Hormones and ED beyond testosterone: what thyroid problems and other hormone issues have to do with erections

The short version: when ED comes up, testosterone gets most of the attention, but it is not the only hormone on the list. The National Institutes of Health names hormone issues among the most common conditions that can lead to erectile dysfunction, and gives two examples: low testosterone and thyroid imbalance. This page covers the thyroid side, which our other guides only touch on, along with prolactin, the stress hormone cortisol, anabolic steroids, and the hormone medicines that can play a part. It sets out what the research found, how sure it is, and which blood tests a clinician may use. None of it can tell you whether a hormone is behind your own ED. That takes an evaluation with a licensed clinician.

Can hormones other than testosterone cause ED?

They can. The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that some diseases or health conditions that affect your blood vessels, nerves or hormones can lead to ED. Its list of the most common ones includes “hormone issues, such as low testosterone and thyroid imbalance”, next to diabetes, heart and blood vessel diseases, nerve damage and chronic conditions such as kidney disease (NIDDK, Symptoms & Causes of ED). NIDDK also lists “chemotherapy and hormone medicines” among the common prescription medicines that can have ED as a side effect, and it describes a noncancerous pituitary tumor called a prolactinoma, which can raise the hormone prolactin, as having ED among its common symptoms in men (NIDDK, Prolactinoma). Hormones are one branch of a longer list, which our overview of what causes ED sets out in full.

Can thyroid problems affect erections?

Yes, thyroid imbalance is one of the two hormone examples NIDDK gives when it lists the common conditions that can lead to ED (NIDDK, Symptoms & Causes of ED). The thyroid is a small, butterfly-shaped gland in the front of the neck that makes two hormones, thyroxine (T4) and triiodothyronine (T3). NIDDK explains that thyroid hormones control how the body uses energy, so they affect nearly every organ in the body, including the heart (NIDDK, Thyroid Tests). A thyroid can go wrong in either direction. Hyperthyroidism, or an overactive thyroid, means the gland makes more thyroid hormone than the body needs (NIDDK, Hyperthyroidism). Hypothyroidism, or an underactive thyroid, means it does not make enough (NIDDK, Hypothyroidism). The studies below looked at both.

How common is ED in men with an overactive or underactive thyroid?

In the research that exists, ED showed up more often in men with thyroid disease than in men without it, but there are few studies, and the one that looked at both an overactive and an underactive thyroid was small. A 2008 study in the Journal of Clinical Endocrinology and Metabolism gave a validated five-question erectile function questionnaire, the Sexual Health Inventory for Men (SHIM), to 71 men with thyroid disease (27 with an overactive thyroid and 44 with an underactive one) and a similar number of men without it. Scores of 21 or less, the range the study counted as ED, were found in 78.9% of the men with thyroid disease, compared with 33.8% of the comparison group. The men answered again a year after starting treatment for their thyroid condition, and scores had risen significantly in both the overactive and underactive groups (Krassas et al., J Clin Endocrinol Metab 2008).

A 2024 meta-analysis in BMC Endocrine Disorders looked only at the overactive side. It pooled four observational studies, one of them the 2008 study above, with 25,519 people, 6,429 of them with hyperthyroidism, and found the odds of ED in men with hyperthyroidism were about 1.7 times the odds in men without it (Liu et al., BMC Endocr Disord 2024). The authors are open about the limits: only four studies qualified, the published clinical data on hyperthyroidism and ED is limited, and they call for more research. In their discussion they also note that conditions which travel with hyperthyroidism, such as diabetes and depression, can add to the picture.

Read both studies for what they are. The 2008 study is one before-and-after comparison in 71 men, and the 2024 figures come from observational research that shows how often two things occur together. Neither can show that the thyroid caused ED in a particular man, and neither predicts what would happen for you.

What are the signs of a thyroid problem?

