This is a good example of how headlines of studies, and abstracts, don't provide the full story. When I look at the title, I see that it intentially avoids making any conclusion. It does NOT say, for example, 'testosterone levels reduced by methadone and buprenorphine therapy'. Instead it suggests that the study is about hypogonadism in such patients, without saying whether hypogonadism was or wasn't present in the study group.

I don't think it 'invalidates' patient reports when we try to use objective data. The patient you describe who is not having orgasms raises many questions. So she WAS having orgasms all the time when abusing heroin, but now she isn't? That raises all sorts of questions in my mind. Was she able to have orgasms when she repressed the shame associated with addiction, and now she can't because she is able to experience reality? Many patients, during active addiction, live in a state of denial; when the chaos ends, they have to deal with guilt, shame, and other orgasm-killing emotions. Is she still having sex with the same partner? What is his attitude toward her now, vs. a couple months ago when she was using? Are they just as close and intimate now as they were then? If so, how are they pulling THAT off? Most people say they become different emotionally when they leave the world of active addiction.

I have had many patients over the years who have one type of sexual experience when they are 'fooling around', or 'f-ing', compared to the experience during a fully-aware, sober relatioship. I've had male and female patients who can't climax when things are too 'serious', because of the emotions that get in the way. That's why people tend to engage in fantasy and 'play' to pretend to be someone else-- dressing up, role-playing, acting out fantasies, etc-- to escape the emotions associated with reality.

As for reports about symptoms on this forum, we have no way of knowing the significance of those reports. Readers with an open mind notice that many people tend to look for something to blame, for a wide range of symptoms. If you go on sites about antidepressants, you will see many people blaming those meds for the same problems that people attribute to buprenorphine. On forums about blood pressure meds, you'll see the same. The reality is that we all have a range of 'symptoms' as life progresses, including more and more aches and pains, more problems with urination, more fatigue, more constipation and other GI complaints, more loss of motivation, more isolation, more depression, more problems with concentration, and more sexual problems. Some people realize that in the early 1800's, life expectancy was less than 40 years. Living beyond that age means dealing with symptoms caused by the aging process. Some people accept that simple fact, and do what they can to mitigate the natural increase in symptoms. And some people on the other hand choose to blame the symptoms on whatever medication they choose to resent.

I don't intend to invalidate anyone's symptoms--- but I am not afraid to invalidate inaccurate conclusions about the cause of those symptoms. These days, too many doctors simply agree with whatever their patients say, knowing that is the surest way to shorten an appointment. My goal here is to provide an opinion without fear that someone will be angered by the gift of insight. Open your minds, ye who enter here!


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PostPosted: Wed May 24, 2017 1:50 am 
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Here's a link to the full study: https://drive.google.com/file/d/0BxdOvdgrSokzMkxleGhUVUYtbTg/view?usp=sharing

I don't think anyone is arguing that buprenorphine comes close to a drug like methadone in terms of numbing libido. Some of us just believe that it does have SOME effect, especially on higher doses.

I also never mentioned this woman used heroin. She never used heroin at all actually. She abused codeine and tramadol for a month before she went on buprenorphine. Obviously she's comparing her libido now to what it was prior to abusing opioids.

I'm not going to get into her private sexual proclivities because it's not my place. But let's just say she had one of the biggest appetites I'd ever come across in terms of how often and how many people she slept with. Now, nothing. Nada.

With the studies it appears the jury is still definitely out. At this stage it can't be proven or disproven until a decent size study is done that is less about comparing it with other long acting opioids and more about comparing with healthy controls.

It's a sad indictment on this place that everybody who opened up and got vulnerable about these symptoms over the years, something that takes a lot of courage, especially the last young guy, is now being told that it's all in their head.


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PostPosted: Thu May 25, 2017 11:37 pm 
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I feel a little reluctant to chime in here, but I'm hoping that the open and honest flow of information will help myself and others looking for answers, especially when it relates to such a personal matter. As I've mentioned in previous posts, I'm still new to buprenorphine. I currently take 8 mg in the morning and 8 at night. Since I started taking it in April, I haven't been waking up with an erection and rarely get one throughout the day. This is unusual for me.

