Thyroid Disease and Your Sex Drive

Solutions for Sexual Dysfunction in Thyroid Patients

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Sexual problems are a common thyroid symptom, with low libido and erectile dysfunction frequently listed as symptoms of undiagnosed or improperly treated thyroid conditions. According to a study published in the Journal of the American Medical Association (JAMA), about 43 percent of women and 31 percent of men experience sexual dysfunction. Interestingly, these figures are thought to be low, underestimating the extent of sexual problems in the U.S. 

How many people with sexual dysfunction may actually have underlying thyroid disease that has not been diagnosed is not a question that has been thoroughly researched. But, it's certain that some of the people having a problem could in fact resolve their sexual dysfunction problems simply by having their thyroid function evaluated and properly treated.

Still, many people—women in particular—continue to experience sexual dysfunction even after doctors consider the thyroid problem "treated." Let's explore the types of sexual dysfunction, the thyroid link, and effective solutions.

Causes

It's estimated that the following physical factors are a cause of sexual dysfunction in at least a third of the men who have concerns and more than 10 percent of women with sexual dysfunction issues:

  • Thyroid dysfunction
  • Other hormone imbalances, most commonly sex hormones like estrogen and testosterone
  • Hypertension (high blood pressure)

The remainder of people experiencing sexual dysfunction are thought to have issues that are psychological in origin, with specific causes including:

  • Stress
  • Anxiety
  • Concerns about sexual performance
  • Relationship issues
  • Guilt
  • Depression
  • Body image issues
  • History of sexual trauma

Symptoms

Both men and women can experience sexual dysfunction. Generally, there are four different types:

  • Lack of desire or interest in sex (low libido)
  • An inability to become aroused
  • An inability to orgasm or very slow to orgasm
  • Pain during intercourse

More specifically, the signs and symptoms of sexual dysfunction in men include:

  • An inability to get an erection
  • Difficulty maintaining an erection, known as erectile dysfunction (ED)
  • An inability to ejaculate or inability to control the timing (premature ejaculation or delayed ejaculation)

And, in women, the signs and symptoms of sexual dysfunction include:

  • Inadequate lubrication
  • An inability to relax the vaginal muscles
  • An inability to have an orgasm

Diagnosis

If you have not been diagnosed with thyroid disease, but are experiencing sexual dysfunction, a complete thyroid evaluation should be performed as part of your medical workup. The tests include TSH, Free T4, Free T3, and thyroid antibodies.

If you have already been diagnosed with thyroid disease and are experiencing sexual dysfunction, your first step should be to ensure that your thyroid treatment is not just adequate, but rather, that the treatment is optimized.

Other elements of your medical workup for sexual dysfunction should typically include:

  • A complete medical history
  • A thorough physical
  • Evaluation of other hormones besides thyroid, including testosterone for both men and women
  • Review of medications and supplements being taken
  • A discussion with your practitioner about possible psychological factors, such as stress, relationship problems, fear, and sexual trauma

Treatment

Some men and women who have low testosterone levels can benefit from testosterone supplementation. In some cases, men can benefit from drugs—such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—which increase blood flow to the penis.

Some men can also benefit from vacuum devices and implants that help with erectile dysfunction.

In women who are perimenopausal, or who have had a surgical menopause, hormone treatment involving estrogen and/or progesterone may be helpful, too. For women who have pain due to a narrow vagina or tight muscles, known as vaginismus, dilators may be an effective part of treatment as well.

Make Lifestyle Changes

Research has shown that sexual dysfunction in both men and women can also benefit from weight loss. Losing weight is easier said than done, of course, but excess weight can affect self-image and make you feel less sexy and less interested in sex.

Medically, being overweight can reduce sex drive. Specifically, losing weight reduces levels of sex hormone binding globulin (SHBG), which then leaves you with more free circulating estrogen and testosterone to help with your hormonal balance and sex drive.

Exercise can also be helpful by improving blood flow to all your body parts. Research has found that people who exercise regularly have higher levels of desire, greater sexual confidence and frequency, and an enhanced ability to be aroused and achieve orgasm, no matter what their age.

The best type of exercise is aerobic exercise because it can trigger the release of endorphins—chemicals in the brain that create a feeling of well-being. Finally, sex therapy and or other forms of therapy with trained counselors may also be useful in dealing with the psychological issues involved.

Optimize Treatment

Make sure your thyroid drug treatment is optimized. It may not be enough for your levels to be "normal." You may find that sexual dysfunction is resolved when treatment is considered optimal.

Some people do not find their thyroid symptoms—including sexual dysfunction—resolved when taking a levothyroxine/T4 only drug like Synthroid. In some cases, you may find that your sexual dysfunction is resolved or improved when your doctor adds in a synthetic form of the T3 hormone, for example Cytomel, or switches you to a natural thyroid drug, like Armour or Nature-throid, that includes natural forms of T4 and T3.

Address Hormonal Imbalances

Other endocrine and hormone imbalances are more common in thyroid patients. Be sure to have your sex hormones (estrogen, progesterone, and testosterone) checked.

For men who have thyroid issues, testosterone may be low and supplementation can be an aid in restoring lost libido. Testosterone is available as a pill form, as a transdermal patch, by injection, and sometimes as transdermal pellets implanted under the skin.

Some women can also benefit from testosterone. Doctors frequently will provide testosterone in pill form to women or as testosterone propionate cream. It's also important to have your adrenal function evaluated, specifically cortisol, DHEA, and any other imbalances.

Consider Supplements

There are a number of supplements that reportedly may help with sex drive. Be sure to check with your practitioner for guidance on how to safely use these:

  • Arginine—An amino acid for both men and women
  • Asian ginseng (panax)—May help increase sexual energy
  • Avena-sativa/oat extract—A popular brand is Vigorex which reportedly helps with sex drive
  • DHEA (dehydroepiandrosterone)—A precursor hormone that converts to testosterone in your body and may be useful to both women and men who have borderline low levels of testosterone
  • Ginkgo biloba—An herb that may improve sexual function in men
  • Horny goat weed—Used by Chinese herbalists, it may help improve sexual functions in both men and women
  • Kava kava—An herb most known for use in relaxation but may be useful as an aphrodisiac for women
  • Zinc—Low levels have been associated with low sex drive in women and men
  • Royal maca—A South American herbal remedy that may help men and women with libido

Source:

Laumann E, et. al. "Sexual dysfunction in the United States: prevalence and predictors." JAMA. 10;281(6):537-44.

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