Thyroid disorders and male sexual dysfunction

[madman]

Though early research suggested that thyroid hormones were not involved with the testes, male spermatogenesis, or erectile function, investigations on this topic over the past few decades have increased and shed new light. A literature review of studies conducted between 1963 and 2022 regarding male sexual dysfunction (SD) and thyroid disorders was performed to define the diagnostic consideration, pathophysiology, and management of SD secondary to thyroid dysregulation. This article provides evidence and interpretation of prior clinical and preclinical studies and contextualizes these studies for clinical practice. Clinical manifestations of SDs included erectile and ejaculatory dysfunction, impaired spermatogenesis, and disruption of the hypothalamic-pituitary-gonadal axis. Our aim of this communication was to perform a literature review detailing the impact of thyroid disorders on male SD. We hope to provide a framework for practicing urologists, endocrinologists, or general practitioners when evaluating patients with concurrent thyroid and male SD. It is important to recognize that thyroid disorders can be an important part of the pathophysiology of male SD in patients. Future research studies are needed to further elucidate the mechanisms involved.





INTRODUCTION

The link between thyroid disorders and sexual dysfunction (SD) has been well established in females; however, the link between male SD and thyroid disorders has recently garnered interest [1]. The first review on the relationship between thyroid disorders and male SD detailed the paucity of scientific studies on this topic [2]. The incidence of thyroid dysregulation is well documented by sexual medicine physicians treating patients who have this comorbidity [3]. Due to this relationship, it is also important for sexual medicine physicians to recognize the different symptoms of thyroid disorders, which impact multiple systems in the human body (Table 1). This review will investigate the relationship between thyroid disease states and sexual health by examining the impact of thyroid disorders on testicular function and structure, hormonal balance, clinical symptoms of SD, and evaluation and treatment of sexual disorders.

*Impacts of hypothyroidism on androgenic hormones


*Impacts of hyperthyroidism on androgenic hormones


*Impact of thyroid hormone on development of Sertoli cells


*Impact of thyroid hormone on spermatogenesis


*Impact of hypothyroidism on erectile dysfunction


*Impact of hyperthyroidism on erectile dysfunction


*Impact of thyroid disorders on ejaculation


*Evaluation and treatment of sexual dysfunction secondary to thyroid disorders




CONCLUSION

Male SD is impacted significantly by thyroid disorders. Dysregulation of the hypothalamic-pituitary-gonadal axis is one of the major contributing factors that facilitates changes in libido, ED, and ejaculatory dysfunction in patients with thyroid disorders. Research reveals that thyroid dysfunction impacts the development and function of testicular tissue, action of accessory sex organs, and responsiveness of structures involved in the neuromuscular pathways essential to erectile and ejaculatory function. More studies in animals and human subjects are needed to further elucidate the impact of TH on male sexual function.

 

[madman]

Table 1. Clinical manifestations of disordered thyroid states [52, 55].

 

[madman]

Table 2. Hormonal changes associated with thyroid disorders [2 ,11].

 

[madman]

*Prior to understanding how TH impacts ejaculatory function, it is essential to review how ejaculatory mechanisms work. Ejaculation or the expulsion of seminal fluid is defined as a spinal reflex triggered by genital and/or brain stimulation that occurs in three phases: emission, expulsion, and orgasm [50]. The spinal ejaculation generator (SEG) is located at spinal levels T12-L2 and is responsible for coordinating this reflex [50]. Initially, afferent signals, either from genital nerves or supraspinal (brain) neurons, cause excitation of the SEG and activation of sympathetic and parasympathetic nerves. Parasympathetic nerves stimulate production of seminal fluid, and sympathetic nerves induce spermatozoal transport through the contraction of the vas deferens and seminal vesicles. Next, adrenergic neurons in the pelvis stimulate contraction of the seminal vesicles and prostate, causing seminal and spermatic fluid to pool in the prostatic urethra, which eventually stimulates the urethral-muscular reflex. Final ejaculation is stimulated by somatic nerves from S2-S4 (pudendal), which activate the levator ani, bulbocavernosus, and bulbospongiosus muscles to rhythmically contract [50].

 

[Nelson Vergel]

Excellent paper!! @madman

 

[madman]

Impact of hyperthyroidism on sexual functions in men and women

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...

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