Does thyroid cause erectile dysfunction? Yes, thyroid disorders can contribute to erectile dysfunction through multiple mechanisms affecting hormones, blood flow, and neurological function. Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are associated with increased rates of sexual difficulties in men. The thyroid gland produces hormones essential for cardiovascular health, testosterone regulation, and nerve function—all critical for achieving and maintaining erections. Fortunately, thyroid disorders are treatable conditions, and correcting thyroid imbalance often leads to significant improvement in erectile function. Understanding this connection is important because thyroid dysfunction may be an overlooked cause in men presenting with erectile difficulties.
Summary: Thyroid disorders, both hyperthyroidism and hypothyroidism, can cause erectile dysfunction by disrupting hormones, blood flow, and neurological function essential for sexual health.
- Hyperthyroidism increases sex hormone-binding globulin, reducing free testosterone and impairing erectile function
- Hypothyroidism causes reduced testosterone production, elevated prolactin, and cardiovascular changes that compromise blood flow
- Thyroid-related erectile dysfunction typically occurs alongside systemic symptoms such as weight changes, fatigue, mood disturbances, and temperature sensitivity
- Diagnosis requires thyroid function tests (TSH, FT4, FT3) alongside hormonal assessment including testosterone and prolactin levels
- Treatment focuses on normalising thyroid hormone levels with levothyroxine for hypothyroidism or antithyroid medications for hyperthyroidism
- Erectile function often improves significantly within weeks to months once thyroid hormone levels are corrected and stabilised
Table of Contents
- Understanding the Link Between Thyroid Function and Erectile Dysfunction
- How Thyroid Disorders Affect Sexual Health in Men
- Symptoms of Thyroid-Related Erectile Dysfunction
- Diagnosis and Testing for Thyroid Problems Causing ED
- Treatment Options for Thyroid-Induced Erectile Dysfunction
- When to See Your GP About Thyroid and Sexual Health Concerns
- Frequently Asked Questions
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Understanding the Link Between Thyroid Function and Erectile Dysfunction
The thyroid gland, a small butterfly-shaped organ located in the neck, plays a crucial role in regulating metabolism, energy production, and numerous bodily functions through the hormones it produces. Research has established a clear connection between thyroid disorders and erectile dysfunction (ED), with studies suggesting that men with thyroid problems may be more likely to experience sexual difficulties compared to those with normal thyroid function.
Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can contribute to erectile dysfunction through multiple mechanisms. The thyroid hormones—primarily thyroxine (T4) and triiodothyronine (T3)—influence cardiovascular health, blood flow, neurological function, and hormonal balance, all of which are essential for achieving and maintaining an erection. When thyroid hormone levels become imbalanced, these interconnected systems can be disrupted.
Erectile dysfunction is very common, particularly in men over 40. Whilst estimates vary, thyroid disorders appear to be associated with higher rates of sexual difficulties, though the exact prevalence depends on the population studied and the severity of thyroid disease.
Key points about the thyroid-ED connection:
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Thyroid disorders affect multiple body systems involved in sexual function
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Both overactive and underactive thyroid conditions can cause ED
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Treating thyroid problems often improves erectile function
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Thyroid dysfunction may be an overlooked cause in men presenting with ED
Understanding this connection is important because thyroid disorders are treatable conditions, and addressing the underlying thyroid problem can lead to significant improvement in sexual function without the need for ED-specific treatments in many cases.
How Thyroid Disorders Affect Sexual Health in Men
Thyroid disorders impact male sexual health through several distinct physiological pathways, each contributing to erectile difficulties in different ways. Understanding these mechanisms helps explain why thyroid treatment can be so effective in restoring sexual function.
Hormonal disruption represents one of the primary pathways. Thyroid hormones directly influence the production and regulation of sex hormones, particularly testosterone. In hyperthyroidism, excess thyroid hormone increases the production of sex hormone-binding globulin (SHBG), a protein that binds to testosterone and renders it biologically inactive. This results in reduced levels of free testosterone available for sexual function, despite total testosterone levels appearing normal or even elevated. Hyperthyroidism can also increase the conversion of testosterone to oestradiol (a form of oestrogen), further disrupting the hormonal balance necessary for normal erectile function. Conversely, hypothyroidism can lead to reduced testosterone production and elevated prolactin levels, both of which suppress libido and erectile capacity.