The signs are broad, and most of them are common for other reasons too. NIDDK lists these among the symptoms of an overactive thyroid: weight loss despite an increased appetite, a rapid or irregular heartbeat, nervousness, irritability, trouble sleeping, fatigue, shaky hands, muscle weakness, sweating or trouble tolerating heat, frequent bowel movements, and an enlargement in the neck called a goiter (NIDDK, Hyperthyroidism). For an underactive thyroid it lists fatigue, weight gain, trouble tolerating cold, joint and muscle pain, dry skin or dry, thinning hair, a slowed heart rate and depression. Because hypothyroidism develops slowly, NIDDK says you may not notice symptoms for months or even years, and it adds that many of these symptoms, especially fatigue and weight gain, do not necessarily mean you have a thyroid problem (NIDDK, Hypothyroidism).

For scale: NIDDK says nearly 5 out of 100 Americans aged 12 and older have hypothyroidism, although most cases are mild or have few obvious symptoms, and that women are much more likely than men to develop it. About 1 in 100 Americans aged 12 and older have hyperthyroidism, which is more common in women and in people older than 60 (NIDDK, Hypothyroidism; NIDDK, Hyperthyroidism). A symptom list is a reason to ask, not a way to diagnose yourself.

Does an ED workup include thyroid tests?

It may. NIDDK says that to help find the cause of ED, a health care professional may use blood tests, “including thyroid tests and prostate tests”, along with ultrasound to show blood flow. During the physical exam they often check for blood vessel and nervous system issues, hormonal problems, and physical problems with the penis (NIDDK, Diagnosis of ED). The word “may” matters. The American Urological Association (AUA) guideline asks for a thorough medical, sexual and psychosocial history, a physical exam and selective laboratory testing, and recommends a morning total testosterone level for every man with ED. It also says that, with the possible exception of blood sugar (glucose or hemoglobin A1c) and blood fats, no routine blood test is likely to change how ED is managed (AUA ED Guideline, J Urol 2018). Put together, thyroid tests are a tool a clinician can reach for when your history or exam points that way, not a fixed part of every visit. The 2008 study authors argued for screening men with ED for thyroid problems, but that was the view of one research group, not a guideline recommendation (Krassas et al., 2008). Our guide to how ED is diagnosed walks through the rest of the evaluation.

What do thyroid blood tests measure?

Thyroid blood tests measure the hormone that tells the gland what to do, the hormones the gland makes and, in some cases, thyroid antibodies. NIDDK says the tests may include thyroid stimulating hormone (TSH), T4, T3 and thyroid antibody tests. TSH is usually checked first. It is made in the pituitary gland and tells the thyroid how much T4 and T3 to make. A high TSH level most often means an underactive thyroid, and a low TSH level usually means an overactive one. If the TSH result is not normal, NIDDK says you will need at least one other test to help find the cause (NIDDK, Thyroid Tests). Some situations change T4 levels without a thyroid problem, including severe illness and corticosteroid medicines, which is one reason many clinicians prefer to measure free T4 (NIDDK, Thyroid Tests). Results are something to go over with the clinician who ordered them.

Can high prolactin cause ED?

It can be part of the picture. NIDDK describes a prolactinoma as a benign, noncancerous tumor of the pituitary gland that produces a hormone called prolactin, and calls too much prolactin in the blood hyperprolactinemia. It lists erectile dysfunction, along with loss of interest in sex associated with low testosterone, among the common symptoms in men. It says the prolactin blood test, which measures the level of prolactin in the blood, is one of the tests doctors use to diagnose a prolactinoma (NIDDK, Prolactinoma). NIDDK’s list of the most common conditions that can lead to ED does not name prolactinoma or high prolactin, and a clinician decides whether the test fits your history.

Can cortisol problems (Cushing’s syndrome) affect erections?

They can. Cushing’s syndrome is a disorder in which the body has too much of the hormone cortisol for a long time. NIDDK says that in Cushing’s syndrome, “men may have decreased fertility with lowered interest in sex and may have erectile dysfunction.” It adds that the most common cause is long-term, high-dose use of cortisol-like medicines called glucocorticoids, used for conditions such as asthma, rheumatoid arthritis and lupus, and that some people instead make too much cortisol because of a tumor, most often in the pituitary gland (NIDDK, Cushing’s Syndrome).

