Endocrine Disorders and Sexuality I: Hypothalamus-Pituitary Axes and Peripheral Thyroid and Adrenal Glands

Sexual function requires, among others, intact hypothalamic-pituitary axes. Gonadotropic axis is the most studied in relation to sexual function, and several conditions such as obesity, eating disorders, extreme sports, or severe stress can lead to hypogonadotropic hypogonadism and sexual dysfunction and infertility. Gonadal replacement therapy improves erectile function, sexual desire, orgasm, and satisfaction. Precocious or delayed onset of puberty induces various alterations in fertility and sexual behavior. In relation to the somatotropic axis, both oversecretion of growth hormone (GH) (acromegaly) and GH deficiency are inducing a high prevalence of sexual dysfunctions in both sexes. Hyperprolactinemia is a known cause of central hypogonadism and sexual dysfunction, while decreased prolactin levels (mainly due to dopamine agonists) have been shown to improve sexual function. Hypothyroidism induces ejaculatory dysfunction, hypoactive sexual desire disorder, and alterations in fertility in men and impaired results in libido, orgasm, and dyspareunia in women. Hyperthyroidism has specially been associated with ejaculatory dysfunction; however, in women, there are no concluding results. Corticotropin (ACTH) tumoral oversecretion (Cushing disease) and hypercortisolism affect sexuality directly and through its inhibitory effect on the gonadal, somatotroph, and thyrotrope axes. Adrenal disorders can induce sexual alterations due to the overproduction of androgens, mainly in congenital adrenal hyperplasia and adrenal carcinoma, glucocorticoids (Cushing syndrome), mineralocorticoids (primary hyperaldosteronism), and catecholamines (pheochromocytoma and paraganglioma) in both sexes. Contrarily, primary adrenal insufficiency is associated with sexual dysfunction and decrease in fertility mostly in women.