Thyroid Symptoms in Men + How Low Thyroid Causes Low Testosterone

Much of the conversation on this blog is dedicated to women and what happens when they have hypothyroidism or low thyroid function. 

But what about men?

Do men react the same way? Do they have the same symptoms? Is treatment the same?

It turns out that the answer to each of these questions is ​"No". 

In fact, the treatment, diagnosis, and management are quite different.

Hypothyroidism in men deserves special attention because of how thyroid hormone interacts with their main sex hormone: testosterone.

In this post we will discuss:​

  • The complete list of thyroid symptoms in men
  • How thyroid hormone lowers testosterone
  • Why men get misdiagnosed more frequently than women
  • The difference in treatment between men and women
  • Basic hormone replacement therapy for thyroid hormone and testosterone

Let's dive in...

More...

Men vs Women and Hypothyroid Symptoms

As I've mentioned above men and women present with different signs and symptoms of hypothyroidism.

The problem with men is that many of their presenting signs and symptoms get lumped into the general category of "age-related" decline in health. 

Meaning that Doctors may dismiss their symptoms as a "normal" part of aging.

The truth is that these symptoms are far from normal, and the presentation of any of these symptoms absolutely warrants further work up.

Below I'll go over the most common symptoms that men present with and then a list of more general symptoms of hypothyroidism to help guide you.

Men with hypothyroidism commonly present with any or all of the following symptoms:

  • Increase in fatigue or decreased energy levels
  • Decreased libido/sex drive and other changes in sexual function including erectile dysfunction
  • Inability to build muscle mass or decreased strength
  • Unexplained weight gain or inability to lose weight despite using therapies that have worked in the past
  • Changes in mood ranging from feeling "down" to depression

In addition to these symptoms men usually present with 1 or more of the following general symptoms of hypothyroidism: 

  • Constipation or change in bowel movements trending towards constipation
  • Dry skin or changes in skin texture
  • Other mood changes including anxiety
  • Difficulty with sleeping or insomnia
  • Inability to tolerate cold temperatures
  • Issues with fertility
  • Muscle aches/pains, joint pain and/or back pain
  • Difficulty with concentration decreased attention span and "brain fog"

Many of these symptoms tend to be non-specific in nature, and if you only present with 1-4 of these symptoms it's easy to see how they can easily get dismissed. 

In women presenting with these symptoms, Doctors tend to prescribe anti-depressants.

In men presenting with these symptoms, Doctors tend to suggest that these are normal symptoms. 

In reality, these symptoms are far from normal, and the proper treatment may dramatically improve your performance and/or reduce your symptoms. 

We will talk about how to properly test for hormone imbalances and what to do if you have these symptoms, so just sit tight for a second because we need to talk about an important difference between men and women: ​

​Why do men and women have different presenting symptoms? 

Low circulating levels of thyroid hormone in the body certainly are a big issue by themselves, but the more important part of low thyroid hormone is how it interacts with other hormones in the body.

The one we are focused on in men is Testosterone. ​

In men, low circulating levels of thyroid hormone (or even cellular resistance to thyroid hormone) can directly lead to low levels of testosterone.

You may have noticed that many of the presenting symptoms of hypothyroidism mirror the presenting symptoms of low testosterone.

This is because the two conditions tend to accompany each other. 

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Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

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The Connection between Low Testosterone and Low Thyroid Hormone​

Studies have shown (1) that thyroid hormone interacts with multiple endocrine systems.

Women also experience this alteration in sex hormones (2) but they predominately experience symptoms related to estrogen/progesterone imbalance (which can be more difficult to treat than low testosterone in men). 

The reason each present with unique symptoms has to do with how those sex hormones function in the body. ​

As a man, testosterone is your primary sex hormone. 

Having normal testosterone levels are felt to be protective against many diseases (3), helps men build and maintain muscle mass (4), helps prevent cardiovascular disease (5) and is generally considered to improve longevity and quality of life (6).

Because of how important testosterone is for male health, it's a huge deal when men have sub-optimal levels and need to be addressed immediately.

