The thyroid is a key endocrine gland that produces the hormones T3 and T4, essential for overall metabolism. Any alteration in its levels (hypothyroidism or hyperthyroidism) can affect the entire body, including male sexual function. In fact, thyroid dysfunction is very common in the general population, so it is frequent for sexual health physicians to encounter patients with concurrent hypothyroidism or hyperthyroidism. These disorders affect protein synthesis, the production of sex hormones (such as testosterone), and blood flow (via nitric oxide), all of which are necessary for a normal erection. Furthermore, it has been observed that the presence of erectile dysfunction in a man should raise suspicion of underlying hormonal causes, with the thyroid being one of the key areas to evaluate. In short, timely treatment of thyroid disorders can prevent or reverse many sexual symptoms, sometimes avoiding the need for therapies specifically targeting erectile dysfunction. Next, we review what thyroid diseases are and how they influence male erectile dysfunction.
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What are thyroid diseases?
Thyroid diseases primarily include the Hypothyroidism (underactive gland) and the hyperthyroidism (overactive gland). In primary hypothyroidism, the thyroid gland produces too little hormone, and its most frequent cause is Hashimoto's autoimmune thyroiditis. Typical symptoms of hypothyroidism are fatigue, weight gain, dry skin, cold intolerance, and constipation. In hyperthyroidism, the opposite occurs: the thyroid produces too much hormone. The most common cause is Graves' disease (antibodies that stimulate the thyroid). This causes nervousness, weight loss, palpitations, and sweating. There are also other forms. subclinical (altered TSH with near-normal T3/T4). In the general population, approximately 5–10% of people have some degree of thyroid dysfunction. Normal thyroid function is essential for maintaining overall hormonal balance; for example, thyroid hormones regulate the SHBG transport protein, which controls testosterone availability.
How does the thyroid affect erectile dysfunction?
The thyroid gland impacts male sexual function through several mechanisms. First, it influences the hormonal balance: alters the levels of free testosterone in men by altering SHBG (sex hormone-binding globulin). Furthermore, thyroid hormones directly affect the smooth muscle of the penis (corpora cavernosa) and the production of nitric oxide, a key component in erection. Together, both hypothyroidism and hyperthyroidism can induce an imbalance in the hypothalamic-pituitary-gonadal axis, reducing sex drive (libido) and the quality of erections. Clinical observations and studies confirm that thyroid disorders are associated with a higher prevalence of erectile dysfunction. In fact, in many cases, normalizing thyroid function alleviates or resolves erectile dysfunction.
Hyperthyroidism and sexual problems in men
El hyperthyroidism Excess T3/T4 hormones often activate the sympathetic nervous system. Men with hyperthyroidism frequently experience high levels of SHBG, which decreases free testosterone. This leads to low libido and can induce hypogonadism (insufficient testosterone). Clinically, the literature reports high rates of sexual problems in these patients. One study found that between 48% and 77% of men with hyperthyroidism suffer from low libido, erectile dysfunction, and premature ejaculation. In particular, it is frequently described premature ejaculation In hyperthyroidism, these symptoms are due to overexcitation of the nervous system. This phenomenon occurs because the excess of thyroid hormones accelerates sexual reflexes. Fortunately, when hyperthyroidism is corrected (for example, with antithyroid drugs or radioactive iodine), these symptoms usually improve significantly.
Hypothyroidism and erectile dysfunction
El Hypothyroidism Thyroid hormone deficiency also severely affects male sexual function. In hypothyroidism, SHBG levels typically decrease, which increases the conversion of testosterone to estrogen, further reducing free testosterone. Clinical and research findings agree that many hypothyroid men report fatigue, lack of libido or low libido and difficulty maintaining erectionsFor example, between 59% and 63% of men with hypothyroidism experience low libido and erectile dysfunction. Furthermore, it is common for other symptoms to appear. delayed ejaculationThat is, they take a long time to reach orgasm or do not ejaculate at all during intercourse. The hormonal imbalance of hypothyroidism (sometimes associated with elevated prolactin) contributes to these symptoms. In short, hypothyroidism can induce a combination of functional hypogonadism and vascular problems that impair erectile response.