Cushing’s syndrome is hard to diagnose, NIDDK says, because symptoms such as fatigue and weight gain have many causes. Doctors use urine, saliva or blood tests and usually do two of them, since no single test is perfect (same source). It is not on NIDDK’s list of the most common causes of ED, so it is a question for a clinician when other signs point that way, not a routine check. If you take steroid medicines for another condition, do not stop them on your own; NIDDK’s ED guidance says a clinician may change a dose or switch medicines instead (NIDDK, Treatment for ED).

Can anabolic steroids affect erections?

Yes. Anabolic steroids are synthetic substances similar to testosterone, and taking them without a prescription can disrupt the body’s own hormone signals. The National Institute on Drug Abuse (NIDA) lists decreased sperm production and shrinking of the testicles among the hormonal effects in men, and names sexual dysfunction among the problems people with a steroid use disorder can face (NIDA, Anabolic Steroids). NIDA also reports that steroid users are more likely than non-users to take other substances, including medicines for erectile dysfunction (same source). Our guide to anabolic steroids and ED covers what happens to erections during use and after stopping. If you have used steroids, telling the clinician is one of the most useful things you can do, because it changes how hormone test results are read.

Can hormone medicines cause ED?

Some can. NIDDK lists “chemotherapy and hormone medicines” among the many common prescription and over-the-counter medicines that can have ED as a side effect, alongside antidepressants, blood pressure medicines and others (NIDDK, Symptoms & Causes of ED). NIDDK is also clear that you should not stop any medicine on your own. A clinician may suggest a different dose or a switch to another medicine instead (NIDDK, Treatment for ED). Our guide to medications that affect erections covers the wider list and how to raise it.

Is low sex drive a sign of a hormone problem?

It can be one sign, but not proof. The AUA guideline cites a large European study in which weak morning erections, low sexual desire and ED were each linked to lower testosterone levels, with more sexual symptoms reported the lower the level went (AUA ED Guideline, Statement 4). The European Association of Urology (EAU) guideline says men with ED should always be screened for symptoms of possible low testosterone, including decreased libido and energy, and fatigue (EAU Guidelines, Management of ED). NIDDK also lists loss of interest in sex among the common symptoms of a prolactinoma in men (NIDDK, Prolactinoma). Low desire has many other causes too, from mood and stress to relationship strain and medicines. Our guide to low libido in men covers the full list.

Why is testosterone tested in the morning?

Because testosterone levels move through the day. The AUA guideline explains that late-afternoon levels can be about 20% lower than morning values in young men, so samples should ideally be taken in the morning. It says at least two morning measurements are needed before diagnosing testosterone deficiency, that testosterone should not be measured during an acute illness, and that chronic illness and some medicines, such as opioids, can also change the result (AUA ED Guideline, Statement 4). That is why a single number from a random time of day, or from an at-home kit, is a starting point for a conversation rather than an answer. Our guide to erectile dysfunction tests covers what each blood test can and cannot show.

Does treating a hormone problem help ED?

Sometimes, and the research is clearest for thyroid disease and testosterone. In the 2008 thyroid study above, erectile function scores rose significantly a year after the men started treatment for their thyroid condition (Krassas et al., 2008), though that was one small study without a separate untreated group. For testosterone, the AUA guideline says men with ED and testosterone deficiency who are considering an ED pill “should be informed that PDE5i may be more effective if combined with testosterone therapy” (AUA ED Guideline, Statement 12). NIDDK likewise says clinicians may prescribe testosterone together with an ED pill for men who have both ED and low testosterone (NIDDK, Treatment for ED). Whether any treatment fits your situation is a decision for a licensed clinician who has your results in front of them.

Does having a thyroid problem mean it caused my ED?

No, not on its own. A thyroid problem and ED can show up in the same man for separate reasons, and ED has many possible causes, from blood vessels and nerves to medicines, stress and lifestyle (NIDDK, Symptoms & Causes of ED). The studies on this page describe how often thyroid disease and ED occur together. They do not show which one, if either, is driving things in a particular person. NIDDK’s approach is that health care professionals treat the underlying cause of ED when possible (NIDDK, Treatment for ED), and finding that cause is the job of an evaluation that looks wider than one hormone. The same is true of testosterone: our guide to ED and low testosterone explains why a low reading does not automatically mean it is the reason for ED.