Cardiovascular effects constitute another critical mechanism. Erectile function depends fundamentally on adequate blood flow to the penile tissues. Hyperthyroidism can cause cardiovascular complications including irregular heart rhythms (particularly atrial fibrillation), increased heart rate, and elevated blood pressure (typically systolic hypertension), all of which may impair the vascular responses required for erection. Hypothyroidism, meanwhile, is associated with atherosclerosis (hardening of the arteries), elevated cholesterol levels (dyslipidaemia), and reduced cardiac output, which collectively compromise blood flow throughout the body, including to the penis.
Neurological and psychological factors also play significant roles. Thyroid disorders frequently cause mood disturbances, with hyperthyroidism linked to anxiety, irritability, and restlessness, whilst hypothyroidism commonly causes depression, fatigue, and reduced motivation. These psychological symptoms can substantially diminish sexual desire and performance. Additionally, thyroid hormones are essential for proper nerve function, and thyroid imbalance may affect the neurological signals necessary for the erectile response.
Symptoms of Thyroid-Related Erectile Dysfunction
Recognising thyroid-related erectile dysfunction requires awareness of both sexual symptoms and the broader signs of thyroid disorder. Unlike ED caused solely by vascular or psychological factors, thyroid-induced erectile problems typically occur alongside other systemic symptoms that provide important diagnostic clues.
Sexual symptoms associated with thyroid dysfunction include:
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Difficulty achieving or maintaining erections sufficient for sexual intercourse
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Reduced rigidity of erections
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Decreased sexual desire or libido
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Delayed ejaculation or difficulty reaching orgasm
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Reduced sexual satisfaction
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In some cases, premature ejaculation (which may be more common with hyperthyroidism)
These sexual symptoms rarely occur in isolation when thyroid disease is the underlying cause. Men with hyperthyroidism may additionally experience:
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Unintentional weight loss despite normal or increased appetite
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Rapid or irregular heartbeat (palpitations)
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Increased sweating and heat intolerance
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Tremor in the hands
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Nervousness, anxiety, or irritability
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Difficulty sleeping
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Frequent bowel movements
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Muscle weakness, particularly in the upper arms and thighs
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Fatigue despite feeling 'wired'
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Swelling in the neck (goitre)
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Eye problems (in Graves' disease, such as bulging eyes or grittiness)
Conversely, men with hypothyroidism typically present with:
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Unexplained weight gain or difficulty losing weight
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Persistent fatigue and lack of energy
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Increased sensitivity to cold
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Constipation
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Dry skin and hair
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Muscle aches and weakness
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Depression or low mood
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Slowed thinking and poor concentration ('brain fog')
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Hoarse voice
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Swelling in the neck (goitre)
Blood tests may also reveal elevated cholesterol levels in hypothyroidism, which is a laboratory finding rather than a symptom you would notice yourself.
The timing and pattern of symptoms can provide additional clues. Thyroid-related ED often develops gradually as thyroid function deteriorates, rather than appearing suddenly. Men may notice that their erectile difficulties worsen in parallel with other thyroid symptoms. Importantly, if erectile dysfunction improves with thyroid treatment but no other ED-specific interventions, this strongly suggests the thyroid disorder was the primary cause.
Diagnosis and Testing for Thyroid Problems Causing ED
Proper diagnosis of thyroid-related erectile dysfunction requires a systematic approach combining clinical assessment, blood tests, and evaluation of sexual function. NICE guidance on erectile dysfunction recommends that thyroid function tests should be considered when clinical features suggest thyroid disease may be contributing to erectile problems.
Initial clinical assessment begins with a thorough medical history. Your GP will ask about:
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The nature, duration, and severity of erectile difficulties
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Presence of morning erections (which can help distinguish organic from psychological causes)
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Other symptoms suggestive of thyroid disorder
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Cardiovascular risk factors and existing medical conditions
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Current medications (some drugs affect both thyroid function and erectile function)
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Psychological factors including stress, anxiety, and relationship issues
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Lifestyle factors such as smoking, alcohol consumption, and exercise
A physical examination should include measurement of blood pressure, heart rate, and body mass index (BMI), along with examination of the thyroid gland for enlargement or nodules. Examination of secondary sexual characteristics and genital examination may also be performed.
