The lore and some scientific findings are concerning hypogonadism which seems to be associated with high-dose use over years, and there seems to be a stronger effect wrought by open-chain opioids like methadone than is the case with morphine derivatives and others. It can happen, but there are also people to whom it does not happen, and when it does happen, it seems to resolve rapidly when the drug is discontinued or reduced, and the effects appear to all be well-known ones which can be prevented and managed quite easily.
Hypogonadism is the usual thing for which they keep out an eye in cases like this -- two chronic effects of lowered free and conjugated sex hormones can be osteoporosis in both men and women (get lots of phosphorous, calcium, Vitamin D and make sure to walk at least a little each day -- I've added in magnesium and strontium supplements and had good results) and sex-linked effects like erectile dysfunction and amenorrhoea. The hormone levels and reduced blood pressure can both contribute to the former. The doctors treating me for chronic pain have done bone density scans on me every seven years for quite a long time and started with a baseline whole-body x-ray when I started all those years ago.
Exactly how premature ejaculation works into all of this is a bit confusing; one does hear about it . . . note also that a Stage IV narcotic withdrawal symptom in men can be hair-trigger painful orgasms requiring no erection at all, so maybe that all is related and it is related to the hydraulics of the whole thing.
I would also point out, using morphine as the most common, well-known, and longest-researched example, that taking it will lead to increased libido at moderate doses, then higher ones could reduce it as the contentedness and euphoria is already there and not requiring the endorphin and acetylcholine blast from an orgasm, and the interest may not be as intense, therefore adding the subjective element to anything the actual hormone levels and their effects are causing.
For men, the use of the topical testosterone gel that is rubbed on the upper arm seems to be a very good way to prevent or counteract this, and monitoring of free testosterone levels should be part of the regular testing done at least annually in chronic pain patients, as there are actually is a wide array of bodily changes which can take place. Other herbal and prescription supplements seem to have good effects for people; the combination needs to be put together by a physician and monitored to make sure nothing additional is going to get started or is being masked.
There is papaverine for intracavernous injection into the whanger to treat erectile dysfunction, but it may not be that complicated: I have never had a problem with it and I make sure to have whole opium in some form several times a week so that the papaverine, and morphine, codeine, noscapine, narcotine, and everything else is floating around -- no need to stick a needle in my cock or wait for Viagra or Cialis and risk a week-long hard-on.
The analogous metabolic, endocrine, and reproductive effects in women can and do occur for the exact same reasons of course, with enhanced osteoporosis risk being the big one. I have never heard of women growing beards from narcotics or anything else for that reason.
I have not heard anything about how this, or other drugs like amphetamines, benzodiazepines or other things, could affect hormone levels and therefore the above-mentioned parts of health and related matters in the case of intersex, trans, transitioning, transitioning back or non-binary people or the like.
I did know a long-term dipipanone chronic pain patient who had more trouble with osteoporosis than the doctors would have otherwise expected, though there was no way to know for sure, I suppose. There are people on dextromoramide, propoxyphene, and other open chain opioids who didn't seem to have trouble with anything like this. Then again, the people I knew whose narcotic use careers were in the 55 to 102-year range reported no trouble with that kind of thing at all and looked younger than their years. One person I know who has been on piritramide since the month it went on the market says it makes her horny. I have also heard about pethidine, piminodine, anileridine, and alphaprodine turning people into fuck bunnies as an indirect effect of the neurotoxicity in the patients' own estimation. Must be why alphaprodine was mainly used as an obstetric analgesic which lasted for 60 minutes.
Apparently this is all somewhat dose related, and some recovery can begin to show up later during the first week of cessation. There seems to be no reason to assume permanent changes take place, and this all is suspected to be much of why some men on narcotics have trouble getting it up but also may not be as interested in the first place, and why some women have traditionally used opium, morphine, heroin, and so forth as a second-line crude form of birth control.
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