Everything You Need To Know About Hypothyroidism in Men
- Hypothyroidism (having an underactive thyroid gland) can affect your metabolism, mental capacity, energy levels, and bowel movements.
- There's no way of preventing an underactive thyroid. Most cases are caused either by the immune system attacking the thyroid gland and damaging it, or by damage to the thyroid that occurs during some treatments for an overactive thyroid or thyroid cancer.
- Hashimoto's disease is a common cause of hypothyroidism. When someone has Hashimoto's disease, their immune system attacks the thyroid, which then can't produce enough hormones.
- Thyroid disorders usually require long-term or lifelong treatment, but once the correct dose has been established you will feel fine. You’ll need ongoing monitoring to make sure the dose is still right.
Hypothyroidism is a condition in which the thyroid gland does not release enough thyroid hormone into your bloodstream, slowing your metabolism down. Also referred to as an underactive thyroid gland, hypothyroidism can make you feel tired and moody, and make you gain weight.
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Studies show that hypothyroidism affects between 3% to 16% of men in the U.S., and the risk increases with age.
Men are three times more likely than women to develop a thyroid disorder — specifically, underactive thyroids. Over 99% of affected patients suffer from primary hypothyroidism.
Key Point: What is Secondary Hypothyroidism?
- Secondary hypothyroidism is a condition in which the pituitary gland is underactive.
- The pituitary gland secretes a hormone that stimulates the thyroid gland, but sometimes the pituitary gland doesn’t function properly.
- The pituitary gland produces and secretes hormones like prolactin, growth hormone, and thyroid-stimulating hormone (TSH). TSH stimulates your thyroid to work correctly.
- In secondary hypothyroidism, your pituitary gland does not release enough TSH to stimulate the thyroid to produce thyroid hormones.
- This TSH shortage leads to adverse symptoms similar to primary hypothyroidism, but treatment for this condition is very different.
- The incidence of secondary hypothyroidism is very low.
What is Hypothyroidism?
Hypothyroidism occurs when the thyroid gland — which is in the neck — does not produce enough thyroid hormone to meet the body’s requirements. This can result in heart disease, infertility, and poor brain development in children.
People with hypothyroidism may notice changes in body weight, and they may feel tired, weak, or depressed — all of which can reduce their quality of life.
Globally, an iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism. In areas where there is sufficient iodine, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure.
Hashimoto’s is an autoimmune disease in which the person’s immune system produces cells and antibodies that attack the thyroid gland. In underdeveloped parts of the world, the primary cause of hypothyroidism is people not getting enough iodine from food. Many countries counteract this deficiency by adding iodine to salt.
Key Point: What is the Thyroid Gland?
The thyroid gland is a butterfly-shaped gland in the neck, just in front of the windpipe (trachea).
One of its main functions is to produce hormones that regulate the body's metabolism (the process that turns food into energy). These hormones are called triiodothyronine (T3) and thyroxine (T4).
Many of the body's functions slow down when the thyroid does not produce enough of these hormones.
Thyroid hormones regulate the following vital bodily functions:
- Heart rate
- Central and peripheral nervous systems
- Body weight
- Muscle strength
- Body temperature
- Cholesterol levels
It’s important that T3 and T4 levels are neither too high nor too low. Two glands in the brain — the hypothalamus and the pituitary — communicate to maintain a balance between T3 and T4.
The hypothalamus produces TSH releasing hormone (TRH) that signals the pituitary to tell the thyroid gland to produce more or less of T3 and T4 by either increasing or decreasing the release of a hormone called thyroid stimulating hormone (TSH).
When T3 and T4 levels are low in the blood, the pituitary gland releases more TSH to tell the thyroid gland to produce more thyroid hormones. If T3 and T4 levels are high, the pituitary gland releases less TSH to the thyroid gland to slow the production of these hormones.
Causes of Hypothyroidism
The causes of hypothyroidism include:
- Certain medications, such as lithium and amiodarone
- Radiation or surgery to the thyroid or other areas of the neck
- An iodine deficiency
- Cancer, such as thyroid cancer
The type of autoimmune reaction related to Hashimoto's disease is the most common cause of an underactive thyroid in those with the disease.