I'm a 42 year-old male, and although I'm single and not engaging in sex, I usually have a healthy sex drive and daily erections. I didn't notice much change, if any, in sexual function when I was taking pain medication. But I definitely notice a difference now. Until joining this forum and spending time reading about other men with the same problem, I thought maybe I was just too anxious... even depressed. I thought this has to just be in my head.

I think that part of me associates sex drive and function with pleasure and reward. Maybe I feel so guilty for chasing pleasure by using pills and then ending up in such bad shape that I subconsciously have guilt for wanting to feel good... even if it's natural. Maybe that's what is lowering my libido. I don't drink, smoke, use caffeine products or anything else that provides feelings of pleasure... partly because I need sobriety right now, but I'm not entirely sure I completely understand all of my motives yet.

This has been a whole new level of self discovery for me. I mean, at the moment, I'm okay without having a partner. I've been feeling quite lonely for a while but I know I need to time put myself back together. And frankly, I'm used to long stretches of being single. It's just the way my life has been. But I hope to one day meet a special woman. Someone I can share life's ups and down with. I've always wanted a family and at age 42 I sometimes do feel like my clock is ticking (LOL).

Well, I don't mean to ramble. But something is happening, I do know that. It's causes are unknown to me at the moment and I don't want to automatically place the blame on buprenorphine. This medication feels like a life saver right now. I am putting trust in myself to follow my gut and the advise of the health care providers I'm paying to help me. That's all I can do for now. If this is indeed a side effect of treatment, so be it... for now.

I hope other guys out there that have any experience in this department would advise us about their own situations. I'm glad I'm not alone in this.

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PostPosted: Fri Jul 14, 2017 7:37 pm 
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The one thing I did not like about opioid painkillers was the low libido. I could not care less about sex during opioid active addiction. When I had problems with alcohol earlier in my life it was completely the opposite, alcohol, increased interest in sex exponentially.
I have not noticed much of any change in libido or orgasm since starting Buprenorphine. I am a female, so I can't relate to missed erections but if I was a dude I would totally be freaked out about that. And if my husband was having that problem I know we would both be bothered about it.
I also take an antidepressant, Wellbutrin, that really increases libido and improves sexual functioning. That is not why I take it, but it is a nice side effect (along with increase energy, weight loss, decrese nicotine cravings ). This drug was being discussed in another thread, so I just remembered it's sexual side effects. It may be a good drug if anyone suffers from depression and decreased libido.
I got a little off track, but my final question is why are we so sure that Buprenorphine doesn't cause sexual side effects? Lots of drugs do. It doesn't mean it's not worth taking it, it just means working on dealing with the side effects. I get that it is important to look at data and objective studies. So we can't say it definitely causes these problems. But that doesn't exclude the possibility that it does have this effect on some people.

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PostPosted: Sat Jul 15, 2017 12:13 am 
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Opioid medications in general can affect testosterone.

Some people are impacted by Buprenorphine while others are not.

Anecdotal evidence is the poorest type, that stated I know of several cases where it was a problem while in many cases it was not.

Libido is a big deal but as many are not affected such fear should not stop someone who is interested in trying. Though it sucks the benefits of the medication usually far outweigh the side-effects.

There are some approaches for at least the physical component for men who have issues such as performing Kegel exercises regularly and medications like Cialis and Viagra though they are too expensive.

I can not speak to effectiveness but some tout the benefit beets and watermelon.

If you are on other medications be sure to look at those as potential offenders as well in addition to lifestyle factors (bad diet resulting in extra pounds, regular alcohol intake, etc).

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PostPosted: Sat Jul 15, 2017 11:18 am 
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Before I became an every day user, my favorite place in misusing opiates such as oxycodone, heroin, and bupe was for sexual reasons. It helped to delay ejaculation by having a "numbing" effect. I know many people who use opiates strictly for this reason. Meek Mill put in one of his songs "In the bed i'm gonna pop a perc and go mad long" lol (to my philly people). Opioids definitely suppress sexual function in people for whatever reason. I'm not sure why. I remember being on heroin everyday my member would not work at all, I could barely even pee!

