madman
Super Moderator
This study aimed to review the current knowledge on sexual dysfunction in men and women with hyperthyroidism through a systematic review and meta-analysis. Available clinical trials from the MEDLINE database were searched using a prerecorded protocol (Protocol Prospero ID: CRD42022340587), and obtained data were analyzed and reported according to the PRISMA guidelines. Pooled effect estimates were computed using a random-effects model. Twenty eligible studies were identified, of which 15 were included in this meta-analysis. The prevalence of erectile dysfunction was significantly higher in participants with hyperthyroidism than in controls [odds ratio = 9.16 (95% confidence interval [CI], 5.0–16.5)]. Treatment of hyperthyroidism alone improved erectile functions [effect size, ES = 0.36 (95% CI, −0.01–72)] and mean intra-vaginal ejaculation latency time[ES = 0.63 (95% CI, 0.27–98)] among men with erectile dysfunction and/or premature ejaculation. The prevalence of premature ejaculation also decreased with treatment of hyperthyroidism [odds ratio = 0.11 (95% CI, 0.04–28). Women with hyperthyroidism demonstrated higher odds of female sexual dysfunction than controls [odds ratio = 4.34 (95% CI, 2.63–7.18)]. Female sexual function index scores in women with hyperthyroidism were also significantly lower than those in the controls with moderate effect sizes. An evident and reversible disruption of sexual functions under hyperthyroidism conditions was observed in both sexes.
INTRODUCTION
Hyperthyroidism, also known as thyrotoxicosis, is the physiological manifestation of excessive thyroid hormone levels [1]. It is generally considered overt or subclinical depending on its biochemical severity, although the disease represents continuously active thyroid function [2]. Hyperthyroidism has a 10-fold higher prevalence among women (1%–2%) than that among men (0.1–0.2%) [1]. Over the last two decades, researchers have reported growing evidence of an association between hyperthyroidism and sexual dysfunction in both sexes [3–8]. Sexual dysfunction is a common public health problem that is increasing in importance and affects both genders cognitively and emotionally [9]. Emerging evidence from recent studies investigating the association between hyperthyroidism and sexual dysfunction has revealed that hyperthyroidism is associated with increased odds of premature ejaculation (PE) and erectile dysfunction (ED) in men and impaired sexual function in different domains in women [5, 8, 10–14]. The heterogeneity of current clinical reports, unstandardized diagnostic and prognostic evaluations, and lack of quantitative clinical evidence with sufficient sample sizes have limited the establishment of overall evidence-based conclusions and future projections. Here, we aimed to review the current evidence and quantitatively evaluate the current clinical data regarding the relationship between hyperthyroidism and sexual dysfunction in men and women.
*ED in men with hyperthyroidism
*Ejaculatory dysfunction in men with hyperthyroidism
*Changes after treatment of hyperthyroidism in male sexual functions
*Sexual dysfunction in women with hyperthyroidism
*Changes after treatment of hyperthyroidism in female sexual functions
In conclusion, hyperthyroidism severely affects sexual function in both sexes with moderate-to-large ESs.
Limitations
The main limitations were the high risk of bias arising from the biased selection of participants, measurement of outcomes, and heterogeneity of the available studies.
Implications for research
Our study contributes to the literature and supports the idea that the thyroid gland should be considered a sexual organ, similar to the brain or genitalia. However, further research is necessary to clarify some clinical findings, such as why several domains of sexual function were affected more frequently by hyperthyroidism, why some of them did not appropriately recover at the time of evaluation, the physiological role of thyroxin in the ejaculatory reflex, and the interrelation between the thyroid and gonadal axes through testosterone efficacy.
Implications for clinical practice
Our findings support previous recommendations in the literature[33–35]. Newly diagnosed patients with hyperthyroidism should be adequately counseled that their sexual complaints will improve after achieving a euthyroid state. Moreover, clinicians should investigate TSH levels in men with specific symptoms suggestive of hyperthyroidism. Men who have acquired PE and PE accompanied with anxiety or ED would also benefit from TSH measurement. Women who complain of severe sexual dysfunction accompanied by hypoactive sexual desire and specific symptoms suggestive of hyperthyroidism should also be investigated for underlying thyroid hyperfunction.
INTRODUCTION
Hyperthyroidism, also known as thyrotoxicosis, is the physiological manifestation of excessive thyroid hormone levels [1]. It is generally considered overt or subclinical depending on its biochemical severity, although the disease represents continuously active thyroid function [2]. Hyperthyroidism has a 10-fold higher prevalence among women (1%–2%) than that among men (0.1–0.2%) [1]. Over the last two decades, researchers have reported growing evidence of an association between hyperthyroidism and sexual dysfunction in both sexes [3–8]. Sexual dysfunction is a common public health problem that is increasing in importance and affects both genders cognitively and emotionally [9]. Emerging evidence from recent studies investigating the association between hyperthyroidism and sexual dysfunction has revealed that hyperthyroidism is associated with increased odds of premature ejaculation (PE) and erectile dysfunction (ED) in men and impaired sexual function in different domains in women [5, 8, 10–14]. The heterogeneity of current clinical reports, unstandardized diagnostic and prognostic evaluations, and lack of quantitative clinical evidence with sufficient sample sizes have limited the establishment of overall evidence-based conclusions and future projections. Here, we aimed to review the current evidence and quantitatively evaluate the current clinical data regarding the relationship between hyperthyroidism and sexual dysfunction in men and women.
*ED in men with hyperthyroidism
*Ejaculatory dysfunction in men with hyperthyroidism
*Changes after treatment of hyperthyroidism in male sexual functions
*Sexual dysfunction in women with hyperthyroidism
*Changes after treatment of hyperthyroidism in female sexual functions
In conclusion, hyperthyroidism severely affects sexual function in both sexes with moderate-to-large ESs.
Limitations
The main limitations were the high risk of bias arising from the biased selection of participants, measurement of outcomes, and heterogeneity of the available studies.
Implications for research
Our study contributes to the literature and supports the idea that the thyroid gland should be considered a sexual organ, similar to the brain or genitalia. However, further research is necessary to clarify some clinical findings, such as why several domains of sexual function were affected more frequently by hyperthyroidism, why some of them did not appropriately recover at the time of evaluation, the physiological role of thyroxin in the ejaculatory reflex, and the interrelation between the thyroid and gonadal axes through testosterone efficacy.
Implications for clinical practice
Our findings support previous recommendations in the literature[33–35]. Newly diagnosed patients with hyperthyroidism should be adequately counseled that their sexual complaints will improve after achieving a euthyroid state. Moreover, clinicians should investigate TSH levels in men with specific symptoms suggestive of hyperthyroidism. Men who have acquired PE and PE accompanied with anxiety or ED would also benefit from TSH measurement. Women who complain of severe sexual dysfunction accompanied by hypoactive sexual desire and specific symptoms suggestive of hyperthyroidism should also be investigated for underlying thyroid hyperfunction.
