10 Symptoms of Thyroid Problems in Men

Symptoms of thyroid issues in men may be overlooked since males aren't affected as often as females. Erectile dysfunction (ED) and male breast enlargement, for example, are associated with thyroid dysfunction but otherwise uncommon in males under 40 without an underlying cause.

Hypothyroidism (low thyroid function) is eight or nine times more common in females than males, but fatigue, muscle pain, and related symptoms affect both. Graves' disease, a cause of hyperthyroidism (overactive thyroid), also occurs more often in females. Thyroid issues in males often affect male reproductive health differently as well.

Symptoms

Thyroid disease in males, particularly younger males, can lead to any of these 10 thyroid symptoms:

• Sudden increases in hair loss
• Low libido (reduced sex drive)
• Decreased muscle mass and strength
• Gynecomastia (male breast enlargement)
• Erectile dysfunction (inability to get or maintain an erection)
• Delayed ejaculation (difficulty reaching climax and ejaculating)
• Premature ejaculation (climaxing early due to hypersensitivity)
• Testicular atrophy (shrinking testicles)
• Infertility (due to low sperm count or quality)
• Hip and spine fractures (most commonly in older males with hyperthyroidism)

A 2018 study found 59% to 63% of males with hypothyroidism experienced low libido, erectile dysfunction, and delayed ejaculation. With hyperthyroidism, 48% to 77% had low libido, erectile dysfunction, and premature ejaculation.

Thyroid Function and Hormones

With thyroid disease, the change in thyroid hormone levels can affect other hormones, including sex hormones like testosterone and estrogen.

The thyroid has direct effects on the testes and the corpora cavernosa of the penis, but it also plays a role in regulating sex hormone-binding globulin (SHBG), a protein produced by the liver that controls the amount of sex hormones at work in the blood.

Both hyperthyroidism and hypothyroidism can affect SHBG and testosterone in different ways:

• With hyperthyroidism, SHBG levels increase. When this happens, free testosterone levels drop, resulting in hypogonadism (low testosterone).
• With hypothyroidism, SHBG levels are decreased. When SHBG levels are low, more testosterone remains chemically available to increase conversion of testosterone into estrogen. This leads to higher estrogen levels.

Both of these effects—having too little testosterone or too much estrogen—can have similar effects on the male body. Some studies suggest a genetic predisposition to hyperthyroidism in males with increased SHBG levels, but more study is needed to understand these relationships.

Hypothyroidism

Hashimoto's disease is the most common cause of hypothyroidism in the United States, though there are other causes, too. This autoimmune disorder runs in families and causes your immune system to attack and damage your thyroid gland.

About 3% of males between the ages of 18 and 24 are affected, increasing to 16% by the age of 75. Symptoms of hypothyroidism in both males and females include:

• Weight gain
• Coarse, dry skin
• Hair loss
• Fatigue
• Feeling cold
• Constipation
• Depression
• Anxiety
• Joint pain, stiffness, and muscle aches
• Memory problems
• Goiter (an irregular growth on the thyroid)

Hyperthyroidism

About 80% of the hyperthyroidism cases in the U.S. are due to Graves' disease. Other causes include thyroiditis (inflammation of the thyroid gland, often due to an infection), a thyroid or pituitary gland tumor, or taking too much thyroid medications for hypothyroidism.

Symptoms of hyperthyroidism in males and females include:

• Weight loss
• Feeling nervous or anxious
• Rapid heartbeat
• Heart palpitations
• Sweating
• Tremors and shakiness
• Increased appetite
• Difficulty sleeping
• Fatigue
• Muscle weakness
• Feeling hot
• Goiter

Diagnosis

If a healthcare provider suspects you have thyroid disease, they will review your medical history and symptoms, perform a physical exam, and order blood tests to check your thyroid hormone levels.

Imaging tests are commonly used to check for signs of thyroid disease, including goiter and thyroid hyperplasia (the general enlargement of the thyroid gland). Options include:

• Ultrasound: This non-invasive imaging test can visualize the structure of the thyroid gland and check for any abnormalities using reflected sound waves,
• Computed tomography (CT): This imaging technique composites multiple X-rays to create a 3D visualization of the thyroid gland.
• Magnetic resonance imaging (MRI): This technology creates images using powerful magnetic and radio waves and is especially good at imaging soft tissues like glands.
• Radioactive iodine uptake test: This test involves an iodine pill and a special camera that measures the amount of iodine taken up by the thyroid gland. (Iodine is essential to the production of thyroid hormones).

The diagnosis of thyroid disease is the same no matter a person's sex. It is sometimes overlooked in males since the disease is far less common and causes symptoms commonly associated with aging. Or, the effects are attributed to obesity, smoking, diabetes, or other health factors.

Thyroid Disease Healthcare Provider Discussion Guide

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Treatment

The treatment of thyroid issues in males will vary based on whether you have hypothyroidism or hyperthyroidism. The treatment tends to be the same for males and females, but the dosages can differ. These treatments include:

• Hypothyroidism: Hypothyroidism treatment typically relies on the synthetic hormone Synthroid (levothyroxine). An additional synthetic hormone called Cytomel (liothyronine) may be added to the treatment plan. Hormone replacement therapy is most often required for a lifetime. Another option is to take desiccated thyroid extract, a prescription medication that's made from dried pig thyroid glands.
• Hyperthyroidism: Treating hyperthyroidism usually begins with taking antithyroid medications like Tapazole (propylthiouracil and methimazole). You may need to take it long-term. Other treatment options include radioactive iodine ablation (which destroys thyroid tissues) and thyroidectomy, a surgery that removes part or all of your thyroid gland. Both of these treatments eventually result in hypothyroidism.
  

For many people, treatment of the underlying thyroid condition will resolve some of the symptoms of sexual dysfunction or hair loss that occur in males. This can take time, however.

Gynecomastia, for example, usually resolves when the thyroid condition is treated. You may want to try over-the-counter pain medication if you experience discomfort. But if you find that you're still having problems even with thyroid treatment, talk with your healthcare provider.

Treatment options for erectile dysfunction, low libido, delayed ejaculation, or premature ejaculation may help. If you are still having difficulties, it's possible that your medications need to be adjusted. Your healthcare provider can perform tests to see how well the drugs are working and adjust the dosage or treatment plan if needed.

Summary

Thyroid disease affects males far less often than females, but many of the symptoms are the same. Males may experience unique symptoms like erectile dysfunction and hypogonadism (low testosterone) due to the effect that thyroid disease has on sex hormones.

The diagnosis and treatment of thyroid disease are the same in males and females. However, symptoms in males are sometimes missed because thyroid dysfunction is far more common in females. Symptoms like ED also can occur in older males without thyroid disease. Talk with your healthcare provider if you have concerns about thyroid function.