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What do studies say about hypothyroidism and male sexual dysfunction?
The relationship between hypothyroidism and sexual dysfunction has been studied in several research projects. In general, a high percentage of sexual disorders are observed in these patients. For example, Krassas et al. found that 78.9 % A higher percentage of men with thyroid dysfunction (hypothyroidism or hyperthyroidism) reported erectile dysfunction (ED), compared to only 33.8% in healthy controls. Furthermore, there is an inverse correlation between TSH and erectile function: higher TSH (lower thyroid function) is associated with worse scores on erection questionnaires. In many studies, erectile dysfunction resolves upon restoration of a euthyroid state (normal T4/T3 levels). Other studies observe that, in addition to erectile dysfunction, over 60% of men with hypothyroidism experience low libido and ejaculation problems. Overall, the evidence strongly supports the association of hypothyroidism with sexual difficulties in men.
Relationship between elevated TSH and sexual problems
TSH is thyroid-stimulating hormone, and an elevated level indicates hypothyroidism. Clinical studies show that a High TSH It is linked to greater severity of erectile dysfunction. Specifically, a significant negative correlation has been found between TSH levels and scores on the International Index of Erection (IIEF). That is, as TSH rises (and T4 falls), erectile function worsens. Even subclinical cases (high TSH without overt symptoms) can present with ED, which is why it is generally recommended to include TSH in the hormonal evaluation of any patient with unexplained sexual dysfunction.
Impact on fertility and semen quality
Thyroid disorders also affect the male fertility and semen quality. Hypothyroidism, for example, is associated with decreased spermatogenesis: in animal models, atrophy of the efferent ducts and azoospermia have been documented in congenital hypothyroidism. In humans, hypothyroid men tend to have lower sperm count and motility, along with low testosterone levels. Conversely, it has been observed that correction with levothyroxine can improve fertilityIn fact, a report by the International Society for Sexual Medicine concludes that T4 administration in hypothyroidism significantly improves the hormonal profile and spermatogenesis. Secondary infertility can also occur in hyperthyroidism, although to a lesser extent; the important point is that both disorders, when normalized, tend to restore reproductive parameters.
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Scientific evidence on hyperthyroidism and male sexuality
Several studies confirm that hyperthyroidism affects male sexual health. Research shows that up to half of men with severe hyperthyroidism report erectile and ejaculatory dysfunction. A recent meta-analysis concluded that excess thyroid hormones are correlated with premature ejaculation and erectile problems, and emphasizes that treatment reduces these symptoms. In fact, treating the underlying thyroid cause (for example, with propylthiouracil or surgery) often resolves many sexual disorders, as indicated by numerous clinical series. In summary, current evidence indicates that hyperthyroidism in men can cause unstable erections, premature ejaculation, and decreased libido, effects that are generally reversible with appropriate therapy.
Studies on the prevalence of erectile dysfunction
Epidemiological studies show that patients with thyroid disorders have significantly higher rates of erectile dysfunction than the general population. In addition to the data from Krassas et al. cited above, other research reports variable but high prevalences: for example, ED has been documented in approximately 60–70% of men with clinical hypothyroidism and in about 50% with hyperthyroidism. In comparison, the overall prevalence of ED in the adult male population ranges from 18–37%, depending on age. This means that erectile dysfunction is much more common when a concurrent thyroid disorder is present. These data underscore the importance of investigating thyroid function in any case of ED without an obvious organic cause.
Association with premature ejaculation
A consistent finding is the specific association between thyroid disorders and ejaculation. It has been observed premature ejaculation in a significant proportion of men with hyperthyroidism. The explanation lies in the fact that the excess hormone accelerates genital reflexes. On the other hand, hypothyroidism is more associated with delayed ejaculation or delayed ejaculation. These changes in ejaculation are often accompanied by alterations in libido and contribute to the overall decline in sexual function. The good news is that, as with erections, these ejaculatory disorders respond favorably to thyroid treatment: normalizing thyroid function tends to correct the associated premature or delayed ejaculation.
