Iron Deficiency Can Cause Low Libido
Yes, iron deficiency can cause low libido or hypoactive sexual desire disorder (HSDD) in both men and women. Iron deficiency affects several physiological pathways that directly impact sexual function and desire.
Mechanisms Linking Iron Deficiency to Low Libido
- Iron deficiency can worsen hypometabolic states by impairing thyroid hormone synthesis (T4) and hepatic conversion of T4 to the active metabolite T3, leading to reduced energy and libido 1
- Iron deficiency promotes energy deficiency by shifting ATP production from efficient oxidative phosphorylation to less efficient anaerobic pathways, reducing overall energy available for normal physiological functions including sexual desire 1
- Iron deficiency suppresses osteotrophic hormones including growth hormone and IGF-1, which can affect overall hormonal balance related to sexual function 1
- Iron deficiency affects the hypothalamic-pituitary-thyroid axis, which plays a crucial role in regulating sexual desire 1
Clinical Evidence in Men
- Loss of libido and impotence are recognized clinical features in men with hemochromatosis (which involves iron metabolism dysregulation), appearing in 12-56% of patients across different studies 1
- In men with diabetes who have symptoms of decreased sexual desire or erectile dysfunction, guidelines recommend screening with morning testosterone levels, as low testosterone often coexists with metabolic disorders including iron deficiency 1
- Hypoactive sexual desire in men can be primary or secondary, with secondary causes including conditions that affect metabolism and energy production like iron deficiency 2
Clinical Evidence in Women
- Recent research has established a direct relationship between iron deficiency anemia (IDA) and sexual dysfunction in women 3
- Treatment with oral iron supplementation has been shown to improve sexual function in women with iron deficiency anemia 3
- Iron deficiency without anemia, which affects 24-47% of women at baseline, can still impact sexual function through metabolic and hormonal pathways 1
Diagnostic Considerations
- When evaluating patients with low libido, consider screening for iron deficiency with serum ferritin levels and transferrin saturation 1
- In men with diabetes presenting with decreased sexual desire, guidelines recommend checking morning testosterone levels, but iron studies should also be considered 1
- Testing for iron deficiency is an inexpensive and simple step that can be included in the workup of both men and women with sexual dysfunction 3
Treatment Approach
For patients with confirmed iron deficiency and low libido:
- Correct the underlying iron deficiency with appropriate supplementation 1, 3
- For women with iron deficiency anemia, aim for serum ferritin levels above 100 μg/L 1
- Consider intravenous iron if oral supplementation is not tolerated or ineffective 1
- Monitor for recurrence of iron deficiency every 3 months for at least a year after correction 1
For patients with persistent low libido despite iron correction:
Clinical Pitfalls and Caveats
- Iron deficiency may be overlooked as a cause of low libido because attention is often focused on more obvious causes like hormonal imbalances or psychological factors 6
- Serum ferritin can be falsely elevated in the presence of inflammation, potentially masking iron deficiency 1
- When treating iron deficiency, be aware that oral iron supplements can cause gastrointestinal side effects; consider prolonged-release formulations for better tolerability 3
- Low libido often has multifactorial causes; correcting iron deficiency may improve but not completely resolve symptoms if other factors are present 5, 6
In summary, iron deficiency should be considered as a potential contributing factor in patients presenting with low libido or HSDD. Screening for and treating iron deficiency may significantly improve sexual desire and function in affected individuals.