The Connection Between Thyroid Disorders and Men's Sexual Health

The thyroid hormones—triiodothyronine (T3), thyroxine (T4), reverse triiodothyronine (RT3) and calcitonin—primarily control metabolism, or how the body converts food into energy for cells, according to Cleveland Clinic. They also contribute to fertility, cardiovascular function, digestion, body temperature, brain development, cognition, and skin and bone maintenance.

When the thyroid is underactive or produces insufficient hormones, it's called hypothyroidism. Hyperthyroidism occurs when the thyroid is overactive and produces too many hormones.

Most thyroid disorders involve hypo- or hyperthyroidism. Most of these cases are caused by autoimmunity, wherein the immune system malfunctions and mistakes bodily tissues as foreign invaders. It then releases antibodies to attack these tissues, leading to inflammation that causes damage over time.

Hashimoto's thyroiditis, the most prevalent autoimmune thyroid condition, causes hypothyroidism. Grave's disease is the most common cause of hyperthyroidism, which is more common in men than hypothyroidism.

Iodine deficiency can also cause hyperthyroidism, though it's uncommon in the United States. The thyroid uses iodine, an element found in water and foods such as iodized table salt, to create thyroid hormones. Excess iodine, through diet or medications, can cause hyperthyroidism.

Hypo- and hyperthyroidism can also arise from:

• Thyroiditis, or inflammation of the thyroid gland
• Congenital abnormalities, where the thyroid didn't function properly from birth
• Removal of the thyroid gland due to cancer
• Overtreatment for hypo- or hyperthyroidism
• Tumors on the pituitary gland
• Thyroid nodules, or unusual cell clusters that typically are noncancerous

Plummer's disease, or toxic nodular goiter, where the thyroid is enlarged and has formed nodules that produce excess thyroid hormones

Goiters, or enlarged thyroid, affect about 5 percent of people in the U.S., according to Cleveland Clinic. These can occur because of hypothyroidism, iodine deficiency or certain medications, such as lithium. In some instances, the cause is unknown.

About 43,800 Americans were diagnosed with thyroid cancer in 2022, the National Cancer Institute (NCI) estimates. According to the Centers for Disease Control and Prevention, about 12,000 men and 33,000 women are diagnosed annually.

The four types—papillary, follicular, medullary and anaplastic—vary in aggressiveness, but thyroid cancer's overall five-year relative survival rate is 98.4 percent, according to the NCI.

Thyroid disorder symptoms are typically the same in men and women, according to Deena Adimoolam, M.D., a specialist in endocrinology, diabetes and metabolism at Summit Health in Fair Lawn, New Jersey.

According to Adimoolam and Mayo Clinic, symptoms of hypothyroidism that are not gender-specific include:

• Fatigue
• Brain fog
• Sensitivity to heat and cold
• Dry skin
• Dry, brittle nails and hair
• Puffy skin
• Thinning hair
• Mood changes, including depression
• Constipation
• Memory problems
• Slow heart rate
• Low libido
• Decreased muscle mass and strength

For hyperthyroidism, the nongendered symptoms are:

• Mood changes, including worsening anxiety
• Insomnia
• Heart palpitations
• Diarrhea
• Fatigue
• Abnormal weight loss
• Excessive sweating
• Breast enlargement
• Increased risk of hip and vertebral fractures

According to Kara, Adimoolam and Barry Witt, M.D., a reproductive endocrinologist at Greenwich Fertility in Greenwich, Connecticut, and a member of WINFertility's medical advisory board, thyroid disorders can adversely affect sexual and reproductive health in multiple ways for both men and women. However, some symptoms are male-specific.

With hyperthyroidism, these male-specific symptoms include:

• High testosterone levels
• Lower sperm motility
• Lower sperm counts
• Erectile dysfunction (ED)
• Premature ejaculation
• Testicular atrophy (shrinkage)

In hypothyroidism, they include:

• ED
• Delayed ejaculation
• Increased testicular size

Hyperthyroidism is much more likely to affect men's fertility than hypothyroidism, Witt said. It also may be more likely to impact sexual health overall, according to a review published in 2019 in Sexual Medicine Reviews. The report indicated 59 percent to 63 percent of men with hypothyroidism had sexual dysfunction, such as ED and delayed ejaculation. Meanwhile, 48 percent to 77 percent of men with hyperthyroidism experienced sexual dysfunction, including erectile dysfunction, diminished libido and premature ejaculation.

"The effects of thyroid disease on male reproductive health are thought to result from changes in hormones, like testosterone, and in the amount of protein in the blood that binds and carries the testosterone throughout the body, called sex hormone-binding globulin or SHBG," Witt wrote in an email exchange. "These changes cause adverse effects on the semen parameters—like the volume, sperm count, motility [movement] and shape of the sperm [morphology]—and have adverse effects on sexual behavior and performance."

Thyroid disorders might also affect hormones that support blood vessel function, which could inhibit erections, Kara said. Depression, anxiety and fatigue associated with thyroid dysfunction could contribute to a lack of arousal and erectile difficulties as well.

"Furthermore, studies highlight that thyroid disorders can impact the size and weight of the testicles, which may also lead to low sperm count and fertility issues alongside the disruption in important sex hormones," Kara added.

Witt recommended that all men with erectile dysfunction or abnormal semen parameters be tested for thyroid disorders. However, because thyroid disorders are uncommon in men and symptoms could indicate one of several conditions, you may need to seek a second opinion if your concerns are initially dismissed.

The process to diagnose thyroid dysfunction is the same in men and women and typically includes a physical exam and blood tests. Imaging may also be recommended. If you have an abnormal growth, a doctor may perform a biopsy to test for cancer.

Thyroid treatment, which usually involves medications to balance thyroid hormone levels, typically mitigates sexual symptoms, according to Witt and Kara. However, certain therapies can exacerbate problems, Kara noted.

"For example, beta blockers are sometimes used in thyroid treatment, and recent studies suggest that these can cause erectile dysfunction, reduce semen volume and fertility," Kara said. "If you have a thyroid disorder but are also trying to conceive, it is important to consult your medical professional about your specific health needs before starting a new medication to discuss your options."

Kara added that lifestyle changes, particularly alterations in diet, can support thyroid function and assuage symptoms.

"Foods that are high in sugar, trans fats or are heavily processed can lead to inflammation, which in recent studies has been connected to disruptions in normal thyroid hormone production," he explained. "Reducing inflammation by including anti-inflammatory foods, such as turmeric or Boswellia, and by avoiding foods that are pro-inflammatory, like refined carbohydrates and trans fats, can help when it comes to thyroid health."

Selenium may also support thyroid function, according to Kara. The mineral can be found in seafood, turkey, sunflower seeds, Brazil nuts, eggs and enriched foods such as pasta, whole wheat bread and whole grain cereals, according to Kara and Harvard T.H. Chan School of Public Health.

"Ultimately, it depends on the thyroid condition itself, whether you have an overactive or underactive thyroid," Kara concluded. "So before making any lifestyle changes, it is always best to consult your medical professional about developing a plan specific to your health needs."

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