Thyroid and Libido: What to Expect
Thyroid hormones influence energy, mood, metabolism, and the reproductive hormone network that shapes sexual desire and function. Both hypothyroidism and hyperthyroidism are associated with reduced libido and other sexual difficulties in people of all sexes, likely through combined effects on the hypothalamic-pituitary-gonadal axis, sex hormone–binding globulin, prolactin, mood, sleep, and fatigue.
Treating the underlying thyroid disorder often helps, but evaluation should also consider coexisting contributors such as depression, pain, relationship factors, medications, and sleep quality. This article explains the thyroid–libido connection and practical next steps supported by current evidence.
Thyroid–libido link
How can thyroid hormones influence sexual function?
Thyroid hormones help regulate the brain–reproductive hormone network (the hypothalamic-pituitary-gonadal axis), mood, energy, and sleep. When levels are too low (hypothyroidism) or too high (hyperthyroidism), downstream changes in sex hormone–binding globulin, testosterone/estrogen balance, and prolactin can reduce desire and impair arousal, orgasm, and satisfaction.
Do both hypothyroidism and hyperthyroidism affect libido?
Yes. Reviews and clinical studies report sexual dysfunction in both conditions. Women with thyroid disorders show higher rates of low desire, arousal/lubrication issues, orgasm difficulty, and pain, while men more often report erectile or ejaculatory problems alongside reduced libido. Treating the thyroid disorder can improve symptoms, though responses vary.
Why do symptoms vary between people?
Multiple pathways are involved—biologic (hormones, prolactin, SHBG), psychological (depression, anxiety), and contextual (relationship factors, medications, sleep). Because these interact, two people with the same thyroid labs can experience different sexual symptoms and recovery timelines.
Symptoms
What sexual changes are common?
Reduced desire (low libido) and difficulty with arousal or orgasm can occur in both hypothyroidism and hyperthyroidism. Women commonly report low desire, lubrication issues, orgasm difficulty, and pain; men more often report erectile or ejaculatory problems.
Variation is expected. Responses differ person to person due to hormonal, psychological, and relationship factors.
What suggests hypothyroidism may be involved?
Sexual symptoms: low libido, arousal/orgasm difficulties; in men, possible erectile or ejaculatory dysfunction; in women, vaginal dryness and dyspareunia.
General clues: fatigue, depressed mood, weight gain, cold intolerance, constipation; many health-system resources also list loss of libido among common complaints.
What suggests hyperthyroidism may be involved?
Sexual symptoms: low libido; in men, higher rates of erectile dysfunction and premature ejaculation reported in observational data.
General clues: anxiety/irritability, heat intolerance, weight loss, palpitations, tremor. (General features summarized in national guidance.)
Why do symptoms differ by person?
Changes in sex hormone–binding globulin (SHBG), testosterone/estrogen balance, and prolactin, plus mood and sleep effects, can all influence sexual desire and function—so the same TSH level can produce different lived experiences.
Evaluation
How do clinicians assess low libido when thyroid disease is suspected?
A thorough evaluation starts with history (onset, severity, partner/relationship context, mood, sleep, pain, childbirth/postpartum, and medications such as SSRIs, OCPs, opioids), targeted exam, and validated sexual-function tools. Screening for depression/anxiety and sleep problems is routine because these commonly coexist with thyroid disorders and affect desire.
Which laboratory tests are typically ordered?
Thyroid panel: TSH with free T4 (± free T3 when clinically indicated) to confirm hypo- or hyperthyroidism per guideline practice. Thyroid antibodies may be added when autoimmune disease is suspected.
Prolactin (when indicated): Elevated prolactin can suppress libido and should be checked if symptoms suggest hyperprolactinemia or when hypothyroidism is significant. Treating hypothyroidism can normalize prolactin.
Sex-steroid evaluation (context-specific):
Men with low libido/ED: Morning total testosterone on two separate days; consider SHBG/free testosterone if discordant with symptoms. Follow Endocrine Society guidance.
Women with cycle changes, vaginal dryness, or menopausal symptoms: Consider estradiol, SHBG, and thyroid testing within a broader sexual-dysfunction workup.
Other contributors (as directed by history): Iron studies for suspected deficiency, medication review (e.g., SSRIs), cardiometabolic risk, and sleep disorders.
Treatment and libido
Does treating hypothyroidism help libido?
Yes—restoring euthyroidism with levothyroxine is first-line care and can improve low libido and other sexual symptoms over time. Large guidelines endorse LT4 monotherapy for primary hypothyroidism; combination T3 regimens are not routinely recommended. As thyroid levels normalize, related contributors (fatigue, depressed mood, elevated prolactin) may also improve.
What about hyperthyroidism?
For hyperthyroidism, standard options are antithyroid drugs, radioactive iodine, or surgery, chosen via shared decision-making. Studies in men show erectile and ejaculatory dysfunction often improve after thyroid levels normalize. Symptom timelines vary; beta-blockers may relieve adrenergic symptoms while disease-specific therapy takes effect.