What should I ask a clinician about hormones and ED?

Bring the full picture, then ask what it points to. NIDDK says a clinician will take a medical, sexual and mental health history and may ask about prescribed and over-the-counter medicines, vitamins and supplements (NIDDK, Diagnosis of ED). Useful things to raise:

• Any known thyroid condition, thyroid treatment, or family history of thyroid disease.
• Other changes you have noticed, such as in energy, weight, heart rate, sleep, mood or interest in sex.
• Every medicine and supplement you take, including any hormone medicines.
• Whether your history makes thyroid, testosterone or prolactin tests worth doing, and what the results would change.

If you are unsure whether it is time to book that visit, our guide on when to see a doctor about ED sets out what the first appointment usually involves, and talking to a doctor about ED helps you find the words.

The bottom line

Testosterone is not the only hormone linked to ED. The NIH names thyroid imbalance next to low testosterone among the hormone issues that can lead to it, lists hormone medicines among the medicines that can cause it, and counts ED among the common symptoms of a prolactin-producing pituitary tumor and of Cushing’s syndrome in men. A handful of studies have found ED more often in men with an overactive or underactive thyroid, though they cannot say what is happening for any one man. A clinician looking for the cause of ED may order thyroid tests, and deciding which tests fit your history is part of a full evaluation.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024): hormone issues, such as low testosterone and thyroid imbalance, among the most common conditions that can lead to ED; chemotherapy and hormone medicines among medicines that can cause ED.
• NIH NIDDK, Diagnosis of Erectile Dysfunction (last reviewed October 2024): history, medicine review, physical exam checks for hormonal problems, and blood tests including thyroid tests and prostate tests.
• NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024): treating the underlying cause when possible, not stopping medicines on your own, and testosterone with PDE5 inhibitors for men with ED and low testosterone.
• NIH NIDDK, Thyroid Tests (last reviewed May 2017): what the thyroid is, the TSH, T4, T3 and antibody tests, and how TSH results are read.
• NIH NIDDK, Hypothyroidism (last reviewed March 2021): definition, how common it is, who is more likely to have it, and its symptoms.
• NIH NIDDK, Hyperthyroidism (last reviewed August 2021): definition, how common it is, who is more likely to have it, and its symptoms.
• NIH NIDDK, Prolactinoma (last reviewed September 2019): what prolactin and a prolactinoma are, common symptoms in men including ED and loss of interest in sex, and the prolactin blood test.
• NIH NIDDK, Cushing’s Syndrome (last reviewed May 2018): lowered interest in sex and ED in men; glucocorticoid medicines as the most common cause; pituitary and other tumors; urine, saliva and blood tests, usually two.
• NIDA, Anabolic Steroids and Other Appearance and Performance Enhancing Drugs: hormonal effects in men, sexual dysfunction in steroid use disorder, and use of ED medicines among steroid users.
• European Association of Urology, Guidelines on Sexual and Reproductive Health: Management of ED: screening men with ED for symptoms of low testosterone, including decreased libido and energy, and fatigue.
• Krassas GE, et al. Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? (J Clin Endocrinol Metab, 2008): 71 men with thyroid disease and a similar number of controls; SHIM scores of 21 or less in 78.9% versus 33.8%; scores rose significantly a year after thyroid treatment; the authors’ screening view.
• Liu X, et al. High prevalence of erectile dysfunction in men with hyperthyroidism: a meta-analysis (BMC Endocr Disord, 2024): four observational studies, including Krassas 2008, with 25,519 people (6,429 with hyperthyroidism); pooled odds ratio of 1.73 for ED; the authors’ stated limits.
• American Urological Association, Erectile Dysfunction Guideline (Burnett et al., J Urol 2018): Statement 1 on history, exam and selective laboratory testing; Statement 4 on morning total testosterone, the European study linking sexual symptoms to testosterone level, morning sampling, repeat measurement and acute illness; Statement 12 on testosterone therapy with PDE5 inhibitors; and the discussion that, apart from glucose or hemoglobin A1c and lipids, no routine serum study is likely to change ED management.