Under post-marketing experience:
Androgen deficiency: Cases of androgen deficiency have occurred with chronic use of opioids [see
Clinical Pharmacology (12.2)].
Chronic use of opioids may influence the hypothalamic‐pituitary‐gonadal axis, leading to androgen
deficiency that may manifest as low libido, impotence, erectile dysfunction, amenorrhea, or infertility.
The causal role of opioids in the clinical syndrome of hypogonadism is unknown because the various
medical, physical, lifestyle, and psychological stressors that may influence gonadal hormone levels have
not been adequately controlled for in studies conducted to date. Patients presenting with symptoms of
androgen deficiency should undergo laboratory evaluation.
There's also some bits and pieces about impaired fertility in there, but it doesn't appear to be as much of an issue.
Now I've been back on Suboxone for 3 or 4 years, the old low-T has reared its ugly head again. I'm not too concerned about the sexual symptoms. If I don't desire sex then I don't really miss it. It's more the lacklustre affect it has on motivation and lifestyle. I have little ambition and motivation in life, despite not being depressed at the moment. I feel if I were to continue life like this, I would probably stay single long term, and I honestly have little desire to go out and have fun. I don't really want to live like a recluse from my mid-30's. It'd also be a matter of time before I relapse, given a lack of zest for life and each day seeming evermore like groundhog day.
I remember when I went off Suboxone last time I experienced these symptoms, my zest for life returned within weeks. I started dating, and ambition to achieve and succeed returned. Since I relapsed and went back on Suboxone, over 3-4 years very slowly I found myself becoming less involved in life. The last 6 months it's been particularly noticeable. I feel like the old grandpa from Charlie in the Chocolate Factory who chose to live the rest of his dying days lying in bed, despite being physically fine. Don't get me wrong I do get out of bed, but I honestly feel like I could just float through the rest of my life as a recluse. I don't even appreciate a physically attractive woman like I did when I was on Sub. Nobody turns my head at all.
So yeah, 2018 I'm giving life another go off Suboxone. This time around I'm not going to make the mistake of moving out of a recovery house environment until I have at least 3 years clean. That was my mistake last time. 18 months clean is too early for a long-term heroin addict with bipolar disorder to live alone with no accountability. Willpower and resilience has never been my strong suite, so I need a bit more extended support before I choose to live on my own.
I'm on the waiting list to go to a 6 month therapeutic community to taper back off Suboxone and reintegrate back into the 12-step world. I would personally prefer to live the rest of my life in a subsidised sober house and attend regular NA meetings, than spend the rest of my life dependent on drug-replacement. We all know I'm not a huge fan of 12-step groupthink, but I'm pretty good at taking what I need and leaving the rest these days. Just don't ask me to share because I don't exactly parrot all the expected platitudes!
The only thing you have to change ... is everything!!!