Since depression is a common symptom of sex-hormone deficiency and hypogonadism is quickly induced by opioid medications, the review of the relationships between pain and depression by Bair et al1 might logically have included a discussion of opioid-induced androgen deficiency (OPIAD). Opioids inhibit gonadotropin production in most men soon after beginning therapy with sustained-action oral,2 transdermal,3 or intrathecal4 opioids. A similar illness is present but less well documented in opioid-treated women.3,4