Opioids are poweful analgetics but they can also be misused due to their euphoric effects. During the last two decades, the use of opioids has increased reaching the dimensions of a global epidemic.

These agents have various effects on the endocrine system with mechanisms not fully elucidated. Hypogonadism is the most common adverse sequelae with variable reported prevalence and its severity depends on the dose, duration of action and type of opioid. Inhibitory action on the hypothalamo-pituitary-adrenal axis has also been described with less clearly defined frequency. The clinical significance of this effect and the necessity of glucocorticoid replacement in many of these cases remain to some extent uncertain. Opioids have also a negative impact on bone health (with reduced bone mineral density and increased fracture risk) and occasionally cause hyperprolactinaemia. Discontinuation or reduction of the opioid or consideration of alternative therapies for pain relief are potential management approaches. Hormonal replacement, especially when the above measures are not practically feasible, is also an option.

Further studies establishing the prevalence of hormonal abnormalities with various regimes, doses and routes of opioids and also addressing reliably the long-term benefits and risks of hormonal replacement are necessary.