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Male Menopause and the Thyroid Connection

A look at the link between andropause – the male menopause – and hypothyroidism.
Male Menopause and the Thyroid Connection
Last updated:
8/8/2023
Written by:
Medically Reviewed by:

In this article

As men age, they may experience a condition called andropause, often called male menopause. Andropause is a natural decline in testosterone levels in men as they age. Another condition affecting the thyroid gland, hypothyroidism, can also occur in men as they age. In this article, we will explore the relationship between andropause and hypothyroidism.

What is andropause?

You undoubtedly know about menopause – the timeframe when women’s reproductive hormones drop and menstrual periods stop. You may not be aware that men go through a similar – though more gradual and longer – decline in their hormones, known as andropause, or male menopause. This hormonal decline in men is also called late-onset hypogonadism.

Men’s hormones can begin to decline in their mid to late twenties, with reductions in thyroid hormones, growth hormone (GH), and dehydroepiandrosterone (DHEA, a precursor of testosterone and estrogen). Andropause symptoms typically occur in men between the ages of 40 and 60.

The normal range of testosterone is about 270-1070 ng/dL (nanograms per deciliter), with an average level of around 700 ng/dL. Testosterone levels usually peak when a man reaches age 20 and then slowly decline at about 1 percent each year after age 30. The decline varies by individual and can be accelerated by factors such as chronic illness, obesity, stress, and various medications.

By the time men are in their eighties, their hormone levels are typically the same as pre-puberty levels.

 What causes andropause?

While the specific cause of andropause is unknown, the primary factor influencing it is age, as testosterone levels naturally decline in men as they age. Additionally, certain medications and health conditions can also lead to low testosterone levels, such as obesity, liver or kidney disease, HIV/AIDS, and chemotherapy or radiation therapy. Lifestyle factors like smoking, excessive alcohol consumption, and lack of physical activity have also been linked to decreased testosterone levels.

Low testosterone levels are also associated with hypothyroidism, a condition where the body cannot produce enough thyroid hormones.

 What are the symptoms of andropause?

The symptoms of andropause can vary from man to man and usually develop gradually. As testosterone levels drop, the symptoms can include:

  • Fatigue, reduced energy
  • Loss of motivation
  • Poor concentration, brain fog, forgetfulness
  • Irritability and mood swings
  • Depression
  • Anxiety
  • Decreased testicle size
  • Decreased libido
  • Erectile dysfunction
  • Decreased spontaneous erections
  • Premature ejaculation
  • Reduced strength and volume of ejaculation
  • Circulatory problems
  • Headaches
  • Sensation of heat to the face
  • Excessive sweating
  • Hot flashes and night sweats
  • Weight gain and fat redistribution, especially in the abdominal area
  • Muscle mass loss, difficulty building muscle, loss of strength
  • Increased body fat
  • Reduced ability to exercise
  • Sleep problems
  • Reduced bone density
  • Height loss
  • Development of breasts (gynecomastia), breast discomfort or swelling
  • Hair loss and loss of body hair

 How is andropause diagnosed?

There is controversy surrounding the diagnosis of andropause, and some medical professionals argue that it is not a genuine medical condition but a marketing tool used to sell testosterone replacement therapy. Others believe that it is an actual condition and that the associated symptoms are caused by a natural decline in testosterone levels that occurs with age.

There is no definitive test for andropause, as testosterone levels can fluctuate throughout the day and vary from person to person. However, doctors typically diagnose andropause based on symptoms and a blood test. This test measures testosterone levels in the blood and is usually done in the morning. If your doctor suspects testosterone deficiency, they will order a hormone panel or a total testosterone test. The normal range for total testosterone levels in adult men is between 300-1000 ng/dL.

A physical exam may also be performed to evaluate for any signs of testosterone deficiency, such as swelling or shrinkage in the testicles, and to examine the prostate gland. Doctors may also assess bone density.

Doctors will consider symptoms as crucial factors in diagnosing andropause and testosterone deficiency.

Experts have proposed that the presence of three sexual symptoms –  decreased libido, fewer morning erections, and erectile dysfunction – combined with a total testosterone level of less than 11 nmol/l and a free testosterone level of less than 220 pmol/l can be considered the minimum criteria for the diagnosis of andropause.

While there is no consensus on how to diagnose andropause, most medical professionals agree that men experiencing symptoms should consult with their doctor to explore potential treatments and determine the underlying cause of their symptoms.

Doctors also agree that “depression, hypothyroidism, chronic alcoholism, and use of medications such as corticosteroids, cimetidine, spironolactone, digoxin, opioid analgesics, antidepressants, and antifungal agents should be excluded before making a diagnosis of late-onset hypogonadism [andropause].” 

 Hypothyroidism and andropause

Hypothyroidism and andropause are related in the sense that hypothyroidism is associated with lower testosterone levels. The hormonal changes caused by hypothyroidism can decrease the production of sex hormones, such as testosterone, in both men and women.

The thyroid can affect testosterone levels in several ways. Testosterone is produced by Leydig cells in the testes, and thyroid hormone signals partially control these cells’ activity. So, when the thyroid hormones are low, the activity of the Leydig cells decreases, leading to a decrease in testosterone levels.