Will sexual function always return to baseline?
Not always. Evidence shows average improvement after treating thyroid dysfunction, but recovery depends on coexisting factors such as mood disorders, medications (e.g., SSRIs), pain conditions, sleep problems, cardiometabolic risk, and relationship context. Ongoing sexual symptoms after thyroid correction warrant targeted evaluation and management.
Which adjuncts are commonly used?
Psychological/relationship supports: Cognitive behavioral therapy, sex therapy, or couples counseling can address mood, anxiety, and relational barriers to desire.
Symptom-specific aids: Vaginal moisturizers/lubricants for dryness and dyspareunia; consider menopausal care pathways when appropriate. PDE5 inhibitors can support erectile function while thyroid therapy proceeds.
Hormonal considerations: In men with persistent low libido/ED, follow Endocrine Society guidance for evaluating testosterone and treating confirmed hypogonadism.
Monitoring and follow-up
Recheck thyroid labs after dose changes or definitive therapy according to guideline intervals, then reassess sexual symptoms. If low libido persists despite euthyroidism, revisit medications, sleep, mood, pelvic pain, and cardiometabolic factors, and adjust the plan.
Lifestyle and adjunctive supports
Can lifestyle change improve sexual function?
Regular aerobic exercise is linked with better erectile function in men in randomized trials and systematic reviews; benefits are larger when baseline function is lower. Evidence in women is more limited, but exercise supports mood, energy, and sleep, which are relevant to desire. Start gradually and aim for consistency.
What helps with pain and dryness?
For vaginal dryness or discomfort, over-the-counter vaginal moisturizers and lubricants can improve comfort and sexual satisfaction. Clinical guidance for genitourinary syndrome of menopause also supports local therapies (e.g., vaginal estrogen or DHEA) when appropriate after clinician review.
Can pelvic floor therapy help?
When pelvic pain or dyspareunia is present, pelvic floor physical therapy and related approaches (e.g., biofeedback, trigger-point work) can reduce pain and improve function. Referral is reasonable if pain persists despite basic measures.
What about counseling or CBT?
Low libido often has multifactor contributors (mood, stress, relationship factors). National health guidance supports relationship counseling, sex therapy/psychosexual therapy, and CBT—especially when depression or anxiety are present. These can run alongside medical treatment for thyroid disease.
Are medications sometimes used as adjuncts?
For men with persistent erectile dysfunction, guideline-directed PDE5 inhibitors (e.g., sildenafil, tadalafil) may help while thyroid treatment is optimized. Discuss interactions and cardiovascular safety with your clinician.
When to seek care
Urgent symptoms: Seek immediate care for severe palpitations, chest pain, shortness of breath, fainting, or a very fast or irregular heartbeat. These can be signs of uncontrolled hyperthyroidism or another medical emergency.
Persistent low libido or medication concerns: Book a visit if low sex drive worries you, if it continues after pregnancy, or if you suspect a medicine or hormonal contraception is contributing.
Erectile dysfunction that keeps happening: See a clinician if erections remain difficult despite arousal or if ED persists over time. Evaluation and treatment are available.
Pregnancy and postpartum: If you are pregnant, planning pregnancy, or recently postpartum and have thyroid disease, arrange thyroid testing and close follow-up. For persistent low mood, loss of interest, or thoughts of self-harm after birth, seek help promptly.
Takeaway
Thyroid disorders can affect sexual desire and function in people of all sexes. Both hypothyroidism and hyperthyroidism are linked to low libido and other sexual concerns through hormonal pathways and mood, sleep, and energy effects. Treating the thyroid condition often improves symptoms, but responses vary and coexisting factors (medications, depression/anxiety, pelvic pain, relationship context) may still need care.
If sexual symptoms persist after thyroid levels normalize, discuss adjunct supports such as exercise, lubricants or local therapies for vaginal symptoms, pelvic floor PT, counseling/CBT, or guideline-directed ED therapies. Seek prompt care for urgent symptoms or if you are pregnant or postpartum and feel unwell.
References
Gabrielson, A. T., Sartor, R. A., & Hellstrom, W. J. G. (2019). The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sexual medicine reviews, 7(1), 57–70. https://doi.org/10.1016/j.sxmr.2018.05.002
Salari, N., Heidarian, P., Jalili, F., Babajani, F., Shohaimi, S., Nasirian, M., & Mohammadi, M. (2024). The sexual dysfunction in women with thyroid disorders: a meta-analysis. BMC endocrine disorders, 24(1), 279. https://doi.org/10.1186/s12902-024-01817-9
Kjaergaard, A. D., Marouli, E., Papadopoulou, A., Deloukas, P., Kuś, A., Sterenborg, R., Teumer, A., Burgess, S., Åsvold, B. O., Chasman, D. I., Medici, M., & Ellervik, C. (2021). Thyroid function, sex hormones and sexual function: a Mendelian randomization study. European journal of epidemiology, 36(3), 335–344. https://doi.org/10.1007/s10654-021-00721-z
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