Study Stopped
The original PI (David Siegel) Left the VA
Analgesic Efficacy of Testosterone Replacement in Hypogonadal Opioid-treated Chronic Pain Patients: A Pilot Study.
1 other identifier
interventional
N/A
0 countries
N/A
Brief Summary
The purpose of this pilot study is to test the effects of testosterone replacement on pain, fatigue, mood, cognition and libido in hypogonadal men on long-term opioid therapy for chronic pain.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
Started Oct 2006
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
October 30, 2006
CompletedFirst Submitted
Initial submission to the registry
November 8, 2006
CompletedFirst Posted
Study publicly available on registry
November 10, 2006
CompletedPrimary Completion
Last participant's last visit for primary outcome
September 6, 2007
CompletedStudy Completion
Last participant's last visit for all outcomes
September 6, 2007
CompletedOctober 13, 2023
November 1, 2006
10 months
November 8, 2006
October 11, 2023
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
• To determine if testosterone replacement can improve pain control in opioid-treated, hypogonadal men with chronic pain.
Secondary Outcomes (7)
In opioid-treated, hypogonadal men with chronic pain, to determine whether testosterone replacement therapy (TRT) will:
reduce the opioid requirement.
improve fatigue
improve depression
improve sexual function.
- +2 more secondary outcomes
Interventions
Eligibility Criteria
You may qualify if:
- Adult male patients (above 18 years old and below 60 years old)
- Receiving greater than 20 IV morphine equivalents/day with \<20% change in dosage in the last month.
- AM total testosterone \<300 ng/dL
- Report "worst pain during the past week" grater than 4 on an 11-point numeric scale.
You may not qualify if:
- Females
- Poorly controlled, symptomatic, active medical or psychiatric problems (e.g., HIV, hepatitis, diabetes, cancer, benign prostatic hypertrophy, substance abuse, major depression)
- Neurological or psychiatric disorder that would compromise the patient's ability to give informed consent or adhere to the requirements of the protocol.
- History of prostate cancer, abnormal findings on digital rectal exam, or PSA greater than 4.0 ng/m
- History of polycythemia
- Renal or hepatic dysfunction
- Hematocrit \>55%
- Known history of hypersensitivity to transdermal testosterone gel.
- Abnormalities during digital rectal exam.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Related Publications (70)
American Pain Society, Guidelines for the Management of Acute and Cancer Pain. 4 ed. 1999, Glenview, IL: American Pain Society.
BACKGROUNDPortenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage. 1996 Apr;11(4):203-17. doi: 10.1016/0885-3924(95)00187-5.
PMID: 8869456BACKGROUNDRigoni, G. Drug Utilization for Immediate- and Modified Release Opioids in the U.S. in FDA Anesthesia, Life Support, and Addiction Drug Products Advisory Committee. 2003. Gaithersburg, Maryland.
BACKGROUNDBair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003 Nov 10;163(20):2433-45. doi: 10.1001/archinte.163.20.2433.
PMID: 14609780BACKGROUNDPasschier J, Rupreht J, Koenders ME, Olree M, Luitwieler RL, Bonke B. Patient-controlled analgesia (PCA) leads to more postoperative pain relief, but also to more fatigue and less vigour. Acta Anaesthesiol Scand. 1993 Oct;37(7):659-63. doi: 10.1111/j.1399-6576.1993.tb03784.x.
PMID: 8249554BACKGROUNDJarvik LF, Simpson JH, Guthrie D, Liston EH. Morphine, experimental pain, and psychological reactions. Psychopharmacology (Berl). 1981;75(2):124-31. doi: 10.1007/BF00432173.
PMID: 6798601BACKGROUNDCicero TJ, Bell RD, Wiest WG, Allison JH, Polakoski K, Robins E. Function of the male sex organs in heroin and methadone users. N Engl J Med. 1975 Apr 24;292(17):882-7. doi: 10.1056/NEJM197504242921703.
PMID: 1117911BACKGROUNDCrowley TJ, Simpson R. Methadone dose and human sexual behavior. Int J Addict. 1978 Feb;13(2):285-95. doi: 10.3109/10826087809039281.
PMID: 640760BACKGROUNDCushman P Jr. Sexual behavior in heroin addiction and methadone maintenance. Correlation with plasma luteinizing hormone. N Y State J Med. 1972 Jun 1;72(11):1261-5. No abstract available.
PMID: 4503902BACKGROUNDMintz J, O'Hare K, O'Brien CP, Goldschmidt J. Sexual problems of heroin addicts. Arch Gen Psychiatry. 1974 Nov;31(5):700-3. doi: 10.1001/archpsyc.1974.01760170088014. No abstract available.
