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Kidney transplantation constitutes a pivotal intervention for patients experiencing end-stage renal disease (ESRD), offering significant enhancements in quality of life and longevity relative to dialysis. However, the residual prevalence of erectile dysfunction (ED) in male recipients, affecting approximately 20-50%, signals a pressing concern in post-transplant health management. This review investigates the intricate interplay between hormonal fluctuations, specifically testosterone and thyroid hormones, and the psychosocial dynamics encompassing anxiety, depression, and overall quality of life in this demographic. It explores the multifaceted etiologies of ED, encompassing neurovascular, hormonal, and psychological dimensions that converge post-transplant. Further, the review critically examines current therapeutic strategies, emphasizing an integrated, multidisciplinary approach that simultaneously addresses hormonal disruptions, psychosocial factors, and metabolic disturbances. The primary objective is to bridge the existing knowledge gap regarding the pre- and post-transplant experiences of ED among male patients, thereby informing clinical practices aimed at optimizing sexual health outcomes and enhancing the overall well-being of kidney transplant recipients. Through rigorous evaluation of contemporary studies, this work underscores the necessity for comprehensive interventions that prioritize both physiological and psychological health in addressing ED within this vulnerable population.