Sexual disorders and an underactive thyroid

Photo: Roman Kraft/Unsplash. Design: BOOST Thyroid.

Photo: Roman Kraft/Unsplash. Design: BOOST Thyroid.

The connection between unbalanced hormones, high thyroid antibodies, and impaired sex drive


Hormonal disorders — including an underactive thyroid — are responsible for one third of sexual problems people experience (1–6). Thyroid hormones have a major impact on the quality of your sex life. An underactive thyroid lowers sex drive and can lead to a lower quality sex life.

What types of sexual problems may occur with an underactive thyroid?

When hormone TSH rises and hormone fT4 drops, you might experience (7–10):

  • Low sex drive

  • Difficulty getting aroused

  • Erectile dysfunction

  • Vaginal dryness

  • Inability to orgasm

  • Delayed ejaculation

  • Pain during and after sex

These symptoms are more often experienced by people who have fatigue, muscle pain, or depressed feelings (6).

If you have been experiencing sexual dysfunction, but are not diagnosed with an underactive thyroid, this might be because your brain is very sensitive to even the lowest changes in thyroid hormone levels. You might start experiencing sexual dysfunction way ahead of your thyroid diagnosis (11,12).

T4 medication restoring TSH and T4 to normal levels can help a lot with (13, 14):

  • Improving sex drive

  • Reducing pain during or after sex

And only somewhat with:

  • Arousal

  • Orgasm

  • Lubrication


This restoration will happen within the 3 months of starting to take medication.

Being diagnosed with Hashimoto’s, in addition to the underactive thyroid, can cause more severe sexual dysfunction and lower sex drive — even when TSH and T4 are well balanced with medication (13,15). This problem seems to be a result of the thyroid antibody, especially TPO levels. The higher they are, the more problems people experience (16). It seems that Hashimoto’s has an added effect to an underactive thyroid.

How exactly does an underactive thyroid affect sex drive?

The connection between fT4 and TSH levels and sexual dysfunction is well established. Other hormones are triggered by the low TSH and this might be the cause of sexual function problems:

  1. Underactive thyroid can cause hyperprolactinemia, a condition of elevated hormone prolactin — in this case symptoms are reduced sex drive, breast pain, painful intercourse, and vaginal dryness (6).

  2. Changing levels of SHBG (sex hormone binding globulin), which interfere with the estrogen-testosterone-progesterone balance (17).

  3. Changes in blood vessel and nerve sensitivity caused by low levels of thyroid hormones (18).

Try talking to your doctor about the issues you are experiencing. Changing your medication dose, or using thyroid function enhancing supplements such as selenium, might help you.

Article was originally published on January 4, 2019.

References

  1. Lombardo F, et al. Endocrinological diagnosis in sexology, 2003

  2. Davis SR, et al. Endocrine aspects of female sexual dysfunction, 2004

  3. Morales A, et al. Endocrine aspects of sexual dysfunction in men, 2004

  4. El-Sakka AI, et al. Pattern of endocrine changes in patients with sexual dysfunction, 2005

  5. Corona G, et al. Psychobiological correlates of the metabolic syndrome and associated sexual dysfunction, 2006

  6. Bhasin S, et al. Sexual dysfunction in men and women with endocrine disorders, 2007

  7. Atis G, et al. Sexual dysfunction in women with clinical hypothyroidism and subclinical hypothyroidism

  8. Veronelli A, et al. Sexual dysfunction is frequent in premenopausal women with diabetes, obesity, and hypothyroidism, and correlates with markers of increased cardiovascular risk, 2009

  9. Carani C, et al. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients, 2005

  10. Nikoobakht MR, et al. The role of hypothyroidism in male infertility and erectile dysfunction, 2012

  11. Pop VJ, et al. Are autoimmune thyroid dysfunction and depression related? 1998

  12. Mariotti S, et al. Thyroid autoimmunity and mood disorders, 2007

  13. Oppo A, et al. Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function, 2011

  14. Carani C, et al. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients, 2005

  15. Pasquali D, et al. Female sexual dysfunction in women with thyroid disorders, 2013

  16. Krysiak R, et al. Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism, 2016

  17. Poppe K, et al. Thyroid disease and female reproduction, 2007

  18. Joffe RT, et al. Thyroid hormones, the brain, and affective disorders, 1994