PMID: 4474860BACKGROUNDSmith DE, Moser C, Wesson DR, Apter M, Buxton ME, Davison JV, Orgel M, Buffum J. A clinical guide to the diagnosis and treatment of heroin-related sexual dysfunction. J Psychoactive Drugs. 1982 Jan-Jun;14(1-2):91-9. doi: 10.1080/02791072.1982.10471916.
PMID: 7119946BACKGROUNDAzizi F, Vagenakis AG, Longcope C, Ingbar SH, Braverman LE. Decreased serum testosterone concentration in male heroin and methadone addicts. Steroids. 1973 Oct;22(4):467-72. doi: 10.1016/0039-128x(73)90002-0. No abstract available.
PMID: 4747447BACKGROUNDBolelli G, Lafisca S, Flamigni C, Lodi S, Franceschetti F, Filicori M, Mosca R. Heroin addiction: relationship between the plasma levels of testosterone, dihydrotestosterone, androstenedione, LH, FSH, and the plasma concentration of heroin. Toxicology. 1979 Dec;15(1):19-29. doi: 10.1016/0300-483x(79)90016-7.
PMID: 120622BACKGROUNDCushman P Jr. Plasma testosterone in narcotic addiction. Am J Med. 1973 Oct;55(3):452-8. doi: 10.1016/0002-9343(73)90202-7. No abstract available.
PMID: 4743346BACKGROUNDMendelson JH, Mendelson JE, Patch VD. Plasma testosterone levels in heroin addiction and during methadone maintenance. J Pharmacol Exp Ther. 1975 Jan;192(1):211-17.
PMID: 1123724BACKGROUNDRasheed A, Tareen IA. Effects of heroin on thyroid function, cortisol and testosterone level in addicts. Pol J Pharmacol. 1995 Sep-Oct;47(5):441-4.
PMID: 8868137BACKGROUNDAfrasiabi MA, Flomm M, Friedlander H, Valenta LJ. Endocrine studies in heroin addicts. Psychoneuroendocrinology. 1979;4(2):145-53. doi: 10.1016/0306-4530(79)90028-3. No abstract available.
PMID: 230529BACKGROUNDBrambilla F, Sacchetti E, Brunetta M. Pituitary-gonadal function in heroin addicts. Neuropsychobiology. 1977;3(2-3):160-6. doi: 10.1159/000117601.
PMID: 331136BACKGROUNDMendelson JH, Mello NK. Plasma testosterone levels during chronic heroin use and protracted abstinence: study of Hong Kong addicts. NIDA Res Monogr. 1978;(19):142-8. No abstract available.
PMID: 106283BACKGROUNDRagni G, De Lauretis L, Bestetti O, Sghedoni D, Gambaro V. Gonadal function in male heroin and methadone addicts. Int J Androl. 1988 Apr;11(2):93-100. doi: 10.1111/j.1365-2605.1988.tb00984.x.
PMID: 3372047BACKGROUNDCushman P Jr, Kreek MJ. Methadone-maintained patients. Effect of methadone on plasma testosterone, FSH, LH, and prolactin. N Y State J Med. 1974 Oct;74(11):1970-3.
PMID: 4528642BACKGROUNDDaniell HW. Narcotic-induced hypogonadism during therapy for heroin addiction. J Addict Dis. 2002;21(4):47-53. doi: 10.1300/J069v21n04_05.
PMID: 12296501BACKGROUNDLafisca S, Bolelli G, Franceschetti F, Filicori M, Flamigni C, Marigo M. Hormone levels in methadone-treated drug addicts. Drug Alcohol Depend. 1981 Nov;8(3):229-34. doi: 10.1016/0376-8716(81)90066-1.
PMID: 6459917BACKGROUNDKley HK, Oellerich M, Wiegelmann W, Herrmann J, Rudorff KH, Nieschlag E, Kruskemper HL. The effect of methadone on hypophyseal and peripheral glandular hormones during withdrawal. Horm Metab Res. 1977 Nov;9(6):484-8. doi: 10.1055/s-0028-1093505. No abstract available.
PMID: 412765BACKGROUNDWoody G, McLellan AT, O'Brien C, Persky H, Stevens G, Arndt I, Carroff S. Hormone secretion in methadone-dependent and abstinent patients. NIDA Res Monogr. 1988;81:216-23. No abstract available.
PMID: 3136363BACKGROUNDDaniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002 Oct;3(5):377-84. doi: 10.1054/jpai.2002.126790.