The cause of Hashimoto’s disease is not proven, but it runs in families. It's also common in people with other immune system conditions, such as vitiligo or type 1 diabetes.
Previous thyroid treatment
An underactive thyroid can also occur as a side effect of previous treatment to the thyroid gland, such as surgery or a treatment called radioactive iodine therapy.
These treatments are sometimes used for an overactive thyroid (where the thyroid gland produces too much hormone), or thyroid cancer.
The pituitary gland
If the pituitary gland is not functioning well, it could lead to an underactive thyroid. The pituitary gland is situated at the base of the brain, and one of its functions is to regulate the thyroid. Damage to the pituitary gland may lead to an underactive thyroid.
It's important to have an underactive thyroid diagnosed as soon as possible. If you are taking medication that you suspect may be affecting your thyroid hormone levels, be sure to speak to a healthcare provider.
Hypothyroidism symptoms are the same for men and women, and the condition is diagnosed by a blood test that measures how well the thyroid is working.
In the U.S., the main cause of hypothyroidism is called Hashimoto’s thyroiditis: an autoimmune disease.
If you have this condition, your immune system manufactures cells that attack your thyroid gland, which stops it from functioning properly. Like most autoimmune diseases, Hashimoto’s is more common in women — which accounts for the higher incidence of hypothyroidism in women.
Symptoms usually develop slowly, and you may not realize you have a medical problem for several years.
Although men and women experience many of the same general symptoms, there are some less obvious ones — like low testosterone and premature ejaculation — that may point toward men having the condition.
Sexual or erectile dysfunction is a term that refers to any problem that affects your enjoyment of or desire for sex. In men, low thyroid levels can cause different types of sexual dysfunction.
Some studies report that over 60% of men with hypothyroidism have low sexual desire (libido), erectile dysfunction, or delayed ejaculation.
Premature ejaculation — a much less common side effect — only affects about 7% of men with the condition. Hypothyroidism can also lower a man’s fertility levels.
This is because it may have an effect on the quality of semen and is associated with a lower sperm count. It is also known to have an impact on the form and the movement of sperm.
While these symptoms may be distressing, it’s important to note that they are often reversible with treatment.
Up to 50% of people with hypothyroidism experience some type of hair loss, ranging from partial to very extensive. Each individual hair follicle has a specific cycle with both growth and rest phases. Hypothyroidism impacts this cycle negatively, resulting in hair loss.
Other changes to hair may also be noticeable with hypothyroidism. Your hair may become brittle, dry, or coarse, and it may take longer to grow.
The sex hormone testosterone plays a vital role in men’s health, impacting bone and muscle growth, sex drive, and sexual reproduction.
Hypothyroidism can result in lower levels of testosterone in the blood. In addition, hypothyroidism has been associated with lower levels of globulin (a sex hormone binding protein) that carries testosterone throughout the body.
Both of these effects can contribute to symptoms of low testosterone in men.
Muscle weakness and cramps
Hypothyroidism can affect muscles and cause weakness and cramps.
Some studies show that about 20% of people with hypothyroidism experience weak muscles, and almost 35% have muscle cramps.
Muscle weakness brought on by hypothyroidism typically affects the muscles in the upper arms and legs. This makes it difficult to perform actions such as brushing or combing your hair or getting yourself out of a chair.
Very rarely, hypothyroidism can result in Hoffman's syndrome — a severe muscle problem that causes muscles to become very large.
Other common symptoms of hypothyroidism in men include:
- Fatigue: Low thyroid levels can slow down your metabolism and decrease your energy levels. About 40% of people with hypothyroidism report feeling more tired than usual.
- Depression: As many as 70% of people with hyperthyroidism experience depression. Other mental health issues associated with the condition are trouble concentrating, anxiety, and decreased memory.
- Constipation: Hypothyroidism can also slow down the movement of your gut. About 17% of people with low thyroid levels report constipation.
