erectile dysfunction

[drpasser]

I have lots of pts c/o sexual side effects from Suboxone and have some success with yohimbine. It can also promote wt loss so it's often easy to get women to try it. It's in the form of Yocon-5.4 mgs PO TID by Rx. It seems like it helps about half of the time.

[gsouthiere]

Does anyone have any experience with decreased Libido with Women on Suboxone? I have a patient with depression treated with bupropion 150 and on 20 mg suboxone totally clean urines. What are the options here?

[carol]

Mike, do you do any other testing before administering testosterone, and do you do the injections yourself? How do you follow-up? Do injections need to be continued indefinitely? Several months ago I read an article which said that past studies showed that methadone induced suppression of testosterone (due to inhibition of hypthalamic gonadotropin), and in 2005, a study by Bliesener et al did not find abnormalities in serum testosterone levels in 17 men on buprenorphine.
However, the article goes on to describe several recent case studies where pts on bupe did develop symptoms of testosterone deficiency, not only effects on sexual functioning, but also symptoms that actually could be confused with withdrawal such as fatigue, depression, sweatiness, difficulty sleeping...like male menopause. Most of this small group of patients were on high doses of suboxone, above 16 mg/day. Sorry I can't find the article right now to send you the exact reference. But it does seem that further studies need to be done to nail down more precisely how much Suboxone affects testosterone levels and at what dose...eg, lower doses may not affect testosterone, while higher doses may. I have been getting testosterone levels in my male patients when they come into treatment and most have low testosterone secondary to their opioid abuses prior to treatment. I intend to get follow-up levels at 6 m and 1 year (for those in treatment that long) to see if being on Suboxone can improve testosterone levels. Of course, with severe deficiency, I refer to the primary care doc to follow-up and treat...one patient had a level of around 40.

Carol

[miket]

Any and all opiates have a natural tendency to decrease free and total serum Testosterone levels. I have checked these levels on several of my patients and found this to be true. After administering testosterone replacement injections both the libido and ED improve. Viagra and similar meds are nitric oxide dependent, and without sufficient testosterone these meds will work only briefly with limited effectiveness.
Mike

[cking007]

In my experience, the ED is more likely to be related to the Suboxone, although could be either, or both. I have many patients on Suboxone complain of this- and it does not seem to be dose related. It is easily treated with Viagra, or similar meds.