PMID: 14622741BACKGROUNDRajagopal A, Vassilopoulou-Sellin R, Palmer JL, Kaur G, Bruera E. Hypogonadism and sexual dysfunction in male cancer survivors receiving chronic opioid therapy. J Pain Symptom Manage. 2003 Nov;26(5):1055-61. doi: 10.1016/s0885-3924(03)00331-2.
PMID: 14585556BACKGROUNDAbs R, Verhelst J, Maeyaert J, Van Buyten JP, Opsomer F, Adriaensen H, Verlooy J, Van Havenbergh T, Smet M, Van Acker K. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000 Jun;85(6):2215-22. doi: 10.1210/jcem.85.6.6615.
PMID: 10852454BACKGROUNDFinch PM, Roberts LJ, Price L, Hadlow NC, Pullan PT. Hypogonadism in patients treated with intrathecal morphine. Clin J Pain. 2000 Sep;16(3):251-4. doi: 10.1097/00002508-200009000-00011.
PMID: 11014399BACKGROUNDPaice JA, Penn RD, Ryan WG. Altered sexual function and decreased testosterone in patients receiving intraspinal opioids. J Pain Symptom Manage. 1994 Feb;9(2):126-31. doi: 10.1016/0885-3924(94)90166-x.
PMID: 7517429BACKGROUNDRoberts LJ, Finch PM, Pullan PT, Bhagat CI, Price LM. Sex hormone suppression by intrathecal opioids: a prospective study. Clin J Pain. 2002 May-Jun;18(3):144-8. doi: 10.1097/00002508-200205000-00002.
PMID: 12048415BACKGROUNDMendelson JH, Inturrisi CE, Renault P, Senay EC. Effects of acetylmethadol on plasma testosterone. Clin Pharmacol Ther. 1976 Mar;19(3):371-4. doi: 10.1002/cpt1976193371.
PMID: 1261171BACKGROUNDMendelson JH, Ellingboe J, Judson BA, Goldstein A. Plasma testosterone and luteinizing hormone levels during levo-alpha-acetylmethadol maintenance and withdrawal. Clin Pharmacol Ther. 1984 Apr;35(4):545-7. doi: 10.1038/clpt.1984.75.
PMID: 6705455BACKGROUNDYilmaz B, Konar V, Kutlu S, Sandal S, Canpolat S, Gezen MR, Kelestimur H. Influence of chronic morphine exposure on serum LH, FSH, testosterone levels, and body and testicular weights in the developing male rat. Arch Androl. 1999 Nov-Dec;43(3):189-96. doi: 10.1080/014850199262481.
PMID: 10624501BACKGROUNDAdams ML, Sewing B, Forman JB, Meyer ER, Cicero TJ. Opioid-induced suppression of rat testicular function. J Pharmacol Exp Ther. 1993 Jul;266(1):323-8.
PMID: 8392556BACKGROUNDKhan C, Malik SA, Iqbal MA. Testosterone suppression by heroin. J Pak Med Assoc. 1990 Jul;40(7):172-3. No abstract available.
PMID: 2125664BACKGROUNDMalik SA, Khan C, Jabbar A, Iqbal A. Heroin addiction and sex hormones in males. J Pak Med Assoc. 1992 Sep;42(9):210-2.
PMID: 1433805BACKGROUNDCicero TJ, Wilcox CE, Bell RD, Meyer ER. Acute reductions in serum testosterone levels by narcotics in the male rat: stereospecificity, blockade by naloxone and tolerance. J Pharmacol Exp Ther. 1976 Aug;198(2):340-6.
PMID: 948030BACKGROUNDCicero TJ, Badger TM. A comparative analysis of the effects of narcotics, alcohol and the barbiturates on the hypothalamic-pituitary-gonadal axis. Adv Exp Med Biol. 1977;85B:95-115. doi: 10.1007/978-1-4615-9038-5_8.
PMID: 596294BACKGROUNDCicero TJ, Meyer ER, Wiest WG, Olney JW, Bell RD. Effects of chronic morphine administration on the reproductive system of the male rat. J Pharmacol Exp Ther. 1975 Mar;192(3):542-8.
PMID: 1168254BACKGROUNDCicero TJ, Bell RD, Meyer ER, Schweitzer J. Narcotics and the hypothalamic-pituitary-gonadal axix: acute effects on luteinizing hormone, testosterone and androgen-dependent systems. J Pharmacol Exp Ther. 1977 Apr;201(1):76-83.
PMID: 850146BACKGROUNDCicero TJ, Badger TM, Wilcox CE, Bell RD, Meyer ER. Morphine decreases luteinizing hormone by an action on the hypothalamic-pituitary axis. J Pharmacol Exp Ther. 1977 Dec;203(3):548-55. No abstract available.
