madman
Super Moderator
CONCLUSION
Male and female sexual function require normal libido, an intact hypo-thalamic-pituitary-gonadal axis, neurovascular integrity to the genitalia, as well as physiologic levels of sex hormones. However, recent evidence presented in this review and others suggests that thyroid axis dysregulation also plays a major role in sexual dysfunction that cannot be overlooked.64 Unfortunately, well-designed studies that describe the prevalence, pathophysiology, and outcomes of patients with sexual dysfunction in the setting of thyroid disease are severely lacking. This may be attributed to the fact that sexual symptoms are often not a priority when dealing with the systemic effects of thyroid hormone deficiency or excess. Additionally, patients may be reticent to discuss sexual dysfunction during visits to their primary physician or endocrine specialist due to embarrassment or shame. Despite the limitations on available studies, several reports in select patient populations have allowed researchers to estimate the prevalence and suggest potential mechanisms for how thyroid disease causes sexual dysfunction.
Recent studies have demonstrated that the prevalence of sexual dysfunction in patients with hypothyroidism is as high as 59-63% and 22-46% in men and women, respectively. The rates of sexual dysfunction in patients with hyperthyroidism are similarly striking: 48-77% and 44-60% in men and women, respectively. Interestingly, many of the men and women included in the aforementioned studies were below the age of 40 years, suggesting that thyroid disease may be a particularly relevant etiology of sexual health problems in young adults.13,22 A previous review has also drawn attention to thyroid disease as an important potential cause of ED in young men. 65 The mechanism by which thyroid disease drives sexual dysfunction remains unknown, however, studies have demonstrated that hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways as well as indirectly provoke psychiatric and autonomic dysregu-lation that can impair sexual function. Hypothyroid patients have been found to have decreased concentrations of total and free serum testosterone, SHBG, DHEA, and metabolites of DHEA, as well as increased concentrations of PRL, which promotes a hypo-gonadotropic hypo-gonadal state. Hypothyroidism is also classically associated with symptoms of fatigue, weight gain, and depressed mood, which contribute to diminished interest in sexual activity in both men and women. In contrast, hyperthyroidism enhances sensitivity to circulating catecholamines, alters serotonin turnover, exerts direct effects on thyroid hormone receptors found in human cavernosal tissue, and impairs NO-dependent corporal vasodilation. Hyperthroidism also increases SHBG, leading to a relative hyper estrogenism and reduces bioavailable testosterone.
Both hypothyroidism and hyperthyroidism were strongly associated with ED and ejaculatory dysfunction. Hypothyroidism was associated with DE whereas hyperthyroidism was associated with PE. Both forms of thyroid disease impaired libido in men and women. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Interestingly, correction of the thyroid deficiency or excess was associated with dramatic resolution of sexual dysfunction in men and women patients with hypothyroidism or hyperthyroidism. By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms can be remedied by treating an underlying thyroid disorder.
Male and female sexual function require normal libido, an intact hypo-thalamic-pituitary-gonadal axis, neurovascular integrity to the genitalia, as well as physiologic levels of sex hormones. However, recent evidence presented in this review and others suggests that thyroid axis dysregulation also plays a major role in sexual dysfunction that cannot be overlooked.64 Unfortunately, well-designed studies that describe the prevalence, pathophysiology, and outcomes of patients with sexual dysfunction in the setting of thyroid disease are severely lacking. This may be attributed to the fact that sexual symptoms are often not a priority when dealing with the systemic effects of thyroid hormone deficiency or excess. Additionally, patients may be reticent to discuss sexual dysfunction during visits to their primary physician or endocrine specialist due to embarrassment or shame. Despite the limitations on available studies, several reports in select patient populations have allowed researchers to estimate the prevalence and suggest potential mechanisms for how thyroid disease causes sexual dysfunction.
Recent studies have demonstrated that the prevalence of sexual dysfunction in patients with hypothyroidism is as high as 59-63% and 22-46% in men and women, respectively. The rates of sexual dysfunction in patients with hyperthyroidism are similarly striking: 48-77% and 44-60% in men and women, respectively. Interestingly, many of the men and women included in the aforementioned studies were below the age of 40 years, suggesting that thyroid disease may be a particularly relevant etiology of sexual health problems in young adults.13,22 A previous review has also drawn attention to thyroid disease as an important potential cause of ED in young men. 65 The mechanism by which thyroid disease drives sexual dysfunction remains unknown, however, studies have demonstrated that hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways as well as indirectly provoke psychiatric and autonomic dysregu-lation that can impair sexual function. Hypothyroid patients have been found to have decreased concentrations of total and free serum testosterone, SHBG, DHEA, and metabolites of DHEA, as well as increased concentrations of PRL, which promotes a hypo-gonadotropic hypo-gonadal state. Hypothyroidism is also classically associated with symptoms of fatigue, weight gain, and depressed mood, which contribute to diminished interest in sexual activity in both men and women. In contrast, hyperthyroidism enhances sensitivity to circulating catecholamines, alters serotonin turnover, exerts direct effects on thyroid hormone receptors found in human cavernosal tissue, and impairs NO-dependent corporal vasodilation. Hyperthroidism also increases SHBG, leading to a relative hyper estrogenism and reduces bioavailable testosterone.
Both hypothyroidism and hyperthyroidism were strongly associated with ED and ejaculatory dysfunction. Hypothyroidism was associated with DE whereas hyperthyroidism was associated with PE. Both forms of thyroid disease impaired libido in men and women. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Interestingly, correction of the thyroid deficiency or excess was associated with dramatic resolution of sexual dysfunction in men and women patients with hypothyroidism or hyperthyroidism. By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms can be remedied by treating an underlying thyroid disorder.
