Can oxycodone (opioid analgesic) affect libido (sexual desire)?

Oxycodone's Effects on Libido

Oxycodone can significantly decrease libido through its effects on the endocrine system, causing opioid-induced androgen deficiency (OPIAD) that manifests as reduced sexual desire and function. 1

Mechanism of Action

Oxycodone affects sexual function through several pathways:

• Endocrine effects: Opioids inhibit the hypothalamic-pituitary-gonadal axis, leading to:

  • Decreased secretion of luteinizing hormone (LH)
  • Reduced testosterone production
  • Development of hypogonadism 1

• Neurochemical effects: As a full mu-opioid receptor agonist, oxycodone alters neurotransmitter systems involved in sexual function 1

Clinical Manifestations

Patients taking oxycodone commonly experience:

• Decreased libido (sexual desire)
• Erectile dysfunction in males
• Reduced sexual satisfaction
• Changes in sexual function that may begin within one month of starting therapy 2

Evidence of Hormonal Impact

Research demonstrates significant hormonal changes with oxycodone use:

• Total testosterone levels can decrease by 2.1-2.7 nmol/L with regular oxycodone use 3
• Testosterone levels in opioid users can fall well below the normal range (350-1500 ng/dL) to as low as 26-367 ng/dL 2
• Up to 89% of men on sustained-action opioids report sexual dysfunction 4

Risk Factors for More Severe Sexual Dysfunction

• Higher opioid doses
• Longer duration of treatment
• Pre-existing endocrine disorders
• Concurrent medications with sexual side effects
• History of childhood adversity 5

Management Options

For patients experiencing decreased libido while on oxycodone:

1. Dose optimization:

   • Use lowest effective dose of oxycodone
   • Consider opioid rotation to agents with potentially less impact on sexual function (e.g., tapentadol) 3

2. Hormone evaluation:

   • Check testosterone, LH, FSH levels if sexual dysfunction occurs
   • Monitor hormone levels periodically during long-term therapy 2

3. Hormone replacement:

   • Consider testosterone supplementation in men with confirmed hypogonadism when appropriate 2, 4
   • Note: Testosterone therapy is contraindicated in some conditions (e.g., prostate cancer) 6

4. Alternative pain management:

   • Multimodal analgesia to reduce opioid requirements
   • Non-opioid analgesics when possible

Important Clinical Considerations

• Sexual dysfunction from oxycodone is often underreported but significantly impacts quality of life
• The effect appears dose-dependent, with higher doses causing more pronounced hormonal suppression 4
• Sexual dysfunction may persist as long as opioid therapy continues
• Patients should be informed about this potential side effect before starting therapy

Monitoring Recommendations

• Baseline assessment of sexual function before starting oxycodone
• Regular follow-up inquiries about sexual function
• Hormone level testing when sexual dysfunction is reported
• Evaluation for other contributing factors (psychological, other medications)

Clinicians should recognize that decreased libido is a common and significant side effect of oxycodone therapy that warrants attention and management to maintain patients' quality of life.