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Hi Stephen,

I am 22 year old and have been using a herbal drug called kratom to treat generalized anxiety disorder. Although it helped I have been abusing it for the best part of a year, taking high doses daily. I am in the process of stopping.

It turns out that this herb acts on the mu opioid receptors which as I'm sure you know reduces testosterone. I have noticed reduced libido and difficulty gaining/maintaing a full erection, low sperm volume and lack of morning and spontaneous erections which I used to have. I have not had my testosterone levels checked.

My questions to you are -

1) Is opioid induced hypogonadism reversible with abstinence?

2) If it is reversible will my testosterone return to previous high levels or will they be permanently lowered?

3) I am paranoid that I have lost girth/size in my erect penis. Can severely low testosterone/lack of morning erections cause penile atrophy and if so is it permanent?

Massive thank you in advance for your help and your time.


Opiod induced hypogonadism is usually reversible with abstinence, but this is not always guaranteed.  It depends on the degree of opiod use, other chemicals used, the damage done to the system and the presence of any testicular injury.  It also depends on the level of testosterone prior to the opiod abuse.

Your testosterone may or may not return to prior levels.

Size of the penis is usually not affected.  Penile size reduction would be extremely rare due to hypogonadism but is not totally impossible.  Changes in the penis itself are usually permanent.

Now you'll need to talk to your local physician and get a testosterone level checked.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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