How do thyroid hormones affect testosterone and libido?
Thyroid hormones directly modulate male sex hormones. On the one hand, they increase or decrease the SHBG Sex hormone-binding globulin (SHBG) is produced in the liver. Hyperthyroidism elevates SHBG, which reduces available free testosterone (resulting in hypogonadism). Conversely, hypothyroidism decreases SHBG, paradoxically increasing the conversion of testosterone to estrogen (estradiol). Both effects (very low testosterone or too much estrogen) impair libido and sexual performance. Furthermore, the thyroid gland influences the hypothalamic-pituitary-gonadal axis: a thyroid imbalance can alter GnRH, LH, and FSH signaling, affecting testicular sperm and testosterone production. Consequently, testosterone levels are often reduced in hypothyroid patients (especially if secondary hyperprolactinemia is present), while hyperthyroid patients exhibit functional hypogonadism.
Alterations in male hormone production
A thyroid imbalance also represents a general disturbance of the endocrine system. The thyroid interacts with several glands: for example, thyroid dysfunction is often accompanied by increased prolactin (which lowers testosterone) or alterations in cortisol levels. In hypothyroidism, the testicles receive less hormonal stimulation, which can lead to testicular atrophy and reduced spermatogenesis. Hyperthyroidism, in turn, can deplete hormonal reserves through overactivity. Both conditions impact the reproductive axis, reducing the synthesis of testosterone and secondary sex hormones. The result is typically a decrease in... sexual desire and erectile difficulties, although the specific manifestation varies from person to person. In short, thyroid diseases disrupt male hormone production, affecting all levels of sexual function.
Effect on sexual desire and performance
Both hypothyroidism and hyperthyroidism tend to reduce sexual desire (libido) In men, the evidence is extensive for hyperthyroidism: these patients frequently report loss of libido along with anxiety and nervousness. In hypothyroidism, the drop in energy and low mood also lead to a decreased sex drive. However, some studies indicate that the exact impact on male libido in hypothyroidism may vary. In all cases, the neurological coordination for sexual arousal is affected. Regarding the erectile performanceBoth disorders cause significant problems: erections are less firm, shorter in duration, and more difficult to maintain. In short, any thyroid dysfunction often results in a combination of low libido and poorer erectile function, so these symptoms should lead us to suspect an underlying hormonal cause.
Impact on fertility and reproductive function
In addition to erection and desire, thyroid hormones influence the male fertilityThe thyroid gland interacts with spermatogenic development; its dysfunction can cause sperm deficiencies. In animal models of hypothyroidism, atrophied efferent ducts and an underdeveloped epididymis have been found, leading to an absence of mature sperm (azoospermia). In humans, men with hypothyroidism often present with lower sperm counts and reduced motility, along with hormonal alterations that decrease fertility. Fortunately, normalizing thyroid function can reverse some of these problems. Recent studies show that levothyroxine not only improves erectile function but also increases the production of healthy sperm. In conclusion, an abnormal thyroid condition not only impairs sexual life but also male reproductive function, and correcting it usually improves both.
Signs that indicate erectile dysfunction could be hormonal
When a man presents with ED, it is helpful to look for signs that suggest a hormonal or thyroid origin:
Most common physical signs
- Hair loss (diffuse alopecia) and rough or cold skin, typical of hypothyroidism.
- Unexplained weight gain or, in the case of hyperthyroidism, rapid weight loss.
- Sensitivity to cold (hypothyroidism) or heat (hyperthyroidism).
- Chronic fatigue and intense tiredness, even with adequate sleep.
- Metabolic disorders, such as high cholesterol or concomitant glucose intolerance.
Sexual changes
- Decreased sexual desire or reduced libido.
- Weak or short-lived erections.
- Delayed ejaculation (difficult to reach orgasm) is typical in hypothyroidism.
- Premature ejaculation in hyperthyroidism.
- Increasing difficulty in penetration or maintaining an erection during intercourse.
Emotional and psychological signs
- Mental fatigue and loss of motivation.