PMID: 336869BACKGROUNDMurphy MR. Methadone reduces sexual performances and sexual motivation in the male Syrian golden hamster. Pharmacol Biochem Behav. 1981 Apr;14(4):561-7. doi: 10.1016/0091-3057(81)90317-8.
PMID: 7232476BACKGROUNDMendelson JH, Ellingboe J, Kuehnle J, Mello NK. Heroin and naltrexone effects on pituitary-gonadal hormones in man: tolerance and supersensitivity. NIDA Res Monogr. 1979;27:302-8. No abstract available.
PMID: 121347BACKGROUNDMendelson JH, Ellingboe J, Keuhnle JC, Mello NK. Effects of naltrexone on mood and neuroendocrine function in normal adult males. Psychoneuroendocrinology. 1978 Oct;3(3-4):231-6. doi: 10.1016/0306-4530(78)90013-6. No abstract available.
PMID: 219434BACKGROUNDCatlin DH, Poland RE, Gorelick DA, Gerner RH, Hui KK, Rubin RT, Li CH. Intravenous infusion of beta-endorphin increases serum prolactin, but not growth hormone or cortisol, in depressed subjects and withdrawing methadone addicts. J Clin Endocrinol Metab. 1980 Jun;50(6):1021-5. doi: 10.1210/jcem-50-6-1021.
PMID: 7372783BACKGROUNDGrossman A. Brain opiates and neuroendocrine function. Clin Endocrinol Metab. 1983 Nov;12(3):725-46. doi: 10.1016/s0300-595x(83)80062-0.
PMID: 6323067BACKGROUNDMendelson JH, Meyer RE, Ellingboe J, Mirin SM, McDougle M. Effects of heroin and methadone on plasma cortisol and testosterone. J Pharmacol Exp Ther. 1975 Nov;195(2):296-302.
PMID: 1185598BACKGROUNDMirin SM, Meyer RE, Mendelson JH, Ellingboe J. Opiate use and sexual function. Am J Psychiatry. 1980 Aug;137(8):909-15. doi: 10.1176/ajp.137.8.909.
PMID: 6774622BACKGROUNDMorley JE. The endocrinology of the opiates and opioid peptides. Metabolism. 1981 Feb;30(2):195-209. doi: 10.1016/0026-0495(81)90172-4.
PMID: 6258010BACKGROUNDOyama T, Toyota M, Shinozaki Y, Kudo T. Effects of morphine and ketamine anaesthesia and surgery on plasma concentrations of luteinizing hormone, testosterone and cortisol in man. Br J Anaesth. 1977 Oct;49(10):983-90. doi: 10.1093/bja/49.10.983.
PMID: 921876BACKGROUNDSu CF, Liu MY, Lin MT. Intraventricular morphine produces pain relief, hypothermia, hyperglycaemia and increased prolactin and growth hormone levels in patients with cancer pain. J Neurol. 1987 Dec;235(2):105-8. doi: 10.1007/BF00718020.
PMID: 3430186BACKGROUNDvon Graffenried B, del Pozo E, Roubicek J, Krebs E, Poldinger W, Burmeister P, Kerp L. Effects of the synthetic enkephalin analogue FK 33-824 in man. Nature. 1978 Apr 20;272(5655):729-30. doi: 10.1038/272729a0. No abstract available.
PMID: 643067BACKGROUNDCicero TJ. Effects of exogenous and endogenous opiates on the hypothalamic--pituitary--gonadal axis in the male. Fed Proc. 1980 Jun;39(8):2551-4.
PMID: 6247215BACKGROUNDPurohit V, Singh HH, Ahluwalia BS. Failure of methadone-treated human testes to respond to the stimulatory effect of human chorionic gonadotrophin on testosterone biosynthesis in vitro. J Endocrinol. 1978 Aug;78(2):299-300. doi: 10.1677/joe.0.0780299. No abstract available.
PMID: 702024BACKGROUNDRagni G, De Lauretis L, Gambaro V, Di Pietro R, Bestetti O, Recalcati F, Papetti C. Semen evaluation in heroin and methadone addicts. Acta Eur Fertil. 1985 Jul-Aug;16(4):245-9.
PMID: 4072581BACKGROUNDCouzinet B, Schaison G. The control of gonadotrophin secretion by ovarian steroids. Hum Reprod. 1993 Nov;8 Suppl 2:97-101. doi: 10.1093/humrep/8.suppl_2.97.
