Background & objectives Though sexual dysfunction are common in individuals with opioid dependence, the relative contribution of hormonal and psychological determinants remains unclear. Studies assessing sexual functioning and sex hormone levels together in this population remain limited. This study aimed to evaluate self-reported sexual dysfunction and sex hormone alterations, and their association with demographic, psychosocial, and hormonal factors in men with opioid dependence, primarily using heroin. Methods In this cross-sectional study, 143 sexually active males (aged 18-50 yr) with opioid dependence were recruited. Sexual functioning was assessed using the international index of erectile function (IIEF-15). Hormonal assays included total testosterone, prolactin (PRL), luteinising hormone (LH), follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH), sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulphate (DHEA-S). Descriptive statistics, Spearman’s rank correlation with FDR (false discovery rate) correction, and hierarchical multiple regression with bootstrapped confidence intervals (1000 samples) were conducted. A sensitivity analysis restricted to married participants (n=78) allowed inclusion of intimate partner violence as predictor. Results The median age of participants (n=143) was 26 yr Interquartile range (IQR):24-30, with 93 per cent identifying as heterosexual. Erectile dysfunction (93.7%, n=134), orgasmic dysfunction (95.1%, n=136), low sexual desire (94.4%, n=135), dissatisfaction with sexual intercourse (99.3%, n=142), and premature ejaculation (72%, n=103) were highly prevalent. Hormonal analysis showed low testosterone in 7.7 per cent (n=11), high PRL in 8.4 per cent (n=12), and elevated GnRH in 57.3 per cent (n=82) of participants. Median hormone levels were: Testosterone 20.5 (15.0-27.3) nmol/L, PRL 5.8 (3.5-11.2) ng/mL, and GnRH 160.3 (132.2-178.1) pg/mL. No significant correlations were observed between hormone levels and sexual function. In regression analysis, demographic and psychosocial variables predicted sexual functioning, while hormonal measures did not contribute independently. The final model explained 17 per cent of variance (adjusted R 2 = 0.17). Interpretation & conclusion Sexual dysfunction in men with opioid dependence primarily using heroin was driven more by psychosocial and demographic determinants than by hormonal changes. Endocrine alterations were not sufficient to explain the high burden of dysfunction. Addressing sexual health in opioid dependence requires a multifactorial approach, with attention to social and psychological contributors alongside biological assessment.
Patel et al. (Sat,) studied this question.