​Studies have also shown that replacing thyroid hormone tends to cause a general increase in testosterone levels but I've found that to less accurate in males > 40-50 years old

In men, it is well established that both insulin resistance and hypothyroidism can act to reduce testosterone in males.

The problem is that low thyroid hormone potentiates insulin resistance (7) in men as well.

In addition, hypothyroidism promotes weight gain which further impairs testosterone production (8)...

This leads to a combination of hormones and metabolic changes that fight to keep testosterone levels low and symptoms high. 

In this setting, replacing thyroid hormone may improve testosterone levels slightly, but it does nothing to treat insulin resistance. 

How do you know if you have low testosterone and low thyroid hormone?

Both conditions can be tested for quite easily using standard lab tests which we will go over below​. 

Complete Thyroid Lab + Hormone Panel for Men

It's important to note that standard and conventionally trained physicians may not be experienced in thyroid hormone replacement or testosterone replacement therapy.

In order to receive the proper treatment you may ultimately need to seek out a provider who understands these hormone interactions and can treat accordingly.

​If you've experienced any of the symptoms highlighted above then consider this thyroid lab panel + complete hormone panel as a means to get started:

  • TSH: Should be < 2.0. Men frequently present with symptoms with a TSH in the 2-5 range that often goes undiagnosed but this level often correlates with subclinical hypothyroidism (9). The combination of low testosterone + subclinical hypothyroid TSH levels leads to symptoms frequently. 
  • Free T3: Should be in the upper 50% of the reference range. Note that men tend to tolerate lower levels of T3 when compared to women but still need T3 for optimal function. 
  • Total T3: Should be in the top 50% of the reference range. 
  • Reverse T3: Should be < 15 by standard labs. Higher levels often indicate poor thyroid conversion and are associated with high-stress levels. 
  • Sex hormone binding globulin: In men, this should be between 20-30, too much SHBG will bind up testosterone and limit free and active testosterone leading to symptoms. Thyroid hormone and estrogen both increase this value. 
  • Free Testosterone: Generally this number should be in the upper 1/3 of the reference range provided, this represents the active testosterone in the serum. 
  • Total Testosterone: Optimal levels are generally > 600-700 (depending on the reference range), but note that this number is highly variable between men. If your body is used to a 1,200 testosterone level and you suddenly drop to 600, this value may seem "normal" but in reality, it's not for your body. 
  • Estradiol: This should be < 30. Higher levels increase SHBG and bind up testosterone leading to issues like erectile dysfunction, etc. 

This set of labs will provide you with a great starting point but a complete lab panel should also include other factors like inflammatory markers, cholesterol & lipid profile and other basic blood tests. 

The reference ranges provided above are different from the auto-generated lab reference ranges on typical lab slips so base your results off of the "optimal" ranges listed above. 

After treating many patients with hypothyroidism and other hormone imbalances I've found that men (ages 40-50) with hypothyroidism generally present with lab values in the following ranges: 

  • TSH: Usually between 2-5
  • Reverse T3: Generally > 20
  • Free T3: Often at the low end of the reference range
  • Testosterone: Generally between 200-300
  • Hgb A1c: Generally > 5.7
  • Fasting insulin: Generally around 10
  • SHBG: Generally low (15-20)
  • Estradiol levels: Generally > 35

This is just to give you an idea of what may be deemed "normal" by providers but in reality is very suboptimal and will present with symptoms (noted above). 

supoptimal hormone panel for men
low testosterone in male with hypothyroidism
abnormal thyroid results men

You can see from the example above several problems with this profile:

  • TSH of 6.192 (outside of the reference range in this case) which is way too high and indicating hypothyroidism right off the bat
  • Low testosterone at 497 (suboptimal for this particular patient)
  • Low Free T4 at 0.58 with a reference range of 0.89 to 1.76 (again indicating low circulating levels of thyroid hormone)
  • Elevated antibodies with thyroglobulin antibodies at 2075 and thyroperoxidase antibodies at 232, concerning for Hashimoto's thyroiditis or autoimmune thyroiditis
  • High Hgb A1c at 5.7 indicating impaired fasting insulin
  • High estradiol at 43.1 contributing to symptoms

This patient had a great improvement in symptoms once treated with both testosterone and thyroid hormone replacement which we will discuss below. 

