The role of hypothyroidism in male infertility and erectile dysfunction

You should arrange to have your blood tested around three months after delivery and at intervals thereafter. If you stopped taking antithyroid drugs during your pregnancy you should see your doctor if you notice any symptoms of hyperthyroidism. Thyroid dysfunction is an important factor in the pathogenesis of sexual dysfunction in men and possibly women. Evidence suggests a reversibility of sexual dysfunction with correction of thyroid dysfunction, though the exact pathophysiology of thyroid-mediated sexual dysfunction remains unknown. However, current evidence supports thyroid derangements rather than autoantibodies as the causative factor in men, while autoantibodies appear to play a more prominent role in women.

Subclinical Hypothyroidism in Women

However, studies vary on the strength of correlation between hormonal derangement and level of sexual dysfunction. In both hyper- and hypothyroid men, treatment of thyroid disorder at least partially reverses sexual dysfunction. In contrast, the current literature provides no consensus on the effect of hypothyroidism, hyperthyroidism, or Hashimoto’s thyroiditis on female sexual function. In studies that observed increased rates of sexual dysfunction in women with thyroid disorders, correction of the thyroid derangement resulted in resolution of some sexual dysfunction. Studies are also conflicted on whether there is a relationship between degree of sexual dysfunction and degree of hormone derangement in women.

In conclusion, although the screening of thyroid function is not recommended to dateas part of the diagnostic workup of the infertile male, it might be reconsidered inlight of the physiopathological background, provided that the evidence is furtherconfirmed by multicentric studies on larger and homogeneous cohorts. Indeed, bothhyperthyroidism and hypothyroidism are common in the general population, with aprevalence of 1% and at least 6%, respectively. Postpartum thyroiditis, a temporary inflammatory thyroid disorder, occurs following 5-10% of pregnancies and is typically found in women with thyroid auto-antibodies. It usually starts with symptoms of an overactive thyroid (hyperthyroidism), which can resolve by itself but may develop into symptoms of an underactive thyroid (hypothyroidism). If you develop hypothyroidism you may feel tired, lethargic, depressed and cold, and your skin may be dry. Most women are able to stop taking these tablets after six to twelve months, but around a third of women develop permanent hypothyroidism and need levothyroxine treatment in the long term.

Pregnancy and hyperthyroidism

  • These changes result in decreased testosterone level and altered seminal plasma components which affect semen quality.
  • Taken together, these studies demonstrate the lack of consensus in the association of hyperthyroidism and ED.
  • Thyroid hormones and their impacts on male reproduction have been reported in numerous studies in past few decades.
  • In both cases, fertility issues like reduced sperm count and poor sperm quality are common, which is why seeking medical advice for these symptoms is important.

A thyroid blood test is essential for diagnosing thyroid imbalances that may impact male fertility. This test helps identify conditions like hypothyroidism or hyperthyroidism, both of which can disrupt hormone levels and sperm health. The good news is that many thyroid-related fertility challenges are manageable with the right fertility treatment and lifestyle adjustments. Regular monitoring through a thyroid blood test can aid in early detection and effective management, ensuring better reproductive health outcomes.

  • An excess or deficit of thyroid hormones not only alter the testicular functions but also interrupts neuroendocrine axis through the crosstalk between hypothalamic-pituitary-thyroid (HPT) axis and hypothalamic-pituitary-gonadal (HPG) axis.
  • A healthy thyroid gland supports overall male reproductive health by ensuring normal sperm count and sperm motility.
  • Thus, there is conflicting information on whether hyperthyroidism affects female sexual function, with two studies finding a relationship and one failing to find a relationship (Table 5).
  • We discuss the impact of correcting thyroid derangements and the pathophysiologic basis of thyroid hormone on the genitalia, and suggest future directions for research into the impact of thyroid disease on sexual functioning.
  • In our studies, we too report a similar positive feedback effect of raised estradiol levels on LH secretion; suggesting a key role of estrogen in regulating serum gonadotropin levels.
  • You should arrange to have your blood tested around three months after delivery and at intervals thereafter.

