Low Thyroid in Men: Not Just a Woman’s Issue



A doctor touches a man's throat during an examination in a doctor's office.

Hypothyroidism – low thyroid function – is an extremely common disorder in which the thyroid gland releases inadequate amounts of thyroid hormones T3 and T4 into the body. While it’s true that women are more likely to develop problems with their thyroid, increasingly more and more men are being diagnosed.

The majority of literature published today tends to focus on ways hypothyroidism can affect women, excluding men from the conversation and the specific challenges they face. It can be difficult for men to talk about changes in their bodies that are impacting things like sexuality and brain function. It gets even more complicated considering thyroid conditions are wildly under-diagnosed and often missed by routine testing, leaving patients to wonder what’s going on with their bodies.

When it comes to men, many doctors simply overlook low thyroid, ignoring the signs and failing to put all the pieces together because it’s more common for women to be affected. Patients wonder if their problems are all in their heads, while doctors suggest they’re just working too hard or getting older – or even that they need to go on antidepressants.

How are Men Affected?

The thyroid regulates the energy production and metabolism of every cell in the body, so changes in its function can affect every system and look very different from person to person. Many of the issues that occur are similar to those found in women, such as dry skin, exhaustion, cold extremities and constipation. Men, however, also have their own special set of concerns. For example, while women tend to have unexplained weight gain, men may lose muscle mass and strength.

Here is a partial list of symptoms male patients often report:

  • loss in executive function
  • diminished ability to think clearly and make decisions
  • reduced feeling of empowerment and self-assuredness
  • decrease in sex drive
  • erectile dysfunction
  • balding/hair loss
  • high cholesterol
  • decreased ability to deal with stress
  • reduced energy and fatigue
  • decreased testosterone levels (low T)
  • depression
  • anxiety

Most men today are familiar with low testosterone, or “low T,” thanks to an onslaught of TV commercials and ads. What many don’t know, however, is the symptoms are very similar to that of low thyroid, and low thyroid function can actually cause low testosterone levels. I often see patients who have been treated for low testosterone, but the underlying thyroid condition was missed.

Studies show that low thyroid function can lead to lowered amounts of sex hormone-binding blobulin. SHBG is important because it carries testosterone through the body, making it available to cells and tissues. Without it, there will be a decrease in the amount of usable testosterone. Commonly, lowered SHBG and testosterone are related to a drop in fertility.

Another effect of low thyroid is an increase in the number of cells of the testicles with a drop in mature germ cells. In these patients, larger testicular size may be observed with a decrease in the amount and quality of sperm produced. Two additional studies have shown a direct relationship between hypothyroidism to sperm count and motility, negatively impacting male fertility.

There are many other ways low thyroid can manifest itself. Undiagnosed hypothyroidism is also a health risk that can lead to poor circulation, increased infections and serious conditions like cardiovascular disease.

Why is Getting Diagnosed So Difficult?

Getting properly diagnosed and treated is the key to avoiding long-term complications and reversing the current issues but it has its challenges. I see many patients who have been from doctor to doctor before arriving at my office with the same story. They have symptoms that are negatively impacting their lives – sometimes radically changing their ability to enjoy life, their relationship or work, and yet their medical tests come back normal.

The first problem is a lack of comprehensive testing. A thorough test will include blood levels of TSH, free and total T3, free and total T4, reverse T3 and TSI, TPO and TBG, which are different antibodies the immune system can make against thyroid tissue. Each of these values is a piece of the puzzle – each answering different questions needed to fully understand thyroid function.

Although all doctors have access to this full panel, most conventional medical doctors only order a thyroid stimulating hormone test, or TSH. This is inadequate and misses the big picture. Additionally, there are problems with the reference range used to interpret this particular test. The range is set to give physicians a guideline for what is “normal” and what requires treatment. There is a lot of controversy surrounding the TSH test, because the range can’t seem to be agreed upon and keeps changing. While the newer recommendations are improvements from the old range, clinically, I still see many cases where patients’ test results come back “normal” and within the range, but they are quite sick.

Further, different labs use different ranges, so one lab will find you require treatment – while another says you’re healthy. Some physicians are still using old outdated guidelines, and even the two main thyroid authorities – The American Association of Clinical Endocrinology and The National Academy of Clinical Biochemistry – have different recommendations for diagnosing low thyroid function.

When working with thyroid conditions, its critical to take into consideration the big picture: How does the patient feel, and what are the specific concerns and symptoms? And then add to that a full range of lab testing that looks at the thyroid from many different angles. This is a more personalized and holistic approach, rather than relying on one test result.

Additionally, I always run a highly specialized and precise test called the TRH stimulation test. In my experience, this test is the most accurate way to diagnosis thyroid function. It’s similar to a cardiac stress test in that it measures function on demand, so it gives a more realistic picture of what’s happening in the body in real time. Unfortunately, this test is not currently in wide use, because it’s more expensive to run than routine testing and requires special supplies and training to administer. Some integrative doctors beside myself do run it, however, and whenever possible, I recommend getting it done. I have seen many cases where this test picks up on thyroid disorders years before it’s reflected in the routine blood tests, making it possible for patients to get a firm diagnosis and needed treatment that much sooner.

Steps to Take to Regain Your Power

1) Find an integrative and functional doctor who understands the nuances of the thyroid, uses comprehensive testing and practices personalized medicine.

2) Say something! Don’t suffer in silence. Talk to your doctor about all of your symptoms, and don’t be afraid to discuss what you are going through. Your symptoms are not all in your head.

3) Get properly tested. Whenever possible, find a doctor who uses the TRH test. In my experience, it’s the most important and accurate test for diagnosing and monitoring low thyroid and its treatment.

4) Take care of yourself. Eat a healthy diet, get proper sleep and make changes that will create a lifetime of good health.

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