Testosterone + Thyroid hormone Replacement Therapy

In addition to presenting with different symptoms than women, men often require slightly different treatment.

Thyroid hormone (in conjunction with other hormones) helps to regulate the metabolism of the entire body. 

Because males tend to have higher resting energy expenditures (10) (AKA metabolism) than women, men often require higher doses of thyroid hormone. 

In addition, thyroid dosing tends (at least somewhat) is dependent upon total body weight (11).

As a result, men tend to require higher doses of thyroid hormone than women. 

While it is true that each person is unique, I have found that this tends to hold true for men.

They tend to also take longer to notice the effects after supplementing with thyroid hormone as well.

Women may notice changes in symptoms within 4-6 weeks, but in men, it tends to require 8+ weeks for these changes to be noticed (using subjective symptoms as a guide).

As a general rule, I have also found that men tend to tolerate T3 containing medications (and often do better on these medications) than most women. 

If you are a man, currently taking thyroid hormone, and not noticing any changes to your symptoms, it might be worth considering changing medications to something containing T3 hormone or simply increasing your dose.

T3 conversion booster results

Preferably this would include medications such as WP thyroid, Nature-throid, Armour thyroid, NP Thyroid, liothyronine or Cytomel

​These formulations have T3 in them which is the active thyroid hormone. 

You can read more about T3 vs T4 medications in the links above.

In addition, it's important to remember that some of your symptoms may overlap with other hormone imbalances. 

I'm specifically talking about low testosterone.

If your symptoms have not improved with thyroid hormone replacement then it would be worth evaluation of testosterone and other hormone levels and replacement of these hormones as necessary. 

Final Thoughts + Recap

​Hypothyroidism, while more common in women, should not be overlooked in men. 

The consequence of low circulating levels of thyroid hormone in the body impacts other important hormone systems in men - especially testosterone levels.

What's also important is that these low levels of testosterone may not improve with thyroid hormone replacement therapy.

Men also may require a higher total dose of thyroid hormone and may require more T3 when compared to women.

Ultimately if you are being treated for hypothyroidism as a male and not improving, consider checking other hormones and/or changing/altering your thyroid medication.

Are you suffering from hypothyroidism?

Is your thyroid hormone replacement helping?

Do you think it may be lowering your testosterone levels? 

Why or why not?

Leave your questions or comments below! 

References (Click to Expand)

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

32 thoughts on “Thyroid Symptoms in Men + How Low Thyroid Causes Low Testosterone”

  1. I am trying to help my wife. She has Hypo with all of these symptoms taking meds but cant lose weight and is VERY depressed. I was wondering what you charge for taking in patients. i am looking for any and all of the help I can give her.

    • Hey Preston,

      I’m not taking any new patients at this time, but you will find a lot of helpful information to get started on this blog if you poke around.

  2. Hello Westin,

    I understand that you’re not accepting new patients. Are you familiar with any doctors in Southern California who employ a similar protocol for treating men with Hashimoto’s? I cannot tolerate NDT, T4 only, nor T3 only drugs. Even at low doses, I experience hyper symptoms.I endure many of the typical hypothyroidism symptoms and have nodules on my thyroid. It is demoralizing and disheartening when conventional physicians simply monitor TSH and prescribe T4 without digging deeper.

    Thank you

    • Hey Paul,

      Unfortunately I don’t know anyone in that area. I would make sure you also evaluate other hormones as some nutrient deficiencies can trigger the symptoms you are describing with the addition of thyroid hormone.

      • Thank for your response. When my Hashimoto’s escalated, I began to experience sudden tinnitus (never had prior hearing issues). What’s your assessment of what’s causing this and how it can be mitigated? Also, my vision deteriorated. Thank you again.

  3. Hi

    My husband has hypo. Hes on medication for thyroid and tsh is good but hes extremely fatigue, has muscle pain and cant wake up in the morning and extremely tired during the day.

