The interrelationships between thyroid dysfunction and hypogonadism in men and boys
Abstract
Thyroid hormone deficiency affects all tissues of the body, including multiple endocrine changes that alter growth hormone, corticotrophin, glucocorticoids, and gonadal function. Primary hypothyroidism is associated with hypogonadotropic hypogonadism, which is reversible with thyroid hormone replacement therapy. In male children follicle-stimulating hormone (FSH) is elevated and associated with testicular enlargement without virilization. Men with primary hypothyroidism have subnormal responses of luteinizing hormone (LH) to gonadotropin-releasing hormone (GnRH) administration and normal response to human chorionic gonadotropin (hCG). Free testosterone concentrations are reduced in men with primary hypothyroidism and thyroid hormone replacement normalizes free testosterone concentrations. In men with primary hypothyroidism, prolactin is not consistently elevated (except in men and children with longstanding severe primary hypothyroidism), but prolactin declines following thyroid hormone replacement therapy. Thyroid hormone is known to affect sex hormone-binding hormonal globulin (SHBG) concentrations. Men with hyperthyroidism have elevated concentrations of testosterone and SHBG. Thyroid hormone therapy in normal men may also duplicate this elevation. In addition estradiol elevations are observed in men with hyperthyroidism, and gynecomastia is common in them as well. In contrast to patients with primary hypothyroidism, men with hyperthyroidism exhibit hyperresponsiveness of LH to GnRH administration and subnormal responses to hCG. Radioactive iodine therapy (RAI) of men treated for thyroid cancer produces a dose-dependent impairment of spermatogenesis and elevation of FSH up to approximately 2 years. Permanent testicular germ cell damage may occur in men treated with high doses of RAI. RAI commonly increases serum concentrations of FSH and LH while reducing inhibin B levels without affecting serum concentrations of testosterone. Thus, radioiodine therapy transiently impairs both germinal and Leydig cell function that usually recover by 18 months posttherapy.
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More pronounced hypothyroidism can lower gonadotropin and sex hormone levels in otherwise eugonadal subjects, potentially causing mild to moderate central hypogonadism with low testosterone in men.
“Because the effects of more pronounced hypothyroidism include lowering of gonadotropin and sex hormone levels in otherwise eugonadal subjects, a state of mild or moderate central hypogonadism with low testosterone levels could ensue in men.(30)”
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- Authors
- Meikle, A. W.
- Affiliations
- University of Utah (US)
- Corresponding author
- Meikle, A. Wayne
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2004-04-27
- Volume
- 14
- Issue
- supplement 1
- Pages
- 17-25
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2111107715
- Cited by
- 128
- References
- 52
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 10 · 2023: 4 · 2022: 11 · 2021: 12 · 2020: 6 · 2019: 11 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 8
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- thyroid dysfunction, hypogonadism, primary hypothyroidism, hyperthyroidism, hypogonadotropic hypogonadism, thyroid hormone replacement, free testosterone, luteinizing hormone, follicle-stimulating hormone, gonadotropin-releasing hormone, human chorionic gonadotropin, sex hormone-binding globulin, prolactin, estradiol, gynecomastia, radioiodine therapy, spermatogenesis, inhibin B, Leydig cell function
- MeSH terms
- Humans, Hypogonadism, Male, Thyroid Diseases
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