Testosterone Deficiency and Addiction

Over the past 50 years, men in western countries have experienced a progressive deterioration of reproductive function such that testosterone and sperm production have decreased. To combat this crisis, whole industries were created to provide infertility and hormone replacement therapies. But what if I told you that your addiction may be the cause of this? While many substances of abuse may affect sexual function, 2 common ones are often overlooked.


Alcohol has the highest dependence rate in the United States affecting 12% of the adult population. Alcohol demonstrates a dose dependent effect on testosterone and sperm production. The heavier you drink the worse testicular function may become. Alcohol acts directly in the testicles reducing production of testosterone and indirectly in the brain by depressing the function of the hypothalamus-pituitary axis. The hypothalamus and pituitary gland act together to stimulate testicular production of testosterone and sperm. Alcohol makes matters worse by increasing estrogen production further reducing testosterone production.


Heroin and other opioids are well known for reducing testosterone levels through several mechanisms.  They suppress the hypothalamus-pituitary axis that indirectly affect testosterone production in the testicles. Sperm express opioid receptors and frequent opioid use can lead to low sperm count and potential infertility. You don’t have to abuse opioids to experience the side effects. Chronic pain management with opioids is also problematic.


Treating alcohol or heroin/opioid abuse may reverse the damage done to your reproductive health in a way that testosterone replacement therapy alone won’t. There is and shouldn’t be a one size fits all approach to substance induced hormone imbalances. Let’s talk about your concerns and come up with a game plan to make you healthier.