PMID: 8276977BACKGROUNDMartini L, Motta M, Piva F, Zanisi M. LHRF, LHRH, GnRH: what controls the secretion of this hormone? Mol Psychiatry. 1997 Sep;2(5):373-6. doi: 10.1038/sj.mp.4000311.
PMID: 9322226BACKGROUNDYen SS, Quigley ME, Reid RL, Ropert JF, Cetel NS. Neuroendocrinology of opioid peptides and their role in the control of gonadotropin and prolactin secretion. Am J Obstet Gynecol. 1985 Jun 15;152(4):485-93. doi: 10.1016/s0002-9378(85)80162-9.
PMID: 2990210BACKGROUNDRasmussen DD, Liu JH, Wolf PL, Yen SS. Endogenous opioid regulation of gonadotropin-releasing hormone release from the human fetal hypothalamus in vitro. J Clin Endocrinol Metab. 1983 Nov;57(5):881-4. doi: 10.1210/jcem-57-5-881.
PMID: 6311863BACKGROUNDEbeling PR. Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management. Drugs Aging. 1998 Dec;13(6):421-34. doi: 10.2165/00002512-199813060-00002.
PMID: 9883398BACKGROUNDAnderson FH. Osteoporosis in men. Int J Clin Pract. 1998 Apr-May;52(3):176-80.
PMID: 9684434BACKGROUNDElhassan AM, Lindgren JU, Hultenby K, Bergstrom J, Adem A. Methionine-enkephalin in bone and joint tissues. J Bone Miner Res. 1998 Jan;13(1):88-95. doi: 10.1359/jbmr.1998.13.1.88.
PMID: 9443794BACKGROUNDPerez-Castrillon JL, Olmos JM, Gomez JJ, Barrallo A, Riancho JA, Perera L, Valero C, Amado JA, Gonzalez-Macias J. Expression of opioid receptors in osteoblast-like MG-63 cells, and effects of different opioid agonists on alkaline phosphatase and osteocalcin secretion by these cells. Neuroendocrinology. 2000 Sep;72(3):187-94. doi: 10.1159/000054586.
PMID: 11025413BACKGROUNDRico H, Costales C, Cabranes JA, Escudero M. Lower serum osteocalcin levels in pregnant drug users and their newborns at the time of delivery. Obstet Gynecol. 1990 Jun;75(6):998-1000.
PMID: 2342747BACKGROUNDPedrazzoni M, Vescovi PP, Maninetti L, Michelini M, Zaniboni G, Pioli G, Costi D, Alfano FS, Passeri M. Effects of chronic heroin abuse on bone and mineral metabolism. Acta Endocrinol (Copenh). 1993 Jul;129(1):42-5. doi: 10.1530/acta.0.1290042.
PMID: 8351958BACKGROUNDMiller K, Corcoran C, Armstrong C, Caramelli K, Anderson E, Cotton D, Basgoz N, Hirschhorn L, Tuomala R, Schoenfeld D, Daugherty C, Mazer N, Grinspoon S. Transdermal testosterone administration in women with acquired immunodeficiency syndrome wasting: a pilot study. J Clin Endocrinol Metab. 1998 Aug;83(8):2717-25. doi: 10.1210/jcem.83.8.5051.
PMID: 9709937BACKGROUNDForman LJ, Tingle V, Estilow S, Cater J. The response to analgesia testing is affected by gonadal steroids in the rat. Life Sci. 1989;45(5):447-54. doi: 10.1016/0024-3205(89)90631-0.
PMID: 2770410BACKGROUNDFrye CA, Seliga AM. Testosterone increases analgesia, anxiolysis, and cognitive performance of male rats. Cogn Affect Behav Neurosci. 2001 Dec;1(4):371-81. doi: 10.3758/cabn.1.4.371.
PMID: 12467088BACKGROUNDStoffel EC, Ulibarri CM, Craft RM. Gonadal steroid hormone modulation of nociception, morphine antinociception and reproductive indices in male and female rats. Pain. 2003 Jun;103(3):285-302. doi: 10.1016/s0304-3959(02)00457-8.
PMID: 12791435BACKGROUND
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Christopher P Cardozo, M.D.
James J. Peters VAMC
Study Design
- Study Type
- interventional
- Phase
- phase 2
- Allocation
- RANDOMIZED
- Masking
- DOUBLE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- FED
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Staff Physician
Study Record Dates
First Submitted
November 8, 2006
First Posted
November 10, 2006
Study Start
October 30, 2006
Primary Completion
September 6, 2007
Study Completion
September 6, 2007
Last Updated
October 13, 2023
Record last verified: 2006-11