- Low mood or frequent irritability, associated with hypothyroidism.
- Anxiety or panic attacks, more common in hyperthyroidism.
- Concentration and memory problems. Although these symptoms are nonspecific, their association with severe sexual problems indicates the need to evaluate thyroid function.
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Diagnosis of erectile dysfunction related to thyroid problems
The diagnostic approach combines medical history, physical examination, and complementary tests. First, general thyroid symptoms (weight changes, fatigue, etc.) are explored along with a sexual evaluation (IIEF-5 or SHIM index). Then, tests are ordered. hormonal analysisTSH and free T4 (and sometimes free T3) levels are measured to confirm hypothyroidism or hyperthyroidism, along with total and free testosterone, SHBG, and prolactin. A typical finding in hypothyroidism is elevated TSH with low T4; in hyperthyroidism, suppressed TSH with high T4. To quantify erectile dysfunction (ED), the IIEF-5 questionnaire can be used, and if necessary, penile Doppler ultrasound examinations can be performed if a vascular component is suspected.
Most commonly used hormone tests
- TSH and thyroid hormones (free T4, T3): fundamental for thyroid diagnosis.
- Total and free testosterone: evaluates associated hypogonadism.
- Prolactin: It is measured because hyperprolactinemia, in some cases of hypothyroidism, lowers testosterone.
- PSA/estradiol: In selected cases, to rule out prostatic hyperplasia or estrogen excess.
Complementary studies
- Thyroid ultrasound: to examine the gland for goiter or nodules.
- Thyroid scintigraphy (iodine uptake): Useful in hyperthyroidism to determine the cause (Graves' disease vs. nodules).
- Thyroid biopsy: if nodular malignancy is suspected.
- Penile Doppler ultrasound: In persistent ED with vascular cause; evaluate blood flow.
- Semen analysis: if there are associated fertility problems. The combination of these tests provides a complete picture of thyroid function and the cause of ED.
Treatments for erectile dysfunction caused by thyroid diseases
Treatment of thyroid disorder
The cornerstone is normalizing the thyroid. Hypothyroidism, it is administered Levothyroxine (synthetic T4 hormone) to achieve a euthyroid state. In hyperthyroidismAntithyroid medications (methimazole, propylthiouracil) or definitive therapies (radioactive iodine or thyroidectomy) are used. Studies agree that restoring normal thyroid hormone levels leads to spontaneous improvement in many sexual symptoms. Therefore, it is crucial to carefully adjust thyroid medication before initiating symptomatic treatments for erectile dysfunction.
Specific treatments for erectile dysfunction
If ED persists after normalizing the thyroid, conventional ED therapies can be used:
- Phosphodiesterase type 5 (PDE5) inhibitors: Sildenafil (Viagra), tadalafil, vardenafil, etc., improve penile blood flow. Andromedi recommends these drugs as temporary support in many cases secondary to hormonal imbalance.
- Other techniques: Low-intensity shockwave therapy, urethral suppositories, or intracavernosal injections in refractory cases.
- Psychological counseling: The stress of dysfunction can be aggravated by thyroid concern; sex or couples therapy may help.
Changes in lifestyle
In addition to medical treatment, adopting healthy habits promotes recovery. The following is recommended:
- Balanced diet (sufficient natural iodine: dairy products, seafood, iodized salt) and regular exercise.
- Maintain a healthy weight and avoid being overweight (obesity can worsen subclinical hypothyroidism).
- Do not smoke and limit alcohol (these habits affect vascular function).
- Getting enough sleep and managing stress (high cortisol interferes with the hormonal axis) are key changes that improve overall health and hormonal profile, reducing the severity of erectile dysfunction.
Can erectile dysfunction caused by thyroid problems be cured?
In many cases, yesIf erectile dysfunction (ED) is secondary to a thyroid disorder, correcting the underlying condition usually leads to a partial or complete recovery of erectile function. Approximately half of patients improve significantly after achieving a euthyroid state. However, not all are completely cured. Some men may continue to experience residual erectile dysfunction even after normalizing their thyroid hormone levels. Therefore, joint follow-up (urological and endocrinological) is important until sexual health is restored. In summary, ED secondary to thyroid disease has a good prognosis for improvement, but this will depend on each individual case and the promptness of the diagnosis.
