by Mary Shomon

According to a Journal of the American Medical Association (JAMA) study released in February, 1999, about 43 percent of women and 31 percent of men suffer sexual inadequacy for one reason or another. The reasons cited included low desire, performance anxiety, premature ejaculation and/or pain during intercourse. Interestingly, this is thought to actually underestimate the real level of sexual dysfunction in the U.S.

While the study didn't look at the specific physical causes of sexual dysfunction, the research indicated that many of the sexual concerns were likely treatable, as they are due to physical and health issues. These health concerns can include common hormonal imbalances such as hypothyroidism.

How many people with sexual dysfunction may actually have underlying thyroid disease that has not been diagnosed? It's not a question that has been thoroughly researched, but it's certain that some of the people having a problem could solve their sexual dysfunction problem in the first place by having their thyroid function evaluated and treated.

How many people with low sex drive or sexual dysfunction also diagnosed as being hypothyroid? Again, there are no specific statistics, but low libido is a common -- but not often talked about -- symptom of hypothyroidism. It is also a symptom that for everyone, unfortunately, does NOT disappear, despite what doctors deem adequate treatment with levothyroxine into the normal range. Many people -- women in particular -- still complain of a lack of sexual desire even after their doctors consider the thyroid problem sufficiently treated. Low libido is just one of many symptoms that are not resolved for many people, despite treatment.

If you suffer from sexual dysfunction, first, you need to be sure that your thyroid is being fully treated. This means:

1. Make Sure Your Thyroid Drug Treatment is Optimal

Some people do not find their symptoms -- including sexual dysfunction -- resolved in a levothyroxine/T4 only drug like Synthroid. Some people find that their libido returns when their doctors switch them to a drug that contains T3, like Thyrolar, or a natural thyroid drug like Armour that includes natural forms of T4 and T3. Others do well with the addition of Cytomel (synthetic T3) or time released T3 to levothyroxine

The use of T3 is controversial, but some patients and practitioners have found that various symptoms are relieved by adding the thyroid hormone T3 into the typical T4-only (i.e., Synthroid) treatment approach. Others prefer the T4/T3 combination drugs, like the synthetic Thyrolar, or the natural desiccated thyroid drug Armour. Research published in the February 11, 1999, issue of the New England Journal of Medicine , however, reported on a study that showed that many patients feel better on a combination of T4 and T3, not T4 (i.e., Synthroid) alone. The addition of T3 helped relieve depression, brain fog, fatigue and other symptoms. This information about T3 was groundbreaking and has major implications for people who don't feel well on their current thyroid therapies!!! For more info, see my in-depth analysis of this study.

2. Make Sure Your TSH Level is the Best For Your Health

Many thyroid patients report feeling best at TSH levels of 1 - 2. Unfortunately, many thyroid patients are maintained at TSH levels above a 3.0, and continue to suffer a variety of symptoms. The American Association of Clinical Endocrinologists announced in 2003 that the new recommended normal range is .3 to 3.0 (a change from the range of .5 to 5.0). (NOTE: this TSH is usually kept even lower than 1-2 for thyroid cancer survivors to help prevent recurrence.) There are ongoing debates over the right TSH normal range, and many patients whose TSH falls in the limbo of 3.0 to 5.5 are still being told that their thyroid is normal. Make sure that your thyroid is being properly diagnosed and treated according to the latest standards.

3. Check Your Hormones Men should have testosterone, DHEA and other androgen levels checked whenever there is any reduction in sex drive. Women should have a full hormonal profile evaluated, including estrogen levels, testosterone, and progesterone, plus DHEA. In women, adrenal function should also be checked, particularly if the testosterone levels turn out to be low. 4. Have a Thorough Physical Low sex drive may be a result of other non-thyroid health conditions. Diabetes and hypertension/high blood pressure can cause low sex drive in both women and men. You should also ask your doctor to discuss the diagnosable symptoms of depression with you, so you can assess whether or not you are depressed. You should also discuss other prescription drugs you are taking, because some antidepressants, tranquilizers and antihypertensive -- as well as many illegal drugs such as cocaine and marijuana -- can reduce sex drive.

5. Get Testosterone Supplementation if Needed

For men, testosterone can be a tremendous aid in restoring lost libido. Testosterone is available as a pill form (some brands are Android, Virilon, Testred, Oreton), as a transdermal patch, (Testoderm, Androderm), by injection, and sometimes as transdermal pellets implanted under the skin. Some women can benefit from testosterone. Doctors frequently will provide testosterone in pill form to women, or as testosterone propionate cream.

6. For Women, Supplement Estrogen/Progesterone if Needed

Imbalances in estrogen and progesterone -- having either too much or too little -- can cause loss of libido, so it's important to evaluate these levels as well. If supplementation is needed, ask your doctor about estradiol gel or patches, and natural progesterone supplements, rather than conjugated estrogens.

Be careful, however, about soy-based supplements and food products that are supposed to act "like" estrogen to deal with menopausal symptoms. Many of these products contain levels of soy isoflavones that can worsen hypothyroidism in some women.

More information about hormone balancing for women, and the effects of thyroid disease on sexual function, is featured in the book The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age, published by HarperCollins in Nov. 2006.

7. Consider Supplements

There are a number of supplements that can help with sex drive. Check with your practitioner for guidance on how best to use these supplements.

Arginine An amino acid, for both men and women
Asian Ginseng (Panax) Asian ginseng -- also called panax -- can help increase sexual energy,
Avena-Sativa/Oat Extract This supplement (main brand is Vigorex), reportedly does help with sex drive
DHEA (dehydroepiandrosterone) DHEA is a precursor hormone that converts to testosterone by your body, can be useful for both women and men
Ginkgo Biloba Ginkgo biloba is an herb that can improves sexual function in men
Horny Goat Weed Used by Chinese herbalists to improve sexual functions in both men and women
Kava Kava Kava kava is an herb most known for use in relaxation but can also be useful as an aphrodisiac for women
Zinc Low levels of zinc have been associated with low sex drive in women and men
Maca Maca is a South American herbal remedy that can help women with libido and fertility.

Note: Always check with your practitioner about herbs and supplements.

8. Lose Weight

Losing weight is easier said than done, of course, but excess weight can affect self-image -- and make you feel less sexy and less interested in sex. And, medically, being overweight can reduce both fertility and libido.

Losing weight reduces levels of sex hormone binding globulin drops, which then leaves you with more free circulating estrogen and testosterone, to help with your sex drive balance.

For more help and advice on weight loss, read Mary Shomon's book, "The Thyroid Diet".

9. Exercise

Exercise improves blood flow to all body parts. Research has found that people who exercise regularly have higher levels of desire, greater sexual confidence and frequency, and an enhanced ability to be aroused and achieve orgasm--no matter what their age. The best type of exercise is aerobic exercise, because it can trigger the release of endorphins, chemicals in the brain that create a feeling of well-being.

10. Consider Therapy

When there are other psychological and self-esteem issues preventing healthy sexual desire, therapy can sometimes help.