Thyroid Disease in Men
June 1, 2019
While thyroid disease affects women as much as eight times more frequently than men, men of all ages are not immune to thyroid problems and are among the estimated 30 million-plus Americans with a thyroid condition.
Let’s take a look at thyroid disease in men, and how men — and the women who care about them — can tackle issues with the master gland of metabolism.
Hypothyroidism in men
The most common thyroid condition in men is hypothyroidism, an underactive thyroid. While there are many causes of hypothyroidism, the most common cause in the United States is the autoimmune condition known as Hashimoto’s thyroiditis.
Many symptoms of hypothyroidism in men are the same as women’s symptoms, including:
- Dry skin
- Weight gain
- Difficulty losing weight, despite diet and exercise
- Feeling cold all the time
- Cold intolerance
- Low or reduced sex drive
- Fertility problems
- Brain fog
- Concentration problems
- Elevated cholesterol levels
- Sleep disturbances
- Muscle and joint pain or weakness
- Neck discomfort, discomfort wearing ties, turtlenecks, and scarves
- Swelling of the thyroid gland
- Hoarse voice
One common symptom that gets men’s attention fast is hair loss and premature balding. Dave started worrying about his hair at age 25.
“I was totally too young to go bald! My friends were giving me a hard time and making Hair Club for Men jokes. But watching my hairline recede — fast — lit a fire under me, big time. Turned out I had Hashimoto’s; my thyroid was low. My doctor put me on Armour. It took about a year, but eventually, my hair got back to normal.”
Research shows that hypothyroidism in men is associated with decreased testosterone, as well as a reduction in sex hormone binding globulin (SHBG). SHBG helps carry testosterone through the body, so it makes less testosterone available through the body. These hormonal changes give rise to some symptoms unique to men.
Muscle issues: Low testosterone makes it harder to build muscle and can promote muscle loss. Men with hypothyroidism and resulting low testosterone may notice a loss of muscle strength, difficulty building muscle in the gym, and a tendency to become flabbier in general.
Sexual dysfunction: Hypothyroidism — and the resulting low testosterone and low SHBG — also affects sexual function. Specifically, men may experience:
- Difficulty getting an erection
- Difficulty maintaining an erection
- Delayed ejaculation (needing 30 minutes or more to ejaculate)
Low sex drive and erectile dysfunction are, in fact, estimated to affect more than half of men with undiagnosed/untreated hypothyroidism, according to a study published in the Journal of Clinical Endocrinology and Metabolism.
Tomas reports that sexual issues in his mid-50s brought him to the doctor.
“My wife and I never had any problems in the bedroom. But when I started having issues, my wife said maybe it was a testosterone problem, or I figured that maybe I was at the age where I needed some Viagra. It turned out that my testosterone was sort of low, but I have a good doctor, and he also checked my thyroid, which was good because I was really hypothyroid. Once I started treatment, the testosterone went back to normal after a few months. And no Viagra needed!”
Fertility problems: Men with hypothyroidism have a higher rate of abnormal sperm and reduced sperm motility. Says Cathy:
“My husband Ed and I tried for a long time to have a baby and were already starting the whole fertility treatment runaround. They said that Ed had ‘slow sperm’ but the fertility doctor didn’t really say why. Totally by accident, it was around that time that Ed was diagnosed with hypothyroidism by our family doctor. After he started the meds, it was only a few months before I got pregnant with our son. We never did have to get any fertility treatment.”
Decision-making confidence: Finally, one symptom — due to both hypothyroidism and low testosterone — that troubles some men is a difficulty making decisions. Robert, who was diagnosed with hypothyroidism at age 44, explains:
“The year before I got diagnosed I wasn’t myself. I could not for the life of me think through what to do next. Every decision felt really stressful. It was not like me at all. I would turn things over in my mind endlessly, had a hard time sleeping, and it took forever to figure out what to do. I was a mess, especially at my job.”