    His latest tests show low testesterone. The specialist told him its due to him being overweight. My husband doesnt believe this is true. Do you what we can do? Do u recommend a doctor in sydney australia? Should my husband be given testesterone replacement? Or ask for additional test. My husband thinks hes dying. I think he feels heart issues too. Not sure what to do when drs dont listen or believe you.

    • Hi, I had that problem and I was continually tested for thyroid and told I was normal but I had a tumor on my thyroid. I went to a Functional Medicine Dr. that specialized in the Wilson’s Temperature and he tested me for T3, T4, FT3, FT4, Reverse T3, TPO, Thyroid antibodies. The tumor tested Hashimoto’s which means that I can take all the T4 but my body was not able to make it into T3 which is what the body needs for energy, digestion, temperature control, metabolism etc. . . So now I am being treated with T3 and NDT.

      Insist that all the thyroid be tested, my Reverse T3 were very high, and TPO were high as well. You are paying for the test so they should not refuse.

      God’s Blessings, Jayne

  4. Hi,…recently my fiancé has been goin to a endocrinologist for very low testerone….he is gona be 47 this year. They found out his testosterone level is 40..which they checked his levels cause we have been have alot of problems in that area…his regular doctor sent him to a endrocrinologist…they tested his thyroid which they said it’s in the normal range but in the low normal range…they have give him synthroid 135…to see if it brings the testorone levels up…which is gona be 3 to 4 month..he has anxiety bad…can’t sleep…and can’t perform…he is very down right now over all of this…he has been on synchroid in the past for thyroid but they took him off a year ago sayin it was normal…..my question is…even though his thyroid level is in the normal range.(low normal range)..can it cause his testosterone levels to be that low (40s)…and what can they do to help….thank you

    • Hi Kristal,

      Assuming you are referring to the US testosterone reference range then your fiance should consider using testosterone replacement therapy. Synthroid may slightly improve his testosterone but not likely by a large margin. You may need to find a testosterone clinic to get the appropriate treatment.

  5. Thank goodness I found your site! I’m a 44 year old male 6′ and 183# that is usually very active and eat healthy. I’ve been feeling so bad for so many months now. Last November, a nurse practitioner started me on 50 mcg of Synthroid as she said my TSH level was slightly low and I had been chronically tired for a year. In February, I still felt so fatigued, I could barely get off the couch after a normal day of work (or rest) so we checked my Testosterone and it was 220; and TSH was 3.120. I continued synthroid 50 mcg daily and started 200mg Testosterone injections biweekly.

    Yesterday, April 18th, I retested and TSH went to 0.033 and testosterone went to 193? Am I going the wrong direction or what! Thank you for any suggestion Dr. Childs. My are is VERY rural and specialist are far and few between…

  6. My 47 yea old husband has been gaining weight, has been tired for years and for the last 2 year gone completely off sex, he has been diagnosed with a underactive thyroid and was commenced on levothyroxine about 6 months ago.. he had a blood test around 2 month ago which reviled that he needed his dosage upping.. he now takes 1 25 micrograms every morning with still no effect, do you think he should have another blood test or wait a few more week?

    • Hi Shavaune,

      That’s reasonable, but I would also recommend he get his testosterone level evaluated as well.

  7. I just recently had my testosterone checked and it came back at 261 and the doctor told me that it wasn’t low because it’s in the reference range. I believe that to be outrageously low for a man of 25 years old. Should I look into getting a new doctor? My thyroid level cam back at a somewhat bad range as well at 3.7.

    • Hi Justin,

      As a 25 year old male your testosterone should be significantly higher than that. Consider that the reference range also includes men in their 50’s and 60’s, and you don’t really want to be compared to them. Giving testosterone to younger men will require knowledge of HCG and how to use it to prevent fertility issues later on in life, so yes you should probably seek out a new physician.

  8. Hey Dr. Childs,

    I’ve got (what I think) is an interesting case.

    I’m a 36 year old male, was diagnosed hyperthyroid at the Endocrine Associates of Dallas by Dr Dorfman when I was 30 (multi module toxic goiter – benign) and about 6 months after the thyroid Dx I ended up asking my PCP to test my testosterone, which came back at 90ng/DL.