- Feeling cold: A lower metabolism may result in a heightened sensitivity to the cold. As many as half of the people with hypothyroidism report feeling the cold more keenly.
- Weight gain: Since hypothyroidism affects the metabolism, it may lead to weight gain. Approximately half of the people who have hypothyroidism notice an increase in weight but, fortunately, this is usually only between 5 to 10 pounds.
- Dry skin: Dry skin is another common symptom of hypothyroidism, affecting more than 70% of people with the condition.
Additional symptoms may include:
- Puffy face
- Elevated blood cholesterol level
- Pain, stiffness, or swelling in your joints
- Slowed heart rate
- Enlarged thyroid gland (goiter)
Treatment of Hypothyroidism
The symptoms of hypothyroidism range from mild to severe, and if left untreated, this condition can negatively impact the quality of your life. Treating hypothyroidism not only improves your symptoms, but it also lowers the risk of ongoing future problems.
Diagnosing hypothyroidism is based on symptoms and a thyroid function test, where a sample of blood is tested to measure your hormone levels.
The main treatment for hypothyroidism is a thyroid-replacement tablet that contains levothyroxine (Synthroid, Levoxyl). Levothyroxine is a chemically-produced thyroid hormone, which works exactly like the hormones in your body.
It is taken daily and, typically, the dose is adjusted based on your symptoms and blood test results. Once you’ve started taking the medication, your healthcare provider will continue to monitor your blood levels.
Most people who take levothyroxine will need to be on it for a lengthy period, perhaps even for the remainder of their lives. But, with properly managed treatment, patients will be able to lead a normal, healthy life.
Treatment with synthetic thyroid hormone is usually simple, safe, and effective once you and your doctor have found the correct dose for you.
To start this process, you’ll have regular blood tests until the correct dose of levothyroxine is determined. It can take a little while to get this right.
You may start on a low dose of levothyroxine, which may be increased gradually, depending on how your body responds. Some people start to feel better soon after beginning treatment, while others do not notice an improvement in their symptoms for several months.
Once the correct dose has been found, you'll usually have an annual blood test to monitor your hormone levels.
If blood tests indicate that you may have an underactive thyroid — but your symptoms are mild or nonexistent — you may not need further treatment at that time. Your healthcare provider may continue to monitor your hormone levels every few months and prescribe levothyroxine if you develop symptoms.
Key Point: What is the Difference between Hypothyroidism and Hyperthyroidism?
There are two types of thyroid dysfunction — hypothyroidism and hyperthyroidism:
- Hypothyroidism, as already mentioned, occurs when you have an underactive thyroid.
- Hyperthyroidism is when your thyroid is overactive.
Treatment options include:
- Hypothyroidism — for an underactive thyroid, treatment includes taking thyroid hormone replacement medication to regulate your hormone levels.
- Hyperthyroidism — when you have an overactive thyroid, treatment usually begins with medication that limits thyroid function. This can be temporary or lifelong, depending on how your body adjusts to the medication.
When to See a Doctor
See your doctor if you're feeling tired for no reason or have any of the other signs or symptoms of hypothyroidism — such as dry skin, a pale, puffy face, constipation, or a hoarse voice.
If you’ve been taking medication to replace your thyroid hormone for an extended period of time but your symptoms persist, it may be a good idea to see a thyroidologist or an endocrinologist for a second opinion.
Some people with hypothyroidism have a more difficult time finding the dose or type of thyroid hormone medication that works best for them. In this situation, a specialist in thyroid or endocrine disorders — as mentioned above — may be able to help.
If you're taking hormone therapy for hypothyroidism, it’s important to schedule follow-up visits as often as your doctor recommends. Remember: over time, your dose may change.
Where Can I Learn More About Hypothyroidism and Other Health Issues?
If you or someone you love is experiencing the symptoms discussed in this article, LifeMD can help. Board-certified doctors and nurse practitioners can talk to you from the comfort of your home. Head over to LifeMD to make a video appointment.