<p>Long-term opioid therapy is a key component in the management of chronic pain; however, in addition to its well-known adverse effects, it may also lead to significant endocrine complications. One of the most important of these is opioid-induced hypogonadism (OiH), which results from dysregulation of the hypothalamic-pituitary-gonadal axis (HPG-axis). Despite its considerable clinical relevance, OiH frequently remains underdiagnosed. Contributing factors include the nonspecific nature of its symptoms and limited awareness among healthcare providers. To date, no evidence-based guideline for the diagnosis and management of OiH has been established. Current recommendations include informing patients about potential symptoms before initiating opioid therapy, assessing baseline hormonal status, and conducting regular symptom-oriented follow-up evaluations during long-term opioid treatment. As the endocrine alterations associated with OiH appear to be reversible following opioid dose reduction or discontinuation, these approaches are considered the preferred therapeutic strategies. When this is not feasible, opioid rotation or – in selected cases – hormone replacement therapy may be considered. Overall, further studies are needed to develop evidence-based recommendations for the screening and management of OiH.</p>