    I started on Testim gel, but it actually have a negative effect on my Low T, so I switched to cypionate injections @ 100mg/ML every 7 days. The injections quickly brought my levels up to the 500 range or so, and I felt and saw a difference in the gym and bedroom in a matter of days.

    At my first visit to the endocrine associates of Dallas, Dr Dorfman suggested to burn out the thyroid gland right then and their, but I was hesitant because I didn’t know that much about the thyroid and didn’t want to move forward with the burn out until I felt comfortable.

    The dr prescribed me Metoprolol and sent me on my way.

    Since 2010, I’ve been to several PCPs, a few different endocrinologists, and a few different psychiatrists.

    My TSH has been consistently very low, ranging from 0.17-1.20, and my T4 has been “borderline high” every time I’ve had labs done, my FSH and LH have been extremely lowbut most recently (1 week ago) my labs were done and my TSH was extremely low again, but my T4 was LOW as well, showing me Hypo!

    In the last 8 weeks or so, I’ve put on about 20LB, been extremely moody, irritable, anxious, depressed, not sleeping, and I’ve experienced insane sweating! Granted I live in Dallas, TX where it’s hotter than h*ll and has very high humidity. My heart rate (bpm) has been high, about 95-105bpm, up until a couple weeks ago where it has lowered to about 85bpm. I’ve started exercising on a P90X style routine about a week ago and dropped about 6LB. My heart rate gets up around 125-150bpm while exercising, but it takes a good 10-15 min to see a good amount of sweat building up. When I am outside and exposed to the hot and humid temps (90-100+ degrees), I am drenched in sweat in a matter of 5 min! And this is not exerting barely any energy… I’m talking about sweat dripping from my head, arms, abdominal area, and back! It’s literally embarrassing!!!

    I know I’m jumping around with all this, please bare with me…

    Over the past 6 years, I’ve been prescribed dozens of medications. Below are all the prescriptions I recall:
    * Xanax
    * Lorazepam
    * Clonazepam
    * Metoprolol
    * Propanolol
    * Gabapentin
    * Tramadol
    * Pristique
    * Paxil
    * Adderrall
    * Testim
    * Fortesta
    * Cypionate
    * Ambien

    I have an appointment with this Monday with an Endocrinologist in Plano, TX. My goal is to have the thyroid burned out, and get back on a testosterone replacement. For the labs, I would think the following need to be done:
    TSH
    T3
    T4
    FSH
    LH
    Total Testosterone
    Free Testosterone
    PSA

    Any suggestions or recommendations? I just want to feel better like I did up until I was 29 years old or so and get back to life!

    Thanks,

    Jeff

  9. Hi,
    My husband has just found he has a problem related to your article.
    You did a Great Job providing Thyroid Information r/t Men and Women. Its easy for non-medical to undrstand and well covered, with lab levels, meds/ esp the aprox. time it may take Therapeutic level, more.
    Thank You,

  10. Hi!! Great article, thank you – it provided some good clarity for me..

    Quick questions is.. Can you have Low T and Hypothyroidism? Would the treatment of one help regulate the other, or would they both need to be treated separately?

    I was diagnosed with Low T, and prescribed androgel. However I wasn’t improving. I had moved and switch PCP.. New one ordered blood tests, and I just got my labs back. and my TSH is above 6, and T is still low. T4 free and estrodal are in ‘normal’ range.. I have a follow up appointment next week but just looking for more info..

    Would love if you replied!! Thanks in advance!!

    • Hi Carl,

      Generally hypothyroidism will cause low testosterone, meaning if you treat low thyroid (and it is the sole cause of low testosterone) then it will increase your thyroid function. Taking testosterone replacement therapy, on the other hand, will not increase thyroid function.

  11. I am aged 71 years have ever increasing systolic high blood pressure (little responsive to medication), BPH Grade II to III (fluctuated size from 60 grams to 93 grams), Knee joint stiffness with pain and swelling (RA-ve & ESR 8-12) weight increased from 62 Kg at youth to 105 Kg at 65 years age, now at 86 Kg reduced after great efforts, ED and premature ejaculation since lat 15 years. T3=105.78 ng/dl, T4=7.4ng/dl, TSH=3.08ng/dl, Testoesterone=486.79ng/dl. I suspect hypothyroidism, Kindly advice.

