Thyroid Symptoms in Males

The symptoms of thyroid disease in males tend to be the same as in females. However, there are differences in how this hormonal disorder affects the male reproductive system, male sexual function, and other systems regulated by hormones.

Some of the symptoms (like erectile dysfunction and male breast enlargement) are uncommon in males under 40 and easily recognized as abnormal. The same may not be true for older males in whom symptoms like these are common and typically aging-elated.

This article describes the top 10 signs and symptoms of thyroid disease in males, as well as symptoms that can affect both males and females. It also explains the challenges in diagnosing thyroid disease in males and what treatments are available.

10 Symptoms of Thyroid Disease in Males

Thyroid disease may be suspected in males, particularly young males, if there are any of the 10 following signs or 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)

How Thyroid Disease Affects Male Hormones

With thyroid disease, the abnormal decrease or increase in thyroid hormones can affect other hormones, including male sex hormones like testosterone and female sex hormones like estrogen.

This is because thyroid hormones direct the production of sex hormone-binding globulin (SHBG), a protein produced by the liver that controls the amount of sex hormones actively working in the blood.

Both hyperthyroidism and hypothyroidism can affect 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. While free testosterone levels are not affected, the large volume of SHBG in the blood promotes a process called estrogen aromatization in which testosterone is converted into estrogen.

Both of these effects—having too little testosterone or too much estrogen—can have similar effects on the male body.

Symptoms of Thyroid Disease in Males and Females

Males are affected by thyroid disease less often than females, but they tend to have similar symptoms. The symptoms are due to changes in the production of thyroid hormones caused by either hypothyroidism or hyperthyroidism.

Thyroid hormones direct many functions, including the regulation of energy levels, weight, internal body temperature, metabolism, and skin, hair, and nail growth.

Hypothyroidism

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

The risk of Hashimoto's is higher for females and older people. But in the United States, about 3% of males between the ages of 18 and 24 are affected, increasing to 16% by the age of 75.

There are other causes of hypothyroidism, including thyroid damage caused by other diseases (secondary hypothyroidism) and thyroid disease caused by a birth defect (congenital hypothyroidism).

Symptoms of hypothyroidism in both males and females include:

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

Hyperthyroidism

Graves' disease, another autoimmune disorder, is the most common cause of hyperthyroidism in the United States. The disease is uncommon in males, occurring at a rate of around 1 per 10,000. The rate is nearly eight times higher in women.

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

Challenge in Diagnosis

The diagnosis of thyroid disease is the same no matter a person's sex. With that said, healthcare providers sometimes overlook thyroid symptoms in males since the disease is far less common and causes symptoms commonly associated with aging.

Because thyroid disease usually affects males over 40, healthcare providers will often chalk up symptoms like erectile dysfunction, low libido, and gynecomastia to aging or conditions like obesity, diabetes, smoking, high blood pressure, or heart disease.

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If Thyroid Disease Is Suspected

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).

Treatment

The treatment of thyroid disease varies based on whether you have hypothyroidism or hyperthyroidism. The treatment tends to be the same for males and females, but the dosages can differ.

Hyperthyroidism

Treating hyperthyroidism usually begins with taking antithyroid medications like Tapazole (propylthiouracil and methimazole). Once your thyroid is back to functioning normally, you may be able to get off of the medication, at least temporarily, or you may need to be on 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.

Hypothyroidism

Hypothyroidism is treated with hormone replacement therapy, typically a synthetic hormone called 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.

Coping

If you've been diagnosed with thyroid disease and are having difficulties with sexual dysfunction, be patient. Treating a thyroid condition can drastically improve sexual function in most people, but it can take time.

If you find that you're still having problems with erectile dysfunction, low libido, delayed ejaculation, or premature ejaculation after being treated, talk to your healthcare provider about other factors that could be contributing to these issues.

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 they can also occur in older males without thyroid disease.