Methadone sexual side effects

[Squirmy1]

I've had severe RLS for a while and went through considerable augmentation twice with pramipexole both times maxing out at 3mg/day. Now I am off of pramipexole and being managed with 20mg/day of methadone and 1,200-1,800mg/day of gabapentin. I'm finally able to sleep now, but I'm experiencing extreme sexual side effects: E.D., loss of libido and anorgasmia. We've increased my testosterone dose, and I'm taking Cialis and sometimes Viagra all to no avail. I'm wondering if switching to a shorter acting opiate might help. If I were to take something that is normally dosed 3 times a day for pain, but not take the morning and afternoon dose, would my sexual function return?

[Rustsmith]

I have had some of those same side effects with methadone. My first suggestion would be to have the doctor that is providing your testosterone to check you serum testosterone levels as well as your estradiol. Maybe something there is causing your problems because my issues went away once I got my free testosterone levels back to normal.

As for switching to a different opioid, that is always something that you can try. All opioids suppress testosterone production in men but maybe a different one wouldn't cause problems that were so severe that the testosterone and ED meds would not be able to overcome it.

[Squirmy1]

Thanks. I haven't had my estradiol levels checked yet. I'll go ahead and requst that. The reason I'm thinking a shorter acting opioid might help is that much of the previous night's dose will be out of my system by the next evening unlike with methadone.

[Rustsmith]

I forgot that total T isn't the only important factor. Free and bio-available, testosterone are calculated values. You can probably find several calculators, but here is a link to one of them. https://www.issam.ch/freetesto.htm

You will also need to know your albumin level and your SHBG (sex hormone-binding globulin) value. My problem at one point was that my SHBG was out of range and that forced my free T value to be below normal.

[stockton2malone2]

I had the same issue as rustsmith. My SHBG was sky high and was binding up all my testosterone leading to a very low free T value. I had hot flashes, nerve pain, ED, depressive spells, etc. Definitely worth checking your SHBG and Free T as well.

[Rustsmith]

Free testosterone is actually a calculated value that depends up your serum albumin, SHBG and total testosterone. You can find a free T calculator online.