How Your Thyroid Affects Your Sex Lifeby Mary Shomon Patient Advocate
If you’ve lost that sizzle between the sheets, there’s one place to look that you may be have considered: your thyroid. Some of more well-known symptoms of a thyroid condition, such as weight changes, fatigue, or mood changes, can affect your sex life. Being overweight, exhausted, anxious, or depressed can all cramp your style in the bedroom. But thyroid disease — especially when undiagnosed and untreated, or poorly treated — can cause many specific sexual problems in both men and women.
Hypothyroidism and hyperthyroidism can cause several major sexual dysfunctions in both men and women, including:
A low sex drive or total lack of sexual desire, known as low libido
An inability to become aroused
Difficulty reaching orgasm, slow to orgasm, or an inability to reach orgasm
Each gender has some additional thyroid-related sexual symptoms. In men, thyroid problems can also cause:
Erectile dysfunction, defined as difficulty getting or maintaining an erection
Delayed ejaculation, defined as requiring a long period of intercourse, i.e., 30 to 40 minutes, in order to ejaculate
There are also some thyroid-related sexual symptoms specific to women, including:
Pain during intercourse
Some statistics about thyroid disease and sexual dysfunction
A study published in the Journal of Clinical Endocrinology and Metabolism (JCEM) provided some statistics on the link between thyroid problems and sexual issues in men.
Almost two-thirds of hypothyroid men complained of low libido, erectile dysfunction, and delayed ejaculation.
Half of hypothyroid men complained of premature ejaculation, and almost one in five men complained about low libido.
According to the researchers, proper treatment to return a man to "normal" thyroid function — known as euthyroidism — was found to reverse most sexual symptoms in men.
A different study in the Journal of Clinical Endocrinology and Metabolism explored the relationship between both hyperthyroidism and hypothyroidism and men's sexual function. They found that around 80 percent of the men with thyroid conditions had erectile dysfunction, compared with around 37.5 percent of the men without thyroid conditions. Erectile dysfunction rates are highest in men with hypothyroidism.
The research also demonstrates a clear link between thyroid problems and sexual dysfunction in women. Around half of all women with thyroid conditions report some degree of sexual dysfunction. Low libido is a particular problem in women with hypothyroidism, and women with Hashimoto’s and goiter have significantly higher rates of low libido, inadequate lubrication, and difficulty reaching orgasm.
One study published in the Journal of Endocrinology Investigation found that women with hyperthyroidism, hypothyroidism, Hashimoto’s thyroiditis, and goiter have, on average, more than double the rate of sexual dysfunction, compared to women without thyroid conditions.
A study in the Journal of Sexual Medicine also found that there is a strong link between hyperthyroidism and sexual dysfunction in women. Specifically, women with hyperthyroidism had significant decreases in sexual desire, arousal, lubrication, and orgasm.
There’s good news!
Experts have found that most thyroid-related sexual dysfunction and symptoms are reversible after you have proper thyroid treatment. There are also medical treatments, lifestyle changes, and supplements that can help you get your bedroom mojo back!
If you don’t have a thyroid diagnosis
If you are experiencing sexual dysfunction, but you haven't yet been diagnosed with thyroid disease, your first step should be a complete thyroid evaluation, including a clinical examination, and blood test panel, including thyroid stimulating hormone (TSH), free thyroxine (Free T4), free triiodothyronine (Free T3), and thyroid peroxidase (TPO) antibodies tests. This will diagnose — or rule out — a thyroid condition as the cause of your sexual dysfunction.
An important note for men: If you are experiencing erectile dysfunction and are diagnosed with a thyroid condition, the American Thyroid Association recommends you wait six months before you pursue treatment for erectile dysfunction. Thyroid-related erectile function is considered reversible with proper thyroid treatment and usually resolves on its own over time.
If you are already diagnosed with a thyroid condition
Make sure that your thyroid drug treatment is optimized. You may still have sexual dysfunction with thyroid test results that fall within the reference range — but are not “optimal.” This may require a change in the type or dosage of your thyroid hormone replacement or antithyroid medication. (Learn more about optimal levels here.)
Next steps: a workup for sexual dysfunction
If optimal thyroid treatment does not resolve your sexual dysfunction, you should also have a complete workup with your health care provider. This should include:
A complete physical and medical history
Hormonal evaluation, including testosterone and estrogen for both men and women, and sex hormone binding globulin (SHBG). Elevated SHBG can lower testosterone levels.
An evaluation of any medications and supplements you are taking. Some drugs — antidepressants, for example — can cause sexual side effects.
A review of any emotional or psychological factors that may be affecting your sexual function. Your doctor should ask about general stress, problems with your relationship, and any history of sexual trauma, for example. Significant issues may be a sign that professional therapy could help.
Medical treatment for sexual dysfunction
Based on your health care provider’s evaluation, treatment may be recommended.
Some possible medical treatments include:
Testosterone treatment for both men and women
Hormone replacement with estrogen/progesterone for women, especially during or after perimenopause/menopause
Vaginal estrogen creams for women, to aid in libido and lubrication, and reduce pain
Drugs to boost erectile function in men, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)
Some men can also benefit from penile implants and vacuum devices to help with erectile dysfunction and impotence.
If you are working with an integrative physician or expert in hormone balance, they may also evaluate your adrenal function — usually with a 24-hour saliva cortisol/dehydroepiandrosterone (DHEA) test. Adrenal imbalances can contribute to fatigue, low libido, and low endurance, and can be resolved with a combination of supplements, lifestyle changes, and medication when necessary.
There are various non-prescription supplements that reportedly help with libido and sexual function. Be sure to check with your health care practitioner for guidance on how to safely use supplements, which include:
Royal Maca — An adaptogenic supplement from the South American maca root vegetable that helps balance and enhance hormones – including the thyroid – in men and women. (Note: Royal Maca is a specialized formulation that, unlike other types of maca, is properly heated so that it is not goitrogenic.)
DHEA — Available without prescription, the hormone DHEA converts into testosterone.
Zinc — Zinc is necessary to produce testosterone, and low levels are associated with low libido.
Omega 3 fatty acids — which help with the body’s production of sex hormones
Avena-sativa/Oats Milky Seed — which reportedly stimulates libido in both men and women
Horny goat weed — This aptly named Chinese herbal remedy is used in men and women to help resolve sexual dysfunction
Self-care and lifestyle changes
Finally, don’t forget the basics. There are several things you can do to help get your sexual function back on track.
Lose weight: Being overweight can affect sex drive and sexual performance, and research shows that losing even a few pounds can increase libido. Weight loss also lowers sex hormone-binding globulin (SHBG), which frees up sex-drive boosting testosterone.
Exercise: Exercise helps blood flow and hormonal balance, and experts have found that regular exercise increases libido and ability to orgasm in both men and women. When it comes to exercise, go for aerobic activities, which help release endorphins to create a sense of well-being.
Get enough sleep: Chronic sleep deprivation can dampen your libido. Aim for at least seven hours of sleep per night.