Furthermore, leptin, which is produced by adipocytes and regulates food intake and energy storage, influences the hypothalamus–pituitary–thyroid axis by regulating the expression and stimulating thyrotropin-releasing hormone (TRH) 11, 12. Thyroid function should be carefully monitored in both male and female, in couples seeking spontaneous pregnancy as well as ART, as treatment is generally immediate and likely to improve chances of success. Secretion of thyroid releasing hormone (TRH) from hypothalamus causes downstream secretion of thyroid stimulating hormone (TSH) from anterior pituitary then T3 and T4 from thyroid.

Other causes, such as toxic multinodular goiter and toxic adenoma, as well as subacute thyroiditis, are less common, and others are very rare. It is, therefore, important to distinguish these clinical manifestations to apply an adequate treatment. First, criteria used to diagnosesemen abnormalities were frequently different from study to study. Second, inseveral studies, cohorts included men from infertile couples, namely, patients withlow semen quality for reasons other than thyroid dysfunction. Third, studiesperformed so far have enrolled small cohorts of patients, hence lowering theirstatistical power. In men, hyperthyroidism can cause a marked reduction in sperm count, resulting in reduced fertility.

EXPRESSION OF THYROID HORMONE RECEPTORS ON TESTIS, REPRODUCTIVE TRACT AND ACCESSORY SEX GLANDS

However, it should be noted that three recent large prospective cohort studies showed no significant associations between TAI and risk for premature delivery 75–77. Increased risk of other complications in TAI-positive women was reported, such as perinatal death 77, placental abruption 78, and postpartum depression 79. The prevalence of overt and subclinical hypothyroidism in the general population is about 0.3–0.4% and 4.3–8.5%, respectively, and it is mainly due autoimmune disease, thyroid surgery and effects of radiations or medications 9. The prevalence in pregnancy is estimated at 0.3–0.5% and 2–3% (or even up to 5%), respectively 9.

Leydig cells

Therefore, Clyde concluded that male infertility is more common than previously thought in males with hyperthyroidism, possibly in correlation with elevated levels of testosterone, LH, and FSH. Hudson and Edwards (27) after conducting study on human subjects stated adverse effects of hyperthyroidism on spermatogenesis by altering sex steroid levels (27). Similarly, Krassas and Perros claimed adverse effects of hyperthyroidism on seminal parameters of human subjects (21). Most calcitriol synthroid of the studies concerning hyperthyroidism were conducted on human subjects with only one conducted on rats. Rijntjes et al., in their study on rats concluded that hyperthyroidism delays Leydig cell development and adversely affects spermatogenesis (28). In four patients’ serum testosterone and SHBG concentrations were found to be less than normal.51Later, Corrales Hernandez and Miralles Garcia investigated spermatogenesis in ten patients who had a history of hypothyroidism and was treated with T4.

Sexual Dysfunction Outcomes After Normalization of Hormone Levels in Hypothyroid Men

Conversely, hypothyroidism or an underactive thyroid can result in a low sperm count, poor semen parameters and decreased testicular function. Men with this condition may experience symptoms such as erectile dysfunction and reduced testosterone levels. However, through thyroid hormone replacement therapy, thyroid levels can be normalised, enhancing both sperm production and overall reproductive health. Patients with primary hypothyroidism show delayed Sertoli cell maturation, with normalization when euthyroidism is restored 103–105, together with Leydig cell function impairment, causing a decrease in androgen production, cell maturation and hCG binding sites 103, 106.

There is extreme heterogeneity across existing studies, with a variety of factors possibly influencing the findings. The main reason is that the definition of “normal thyroid function” and “subclinical hypothyroidism” has been changed during the time. Accordingly, the decision on whether to start treatment with levothyroxine or not, due to TSH cutoff definition, may differ. The definitions or criteria of final outcomes in different studies were often unclear or missing and the study designs were miscellaneous. Contributing factors as patient age, body mass index, previous IVF attempts, infertility cause, are all of great significance for the outcome. Furthermore, the protocol type used in the IVF cycle potentially may influence the outcomes, due to the well-known impact on thyroid function, and the data on fertilization method are frequently imprecise.