Tips for preventing sexual complications from thyroid disease
- Get regular medical checkups that include thyroid function tests, especially if there is a family history of thyroiditis or associated symptoms.
- Follow a healthy lifestyle: a diet rich in nutrients (iodine, selenium), daily physical exercise, and control of body weight.
- Control stress and maintain good sleep hygiene, as chronic exhaustion can precipitate or aggravate hormonal imbalances.
- If you experience abnormal sexual symptoms (low libido, persistent ED), always mention your hormonal symptoms to your doctor. Early detection of a thyroid disorder can prevent the progression of erectile dysfunction.
Frequently Asked Questions (FAQs)
Can a patient with thyroid problems take Viagra?
Yes, but with precautions. The first step is to correct the thyroid disorder; in fact, it's recommended to postpone specific ED treatment for up to 4–6 months after thyroid hormones are normalized. If the thyroid is under control, PDE5 inhibitors (such as sildenafil) may help. This should always be done under medical supervision, with dosage adjustments and symptom monitoring, as hormonal changes alter the response to these medications.
Can you take testosterone along with thyroid medication?
Exogenous testosterone is only recommended if hypogonadism is confirmed after thyroid function has normalized. In many cases, proper treatment of hypothyroidism (levothyroxine) raises free testosterone levels on its own. If clear symptoms of testosterone deficiency (extreme fatigue, very low libido) and low blood test results persist after treatment, testosterone therapy under close monitoring may be considered. There are no direct dangerous interactions between levothyroxine and testosterone gel or injection, but it is important to adjust both therapies with a specialist to avoid hormonal excesses.
How to increase testosterone in cases of hypothyroidism?
First and foremost, treating hypothyroidism is key: with levothyroxine at the appropriate dose, the body can usually restore normal testosterone production. In addition, adopting healthy habits helps: strength training (weightlifting), consuming quality protein, optimizing sleep, and maintaining a healthy body mass index. If, despite these measures, testosterone levels remain low and significant symptoms persist, the doctor may add a small dose of T3 (liothyronine) or consider testosterone therapy. However, it's always best to address the underlying thyroid problem first, as hormonal correction typically raises free testosterone levels on its own.
Do thyroid medications affect sexuality?
In general, thyroid medications (levothyroxine for hypothyroidism, antithyroid drugs, or radioactive iodine for hyperthyroidism) correct the underlying cause of sexual dysfunction rather than exacerbate it. When the dosage is appropriate, they help improve libido and erectile function in the medium term. However, an improperly adjusted dose can induce drug-induced hyperthyroidism or hypothyroidism, with their corresponding symptoms (anxiety or depression). Therefore, monitoring hormone levels during treatment is recommended. One study concludes that effective thyroid treatment gradually improves sexual symptoms or at least prevents them from worsening.
What type of thyroid disorder most affects erectile function?
Both hypothyroidism and hyperthyroidism can causeThere is no clear consensus that one is "worse" than the other in terms of erections: each case varies depending on the severity and individual susceptibility. Some reports suggest that hyperthyroidism produces more acute symptoms (such as premature ejaculation), while hypothyroidism is more chronic (low libido, fatigue). The important thing is to detect any thyroid disorder. In general, correcting the disorder—whether hypothyroidism or hyperthyroidism—tends to improve erectile function in both scenarios.
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Conclusion
Thyroid diseases play a crucial role in male sexual health. This 2026 guide shows that both hypothyroidism and hyperthyroidism can cause erectile dysfunction through hormonal and vascular mechanisms. Scientific literature indicates that a high percentage of men with these conditions experience sexual problems, but in many cases, correcting the thyroid disorder is sufficient to reverse them. Therefore, thyroid function should always be considered in the evaluation of erectile dysfunction. Early diagnosis and timely treatment are key: by normalizing hormone levels, it is common to restore erection, fertility, and sexual desire.
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