Hormones Not to Blame? Study Finds Psychosocial Factors Behind Sexual Dysfunction in Opioid Dependence

Therefore, a cross-sectional community-based study, conducted from January to October 2023, assessed 143 sexually active men aged 18-50 with severe heroin dependence at a specialised clinic in New Delhi, utilizing the International Index of Erectile Function (IIEF-15) and comprehensive assays for hormones like testosterone and prolactin (PRL). The methodology employed consecutive sampling and rigorous analytical techniques, including hierarchical multiple regression with bootstrapped confidence intervals, while specifically excluding participants with severe mental illness or chronic medical conditions to ensure the primary endpoints accurately reflected the impact of opioid dependence alone.

Key clinical findings from the study include:

• Near-Universal Sexual Impairment: The study found that sexual dysfunction was remarkably high, with 93.7 percent of participants reporting erectile dysfunction and 95.1 percent experiencing difficulty in achieving orgasm.
• Prevalent Premature Ejaculation: Approximately 72 percent of men suffered from premature ejaculation, a condition the study suggests is particularly prominent during attempts to reduce heroin intake or during periods of abstinence.
• Unexpected Hormonal Stability: Despite the severity of their addiction, 76.2 percent of participants maintained normal total testosterone levels, although 57.3 percent showed elevated gonadotropin-releasing hormone (GnRH) likely due to the fluctuating intoxication-withdrawal cycles of short-acting heroin.
• Psychosocial Over Hormonal Drivers: Hierarchical regression analysis revealed that demographic and social factors, such as marital status and occupational stability, were stronger predictors of sexual health than hormonal measures, which did not independently contribute to the model's 17 percent explained variance.
• Relational Health Impact: A sensitivity analysis showed that intimate partner violence (IPV) was a significant negative predictor of sexual functioning scores among married participants, 81 percent of whom reported perpetrating such violence.

The results suggest that sexual dysfunction in this population is a complex, multifactorial issue, as evidenced by the finding that nearly all domains of impairment were highly prevalent despite 109 of the 143 participants possessing testosterone levels within the reference range.

The study note the clinicians move beyond simple laboratory testing to integrate psychosocial support, tobacco cessation, and relationship-focused interventions into the routine care of individuals with opioid dependence.

While this research fills a critical evidence gap in India, its cross-sectional design and single-point blood sampling suggest an attractive opportunity for future longitudinal studies to further explore the evolving interplay between endocrine health and social determinants.

Reference

Patel V, Rao R, Bhad I, Mishra AK, Quraishi R, Gupta Y. Prevalence & predictors of sexual functioning & sex hormone profiles among men with opioid dependence: A community-based, cross-sectional study. Indian J Med Res 2025;162:754-63.