Thyroid-stimulating hormone (TSH) affects the metabolism of testosterone. A higher TSH level can lower levels of free and bound testosterone.

Men with hypothyroidism tend to have lower levels of Sex Hormone-Binding Globulin (SHBG). SHBG, a protein made by the liver, binds to testosterone, DHT, and estrogen and helps ensure these hormones reach tissues throughout the body. When SHBG levels are low in hypothyroidism, the testosterone that reaches tissues is lowered.

Hypothyroidism can lower free testosterone in the body by throwing off the balance of many other hormones related to testosterone, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH). 

According to experts, thyroid hormone replacement therapy can reverse low testosterone levels triggered by hypothyroidism. In fact, a study has shown that low free testosterone levels due to hypothyroidism can be normalized when hypothyroidism is optimally treated. Thyroid treatment should be considered a first-line treatment in men with andropause who have hypothyroidism.

When hypothyroidism is treated with thyroid hormone replacement therapy, the activity of the Leydig cells is reactivated, leading to an increase in testosterone levels. This is because the thyroid hormones stimulate the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by the pituitary gland, which in turn stimulates the Leydig cells to produce more testosterone. Thus, the treatment of hypothyroidism can improve testosterone levels in males.

A healthy lifestyle – including regular exercise, a balanced diet, getting enough sleep, and stress management techniques like meditation or yoga – can also help alleviate symptoms associated with andropause. Additionally, medications such as antidepressants or erectile dysfunction medications may be prescribed to address specific symptoms of andropause.

 Testosterone replacement therapy

If thyroid hormone replacement therapy and other related treatments don’t resolve severe andropause symptoms, doctors may recommend hormone replacement therapy (HRT) with testosterone. Testosterone therapy involves supplementing testosterone levels through injections, gels, or patches.

The pros of testosterone therapy for andropause include improved muscle mass and strength, increased bone density, improved libido, and sexual function, increased energy levels, and improved mood.

Some anecdotal evidence shows men saying they feel better and more energized when taking testosterone replacement. However, there is limited research to support these claims.

However, there are also several potential cons of testosterone therapy, such as an increased risk of benign and cancerous growth of the prostate, sleep apnea, acne, and breast enlargement. Other possible side effects may include infertility, mood swings, and the development of blood clots. Additionally, testosterone therapy may increase the risk of heart attacks and strokes in older men, so weighing the potential benefits and risks before starting this treatment is essential.

 A note from Paloma

Andropause is a natural and inevitable condition that affects many men as they age. Understanding the symptoms and treatment options is critical to getting the right help and support to manage the condition effectively.

If you have symptoms of andropause, Paloma Health can help by testing your thyroid levels with a convenient at-home thyroid blood test to determine if a thyroid disorder is behind your symptoms. Paloma’s panel evaluates Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (Free T3), Free Thyroxine (Free T4), and Thyroid Peroxidase (TPO) antibodies. If your lab results indicate hypothyroidism, a  top thyroid doctor from Paloma Health can make a diagnosis and create a personalized thyroid treatment plan to help you get back on track.

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References:

NHS Choices. The “male menopause.” NHS. Published 2019. https://www.nhs.uk/conditions/male-menopause/

Team YM. Why Is There a Steady Decrease in Testosterone Levels of Men in the U.S? Yunique Medical. Published April 21, 2022. https://yuniquemedical.com/testosterone-levels-in-men/

Singh P. Andropause: Current concepts. Indian J Endocrinol Metab. 2013 Dec;17(Suppl 3):S621-9. doi: 10.4103/2230-8210.123552. PMID: 24910824; PMCID: PMC4046605. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/

Schwarz ER, et al. Andropause and the development of cardiovascular disease presentation—more than an epi-phenomenon, 2011 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390065/

Meikle AW. The interrelationships between thyroid dysfunction and hypogonadism in men and boys. Thyroid. 2004;14 Suppl 1:S17-25. doi: 10.1089/105072504323024552. PMID: 15142373. https://pubmed.ncbi.nlm.nih.gov/15142373/

Dirlikov B, Lavoie S, Shem K. Correlation between thyroid function, testosterone levels, and depressive symptoms in females with spinal cord injury. Spinal Cord Ser Cases. 2019 Jun 27;5:61. doi: 10.1038/s41394-019-0203-y. PMID: 31632719; PMCID: PMC6786294. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786294

Crawford M, Kennedy L. Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment. Translational Andrology and Urology. 2016;5(6):850-858. doi:https://doi.org/10.21037/tau.2016.09.01 https://tau.amegroups.com/article/view/11917/html

Ambigapathy JS, Kamalanathan S, Sahoo J, Kumar R, Perumal NL. Effect of Thyroxine 
Replacement on Leydig Cell and Sertoli Cell Function in Men with Hypothyroidism. Indian J Endocrinol Metab. 2020 May-Jun;24(3):265-269. doi: 10.4103/ijem.IJEM_69_20. Epub 2020 Jun 30. PMID: 33083267; PMCID: PMC7539029. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539029/

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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