I had four months sober this last time with a sex drive like never Before! Through the roof. I would have erections all day. Libido seemed to sky rocket for me during PAWS...i relapsed for a few weeks and after 6 chances of rehab and IOP doing the same thing I decided to try suboxone. I'm glad I did. However, after being on the med for 3 weeks I realized.."i haven't masturbated once, nor had any interest too..." I never wake up with erections anymore, and I have little interest in women where as when I was off everything I had a huge sex drive. Hell even when I was on stimulants my sex drive quadrupled..but opiates kill mine.

If any of you have checked out Rockin Roberta on YouTube, she mentions that the three years she was on suboxone she never had sex and barely ever masturbated. When she tapered down to 2mg her libido "came" back. She also never socialized on the drug. She viewed this as positive in hindsight because she needed to isolate and stay away from people to abstain.

Obviously bupe isn't going to have the same level of suppression that methadone is! Methadone is a full agonist, and I assume very powerful. I see methadone patients in my area walking around with their eyes PINNED and nodding an hour after their morning dose. It's as if they never got off heroin, just simply are nodding on a different opioid. I envy them sometimes when I crave ..but I see why they would have test suppression


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PostPosted: Wed Jul 19, 2017 4:33 pm 
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Thank you to everyone that commented here and in the other thread - best-time-get-laid-when-you-subby-t13667.html

I think it's an important topic and until these recent replies, I was wondering if the subject was just too taboo. Obviously this can get very personal very quickly, but it's such an important part of human health an relationships. We need to be able to have these discussions. I've been thinking about it more and more because of the threads here. So I've decided to ask my doctor next time I see him for my subs refill to check my T levels. I was very depressed before I got onto subs and feel like my levels were probably low for quite a while. It will be interesting to see what the doctor finds out.

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PostPosted: Fri Jul 21, 2017 8:29 pm 
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Let us know how it goes OpenMind.

I got my T levels done once, a series of 3 tests done early in the morning. I was on 12mg of Suboxone at the time. Two of those tests were subtherapeutic levels, and the third was barely in the normal range. It was a bad sign given I was a 31 year old man at the time, when the lowest of the low / normal range is what you'd associate with a much older gentleman (70+).

Still my doctor at the time took the third test as a sign I was "okay", given my levels were "on the up". The compounding factor is that I was also coming off a heroin relapse at the time. I'd been using heroin for about a month, then got clean, then a couple of weeks later started to get my T levels tested. My doctor believed that the low T was caused moreso by the heroin use than the Suboxone, and my levels were rebounding, so we didn't explore further. It's a fair conclusion, given in my experience heroin affects T more than Suboxone.

My personal feeling as a result of experiencing recovery both on and off Suboxone, is that Sub does affect T levels, but not to the same extent as methadone, heroin and other agonists. The simple fact that libido skyrockets once a person gets off Sub (it's a common report among people on this forum), and libido is much more consistent wile off Sub than on, indicates to me that T levels are curbed somewhat, but not completely, by Suboxone.

Now there's some other factors that come into play. Age is very important. Obviously a younger man is less likely to be concerned about a minor-moderate hit in their T levels, as there's a surplus of T in younger men anyway (I'm thinking teens-mid 20's). Even teenagers who use a lot of heroin / oxy etc may find their libido unimpeded because there's so much surplus T floating around.

From about the age of 27+ I started to notice that opioid use in any form was starting to affect me, and the difference between libido on and off Suboxone started to be noticeable. Methadone and heroin? Don't even bother!!

There are some things that can be done to address this. Many men prescribed psych medications, SNRI's and antidepressants are also given meds like Cialis or Viagra due to the boner killing effect of some of those meds. Taking a tiny sliver of Viagra could in theory help, and people on this forum have reported the need to do so and have gotten good results from this. BUT the issue is, low T affects desire, not just performance. You're not going to need to drop a sliver of Viagra if you CBF even leaving the house to find a prospective partner in the first place.

A lot of human behaviour, especially in our younger years, is influenced by sexuality and the need to find a partner. Obviously if a man's T is significantly blunted, that whole dimension of their life can be gone. And it's a bit of a shame. IMO humans are sexual animals and we should be able to explore that part of life without it being negatively hit by psych medications, or maintenance medications.

Maybe I'm unusual, but I don't think it should be taboo to talk about at all. If people can't talk about it over an anonymous forum, then how would one broach the subject with a doctor?

Also I'm on the other side of the planet so ... whatever.


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