  12. Hi Dr.,

    What about Free testosterone? I have hypothyroidism, my total testosterone is midrange but my free is on the low end of the range. Is there a relation between hypothyroidism and free test?

  13. Hi Dr. I was just wondering if you can help me with my case 🙂
    It all started in December 2017 one year ago suddenly i got panic attacks and lost weight couldn’t eat anything also I was without any energy feeling just down, after 2 months I somehow started to eat properly and then I gain weight but my energy is still very very low. Also after this 2 months I lost my libido which was very very good 🙂 I have hair loss I feel tired all the time and many other symptoms. Currently I also have ED that’s why I measured my Testosteron and Thyroid. My Testosteron was in April at about 8 then 3 months later it was 5 currently last blood test it is 3,57. I feel awful 🙁
    Also my TSH is 0,794 uiU/ml
    0,400-4,000 uiU/ml
    FT4 1,04 ng/dl
    0,80-1,90 ng/dl

    FT3 3,82pg/ml
    1,80-4,20 pg/ml
    TPO 20,1IU/ml
    0,0-35,0
    Also my cortisol is weak it was high in the beginning and now it’s low 🙁
    My doc said only FT4 is a small problem but he ain’t going to do nothing about it.
    I am from Germany

    I am a male 22 years old.
    Thank you and best regards:)
    Mike

  14. Hi Dr
    I have been diagnosed with low test and I am considering TRT, I’M 47 and I’m also hypothyroidism. I take 150mg of levothyroxine per day. Can I take trt whilst on levothyroxine? I have also been informed that I can’t take hcg during trt because of hypothyroidism.

  15. Good morning Dr Child’s,
    I’m 49 yrs old and I’m 6′ and weight is 134lbs, currently still losing weight… I came out of the military in 1992 weighing 175lbs and have never weighed that since. 2 wks ago my family Dr done full blood workup, my FT4 was very low as well as my free testosterone @ 6.1…I had to do repeat work up 5 days ago and FT4 was still low and free testosterone dropped to 3.6. I’m experiencing almost all of the symptoms above as well. I eat like a horse and within an hour or so, I have to snack cause I’m hungry again… family Dr said my metabolism is sky high, but I always thought that with hypothyroidism I would be totally opposite and gain weight. While in the military, I hardly went to the gym but still had great muscle build and was extremely happy with how I looked, but now for the past 10-15yrs, I look like a scarecrow that’s ready to be retired. I force myself to get to the gym every day and on a 6-day workout regimen, but to be honest, I’m ready to quit cause I’ve been going for over 3yrs and getting no results. I’m not building size at all and I think that muscle definition can’t go much more than where I’m at. I’m hoping that Dr will send me to an endocrinologist or a hormone specialist cause looking back at the past 25 years now and these past 10yrs have been the worse on weight loss..all the Dr’s wanted to do is check to make sure that I didn’t/don’t have HIV/AIDS which I don’t, I’ve been married from 1995 up till 2012 and with my gf the past 5 yrs. Thank you Dr, any suggestions would be greatly appreciated!! Tired of living like this.

  16. Dr.Childs, are you taking new patients at this time? If not, can you suggest a professional for a man with low Thyroid and Low T? I look forward to hearing from you.

  17. Hi, As of Jan 15, TSH 2.29 HGB A1C 5.2 which is low.
    Dec 13 Free T3 2.75 Free T4 .84 TSH 4.24

    Naturally VA MD ignored my requests for Free T, Total T, Prolactin and estrogen. any suggestions as to where I can get those done? I will consult a physician at your suggested webpage, It is obvious, my VA Doc AND local urologist has no interest in either thyroid or T levels. Thoughts? I don’t see my post here yet.

  18. So what about a 75-year-old. Where should my levels be when I have a Free T3 of 2.75, Free T4 of 0.84 and A TSH of 4.24? Va won’t give me the rest.

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