Blood tests form the cornerstone of diagnosis. The essential investigations include:
Thyroid function tests:
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Thyroid-stimulating hormone (TSH)—the primary screening test
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Free thyroxine (FT4) if TSH is abnormal
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Free triiodothyronine (FT3) if hyperthyroidism (thyrotoxicosis) is suspected or in specific clinical scenarios
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Thyroid peroxidase antibodies (TPOAb) if autoimmune thyroid disease is suspected
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TSH receptor antibodies (TRAb) if Graves' disease is suspected
Hormonal assessment:
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Total testosterone (measured between 9–11 am when levels peak)
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If testosterone is low, a confirmatory repeat early morning sample should be taken
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Sex hormone-binding globulin (SHBG) when SHBG is likely to be abnormal or total testosterone is borderline
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Calculated free testosterone when SHBG is abnormal or total testosterone is borderline
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Prolactin
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Luteinising hormone (LH) and follicle-stimulating hormone (FSH) if testosterone is confirmed low
Additional tests:
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Fasting glucose and HbA1c (to exclude diabetes)
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Lipid profile (cholesterol and triglycerides)
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Full blood count
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Liver and kidney function tests
Interpretation of results requires clinical expertise. In hyperthyroidism, TSH is typically suppressed (low) with elevated FT4 and/or FT3. In hypothyroidism, TSH is elevated with low FT4. Subclinical thyroid disorders (where TSH is abnormal but FT4 remains within the normal range) can also contribute to erectile dysfunction. UK guidance suggests considering treatment for subclinical hypothyroidism if TSH is persistently ≥10 mU/L, or if TSH is between 4–10 mU/L with symptoms and positive thyroid antibodies. Repeat testing is important to confirm persistent abnormality before starting treatment. Your GP may refer you to an endocrinologist for specialist assessment if thyroid abnormalities are confirmed or if the clinical picture is complex.
Treatment Options for Thyroid-Induced Erectile Dysfunction
The primary treatment approach for thyroid-related erectile dysfunction focuses on correcting the underlying thyroid disorder. In many cases, normalising thyroid hormone levels leads to significant improvement or complete resolution of erectile difficulties without requiring ED-specific treatments. However, a comprehensive management strategy may incorporate multiple therapeutic elements.
Thyroid-specific treatments vary depending on the type of disorder:
For hypothyroidism, levothyroxine (synthetic T4) is the standard treatment. This medication replaces the deficient thyroid hormone, with dosing adjusted based on regular TSH monitoring. Treatment typically begins with a low dose (particularly in older men or those with cardiovascular disease) and is gradually increased until TSH normalises. NICE guidance recommends aiming for TSH within the laboratory reference range, avoiding overtreatment. Improvement in erectile function may begin within weeks but can take several months to fully manifest as thyroid hormone levels stabilise.
For hyperthyroidism, treatment options include:
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Antithyroid medications (carbimazole or propylthiouracil) that reduce thyroid hormone production
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Beta-blockers (such as propranolol) to control symptoms including rapid heart rate, tremor, and anxiety whilst awaiting definitive treatment
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Radioiodine therapy that permanently reduces thyroid activity
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Thyroid surgery (thyroidectomy) in selected cases
The choice depends on the underlying cause (Graves' disease, toxic nodular goitre, etc.), severity, patient preference, and other clinical factors. Sexual function typically improves as thyroid hormone levels normalise, though this may take several months.
Adjunctive treatments may be considered:
Testosterone replacement therapy might be appropriate if testosterone levels remain persistently low despite thyroid treatment normalisation. However, this should only be initiated after thyroid function has been optimised, as correcting thyroid disorders often restores normal testosterone levels naturally. Diagnosis requires two low early morning testosterone measurements plus clinical symptoms. Underlying causes should be identified and reversible factors addressed. If testosterone therapy is prescribed, monitoring (including haematocrit and, where appropriate, prostate-specific antigen) is necessary according to UK guidance.
Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) can be used if erectile dysfunction persists despite successful thyroid treatment. These medications enhance blood flow to the penis. Important safety considerations include:
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Contraindicated with nitrates (used for angina) or recreational nitrites ('poppers')
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Caution required with alpha-blockers (used for prostate or blood pressure problems)
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Cardiovascular risk assessment is important before prescribing
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Follow UK prescribing information (Summary of Product Characteristics) for dosing and contraindications
These medications are generally safe in men with controlled thyroid disease when used appropriately.
Lifestyle modifications support both thyroid health and erectile function:
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Maintaining a healthy weight
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Regular physical exercise
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Smoking cessation
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Moderating alcohol intake
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Stress management techniques
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Adequate sleep
Psychological support including counselling or psychosexual therapy may benefit men whose erectile difficulties have created anxiety or relationship strain, even after physiological function improves.
If you experience any suspected side effects from your medicines, you can report them via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store.
When to See Your GP About Thyroid and Sexual Health Concerns
Knowing when to seek medical advice is crucial for timely diagnosis and treatment of thyroid-related erectile dysfunction. Many men delay consulting their GP about sexual health concerns due to embarrassment, but early intervention can prevent progression of thyroid disease and improve outcomes.
You should arrange a routine GP appointment if you experience:
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Persistent erectile difficulties lasting more than a few weeks
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Gradual decline in sexual desire or performance
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Erectile problems accompanied by other symptoms suggestive of thyroid disorder (weight changes, fatigue, mood changes, temperature sensitivity, neck swelling)
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Erectile dysfunction that doesn't respond to lifestyle modifications
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Sexual difficulties causing distress or affecting your relationship
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Concerns about your thyroid health, particularly if you have a family history of thyroid disease
Your GP can conduct appropriate investigations, including thyroid function tests, and initiate treatment or referral as needed. Most cases can be managed effectively in primary care. Referral to an endocrinologist may be appropriate if thyroid dysfunction is confirmed, if there is diagnostic uncertainty, or if specialist management is required. Referral to urology or andrology services may be considered if erectile dysfunction does not respond to conservative measures and first-line pharmacological treatment.
Seek urgent medical attention (same-day GP appointment or NHS 111) if you experience:
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Chest pain, particularly with breathlessness
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Severe palpitations or new rapid/irregular heartbeat with dizziness or fainting
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Severe breathlessness
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Fainting or collapse
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High fever with severe agitation, confusion, and marked rapid heart rate (possible thyroid storm—a rare but serious complication of hyperthyroidism)
Go to A&E or call 999 if you develop:
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Chest pain with breathlessness or feeling faint
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Sudden collapse or loss of consciousness
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Symptoms suggesting thyroid storm: very high fever, extreme agitation or confusion, and very rapid heart rate
Preparing for your appointment can help ensure productive consultation:
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Note the duration and pattern of your erectile difficulties
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List all other symptoms you've experienced
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Bring a list of current medications and supplements
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Record your family medical history, particularly thyroid disorders
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Consider keeping a symptom diary
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Prepare questions you want to ask
Remember that erectile dysfunction can be an early indicator of other health conditions, including cardiovascular disease and diabetes, as well as thyroid disorders. Your GP will take your concerns seriously and conduct appropriate investigations. Effective treatments are available for both thyroid disorders and erectile dysfunction, and addressing these issues can significantly improve your quality of life, overall health, and wellbeing. Don't let embarrassment prevent you from seeking the help you need—sexual health is an important component of overall health, and discussing these concerns with your GP is a normal and important part of medical care.
Frequently Asked Questions
Can hypothyroidism cause erectile dysfunction?
Yes, hypothyroidism can cause erectile dysfunction by reducing testosterone production, elevating prolactin levels, and causing cardiovascular changes that impair blood flow to the penis. Treating hypothyroidism with levothyroxine often improves erectile function as thyroid hormone levels normalise.
How long does it take for erectile function to improve after thyroid treatment?
Improvement in erectile function may begin within weeks of starting thyroid treatment but can take several months to fully manifest as thyroid hormone levels stabilise. The timeframe varies depending on the severity of thyroid dysfunction and individual response to treatment.
What blood tests diagnose thyroid-related erectile dysfunction?
Essential blood tests include thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) for thyroid function, alongside total testosterone, sex hormone-binding globulin (SHBG), and prolactin to assess hormonal status. Additional tests may include fasting glucose, lipid profile, and thyroid antibodies.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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