Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormone for normal body function. Subclinical hypothyroidism is defined as a blood test result of thyroid stimulating hormone (TSH) being slightly above the normal range but below the range of a hypothyroid diagnosis. The diagnosis and possible treatment of subclinical hypothyroidism as it relates to low testosterone levels remains a controversial subject in medicine. While some doctors debate how to treat this problem, and further, if to treat it at all, some doctors are publishing research to suggest a connection between the thyroid and testosterone levels and the impact on aging men’s health.
“Androgen deficiency (low testosterone) negatively affects the risk factors of cardiovascular disease in men with hypothyroidism.”
A January 2020 study (1) suggests: “Long-term androgen deficiency (low testosterone) in men with hypothyroidism is an important problem due to the fact that it leads to concomitant cardiac pathology, which remains the leading cause of mortality in the world. The presence of different points of view on the problem of androgen deficiency (low testosterone) and its effect on the risk factors for cardiovascular disease in patients with hypothyroidism attracts attention.”
In this study, researchers assessed the clinical signs of age-related androgen deficiency and their association with cardiovascular risk factors in men with hypothyroidism. 84 patients were examined, 38 of them – with hypothyroidism and age-related androgen deficiency, 46 patients with hypothyroidism and normal testosterone levels.
What did the researchers find? “The decrease of testosterone level in men with hypothyroidism is accompanied by an increase in the frequency of abdominal obesity, triglycerides and glucose escape (rise of blood glucose levels), and is associated with subclinical depression. In men with hypothyroidism and androgen deficiency (low testosterone) , the average blood pressure in the daytime significantly exceeds the similar rates in patients with hypothyroidism and normal levels of testosterone.”
Conclusion: “The presence of androgen deficiency (low testosterone) negatively affects the risk factors of cardiovascular disease in men with hypothyroidism.”
Metformin. Low Testosterone, Hypothyroidism and Type 2 Diabetes
A February 2020 (2) study suggests that metformin (Type 2 diabetes medication) impacts thyrotrope function (the production of Thyroid Stimulating Hormone (TSH))..
The study consisted of 2 groups of men with non-autoimmune hypothyroidism. The groups were matched by age, weight, insulin sensitivity, and thyrotropin levels.
The first group of 11 men included subjects with low serum testosterone levels, while the second, with 12 men, had testosterone levels within the reference range.
Because of concomitant type 2 diabetes, all men were treated with metformin (2550-3000 mg daily).
Circulating levels of glucose, prolactin (the hormone implicated in men having difficulty in maintaining or achieving an erection), testosterone, gonadotropins (luteinizing hormone (LH), and follicle-stimulating hormone (FSH) which stimulate the testes, make sex hormones, and are essential for reproduction), thyrotropin, and free thyroid hormones were measured
In both study groups, metformin decreased plasma glucose levels and improved insulin sensitivity. However, only in men with low testosterone levels, the drug decreased thyrotropin levels, reduced Jostel’s thyrotropin index (also called Thyroid Function Index), and increased SPINA-GT (the secretion of thyroid hormone).
The complexity of balance between managing type 2 diabetes, low testosterone, and hypothyroidism is clearly seen in this study. Men in this study with low testosterone and hypothyroidism suffered from different problems, including erectile dysfunction. The second group moved towards hyperthyroidism and a different set of problems. The researchers concluded: “The obtained results suggest that the impact of metformin on thyrotrope function depends on the androgen status of a patient.” Your thyroid and testosterone are linked.
The connection between subclinical hypothyroidism and Erectile Dysfunction
A recent 2018 study (3) documents that Erectile dysfunction is highly prevalent and hypothyroidism is related with Erectile dysfunction. However there have not been many studies that investigated the association between subclinical hypothyroidism and Erectile dysfunction. This research sought to full this understanding gap.
One hundred nine Erectile dysfunction patients and 32 healthy controls were included in this study. What the researchers were looking for was subclinical hypothyroidism in the Erectile Dysfunction group.
In the study group about 3 in 10 men of the erectile dysfunction males (29.36%) had subclinical hypothyroidism and about 2 out of three erectile dysfunction males had euthyroidism 66% (elevated thyroid-stimulating hormone levels causing some type of thyroid dysfunction).
The IIEF-5 scores (a survey that asks among other questions, a patient’s confidence and ability to get and maintain an erection during intercourse) in Erectile dysfunction patients with subclinical hypothyroidism were significantly lower (worse) than the controls with euthyroidism.
The serum concentrations of TSH and prolactin were significantly higher, and, free thyroxine lower in Erectile dysfunction patients with subclinical hypothyroidism when compared with the controls with euthyroidism. (Low thyroid condition).
Conclusion: “subclinical hypothyroidism is common in Erectile dysfunction patients and may be associated with Erectile dysfunction . . .Screening for thyroid dysfunction in men presenting with Erectile dysfunction is recommended.
A March 2020 study in the Journal of Clinical Medicine (4) supported these findings suggesting: “Levothyroxine therapy is associated with an improvement of the erectile function at the vascular level, a decrease in mean platelet volume (mean platelet volume increase is a marker for vascular disease, it is an increase in blood platelets) and total cholesterol. Levothyroxine therapy should be considered in patients with arterial erectile dysfunction and subclinical hypothyroidism.”
Treating subclinical hypothyroidism
As shown in the research above the recommendation to treat and how to treat the subclinical hypothyroidism should be based on clinical judgment, clinical practice guidelines, and expert opinion. The complexity of this subject requires examination, blood work, and other tests to determine a course of treatment. At the Magaziner Center for Wellness we also try to identify factors that may be adversely affecting the thyroid gland such as environment chemicals or heavy metals, and look for nutrient imbalances or food sensitivities. We then treat these areas to build up the body’s innate healing mechanisms. Since the thyroid is part of the endocrine system and many chemicals contribute to dysfunction of these glands, we educate our patients about exposure to environmental factors that may impair thyroid function. We also assess and treat for bio-energetic weaknesses that can also help to improve thyroid function.
If you would like to explore more information, please contact our office so we can start a conversation with you.
1 Krytskyy T, Pasyechko N, Yarema N, Naumova L, Mazur L. Influence of age related androgen deficiency on the risk factors of cardiovascular diseases in men with hypothyroidism. Georgian Med News. 2020;(298):105–109.
2 Krysiak R, Szkróbka W, Okopień B. The Impact of Testosterone on Metformin Action on Hypothalamic-Pituitary-Thyroid Axis Activity in Men: A Pilot Study. J Clin Pharmacol. 2020;60(2):164–171. doi:10.1002/jcph.1507
3 Chen D, Yan Y, Huang H, Dong Q, Tian H. The association between subclinical hypothyroidism and erectile dysfunction. Pak J Med Sci. 2018 May-Jun;34(3):621-625. doi: 10.12669/pjms.343.14330. PMID: 30034427; PMCID: PMC6041544.
4 Cannarella R, Calogero AE, Aversa A, Condorelli RA, La Vignera S. Is There a Role for Levo-Thyroxine for the Treatment of Arterial Erectile Dysfunction? The Clinical Relevance of the Mean Platelet Volume. Journal of clinical medicine. 2020 Mar;9(3):742.