Diagnosing hypothyroidism is the same in men as in women. In addition to a detailed medical history and clinical examination, blood tests for thyroid stimulating hormone (TSH), free thyroxine (Free T4), free triiodothyronine (Free T3), and thyroid peroxidase (TPO) antibodies can detect an underactive thyroid. If hypothyroidism is detected, men should also have testosterone and SHBG tested.
Men, however, may find it a challenge to get a doctor to test for thyroid disease. The broad nature of these thyroid symptoms, combined with the lower incidence in men, makes thyroid disease far less likely to be properly diagnosed. Doctors are often more likely to misdiagnose a man’s fatigue, brain fog, hair loss, weight gain, or low sex drive as depression or low testosterone (“low T”) — or write it all off to stress, aging, or lack of exercise — rather than conduct the thorough evaluation needed to make a thyroid diagnosis.
“I kept telling my boyfriend to get his thyroid checked. I’m hypothyroid and on Synthroid, and he had the exact same symptoms as me — tired all the time, gaining weight, and feeling ‘blah.’ When he finally went in and asked for a test, the doctor told him that guys hardly ever get thyroid problems, and that he needed more exercise. What’s up with that?! I got him to see my doctor, and sure enough, he was hypo and had a TSH of 20 — higher than mine was when I was diagnosed!"
Treatment for hypothyroidism is also the same in men as in women and includes:
- Levothyroxine (synthetic T4) such as Synthroid, Levoxyl, or Tirosint
- Triiodothyronine (synthetic T3) such as Cytomel
- Natural desiccated thyroid (NDT) drugs such as Nature-throid, Thyroid WP, or Armour Thyroid
Like women, men need to advocate for themselves to not only be treated but to get optimal treatment to safely resolve symptoms.
The good news: Treatment may not fully resolve every hypothyroidism symptom, but research shows that the majority of men have a resolution of thyroid-related sexual and fertility problems after several months of thyroid treatment.
Hyperthyroidism in men
The causes of hyperthyroidism — an overactive thyroid — in men are the same as in women, and primarily include autoimmune Graves’ disease and certain medications.
Hyperthyroidism in men has many of the same symptoms as in women, including:
- Muscle weakness
- Heart palpitations, high heart rate
- Tremors in the hands
- Hair loss
- Weight loss (and in some cases, weight gain)
- Increased appetite
- Heat intolerance
- Loose stools, diarrhea
- Reduced fertility
- Neck discomfort, discomfort wearing scarves, neckties, and turtlenecks
- Swelling of the thyroid gland
- Feeling hot, excessive sweating
In men, there are also some other specific symptoms of an overactive thyroid, including:
- Increased testosterone levels, which can in some cases increase sex drive
- Difficulty getting or maintaining an erection
- Premature ejaculation
Scott experienced one of the less common symptoms of hyperthyroidism unique to men: gynecomastia, an enlargement of the breasts.
“I wasn’t at all fat, but I noticed I had this weird swelling in my chest. My girlfriend finally said that I was getting ‘man boobs!’ That got me to the doctor, and as part of the testing, they picked up the hyperthyroidism.”
Diagnosis of hyperthyroidism in men is done with TSH, Free T4, Free T3, and thyroid stimulating immunoglobulin (TSI) testing. In some cases, a radioactive iodine uptake (RAI-U) test is done to evaluate the thyroid function.
Treatments for hyperthyroidism in men are the same as in women, and include:
- Antithyroid drugs
- Radioactive iodine (RAI)
Research shows that most men have full resolution of hyperthyroidism-triggered sexual and fertility problems after several months of proper treatment.
As with any hyperthyroidism treatment, however, RAI and surgery do usually result in hypothyroidism along with the lifelong need for thyroid hormone replacement.
Radioactive iodine therapy for thyroid cancer
A special note for men who have higher doses of RAI as part of thyroid cancer treatment: RAI can affect sperm quality for up to two years after treatment. Some experts recommend that you wait to father a child for at least 18 months after your RAI treatment for thyroid cancer.