SHM Converge Scientific Abstract ePoster Gallery-Low T and Physical Therapy: A Postoperative Spine Patient Is Readmitted for Side Effect of Methadone

Pdf Summary

This case report highlights methadone-induced hypogonadism as an underrecognized cause of postoperative weakness and rehab failure.<br /><br />A 34-year-old man with polysubstance abuse and hypothyroidism was readmitted from subacute rehab after thoracolumbar and sacral fixation surgery for worsening generalized weakness, difficulty standing, insomnia, and mood swings. He was taking maintenance methadone and levothyroxine as prescribed. Exam showed generalized deconditioning, lower-extremity alopecia, 4/5 strength, and an unstable gait. Standard laboratory tests, inflammatory markers, autoimmune/myopathy testing, and MRI of the brain and spine were unrevealing.<br /><br />The discussion explains that methadone, a full mu-opioid agonist, can suppress the hypothalamic-pituitary-gonadal axis by blocking GnRH release in the hypothalamus. This lowers FSH and LH, leading to reduced testosterone production and resulting hypogonadism. Symptoms may include fatigue, muscle wasting, hair loss, insomnia, mood changes, and sexual dysfunction. Compared with methadone, buprenorphine has less impact on testosterone levels.<br /><br />The patient’s hormone testing confirmed severe testosterone deficiency, with free testosterone of 10 pg/mL and total testosterone of 135 ng/dL. He was treated with clomiphene 50 mg three times daily and improved over four weeks with physical therapy.<br /><br />The authors conclude that methadone can significantly suppress testosterone, impair rehabilitation, and contribute to patient distress and readmissions. Clinicians should consider methadone-induced hypogonadism in patients with unexplained weakness or mood changes and monitor testosterone levels when appropriate.

Asset Subtitle

Rene Daniel

Meta Tag

Author List Allison Lang, Bharath Ganesh, Crystal Benjamin, Donyell Doram, Eric Gladstone, Ethan Zhao, Gregoris Komodikis, Hadi Abou-Rass, Jesse Edwards, Lauren Malinowski-Falk, Linda Mwamuka, Newton Mei, Rebecca Jonas, Rene Daniel, Shelly Gupta, Smriti Kumar, S

Category Clinical Vignettes

Concept Methadone

Concept Hypothalamic-Pituitary-Gonadal Axis

Concept Androgen

Concept Hypogonadism

Concept Testosterone Test

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University Hospital

Presenting Author Rene Daniel

Track Adult

Keywords

methadone-induced hypogonadism

postoperative weakness

rehabilitation failure

testosterone deficiency

hypothalamic-pituitary-gonadal axis

opioid-induced endocrinopathy

clomiphene therapy

muscle weakness

mood swings

maintenance methadone

Methadone

Hypothalamic-Pituitary-Gonadal Axis

Androgen

Hypogonadism

Testosterone Test