The interaction between thyroid hormones and androgens is important for maintaining hormonal balance. Both androgens like testosterone and DHEA play roles in reproductive health and metabolism, while thyroid hormones are also involved in metabolism, fertility, and energy.
Current research suggests a relationship between androgens and thyroid hormones. In this article, we will explore the connection between these two hormonal systems and their potential impact on health.
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Androgens and Thyroid Hormones: A Clinical Overview
Androgens are a group of steroid hormones that contribute to sexual and reproductive development in both men and women. The main androgens in the body include testosterone, DHEA, dihydrotestosterone (DHT), and androstenedione. These hormones not only influence sexual and reproductive health but also affect cardiovascular health, metabolism, muscle mass, bone health, and brain health (5).
Thyroid hormones include a group of hormones such as thyroid releasing hormone (TRH), thyroid stimulating hormone (TSH), T3 & T4. The thyroid hormone process begins in the hypothalamus where TRH is released. TRH signals the pituitary to release TSH, which then signals the body to produce mainly T4 and a small amount of T3. If the body is functioning properly, T4 is converted to T3, the active form of thyroid hormone. Active T3 supports metabolism, bone growth during childhood, fertility, and ovulation (41).
Clinical Implications of Androgens on Thyroid Function
The relationship between androgens and thyroid hormone is less commonly discussed. Both androgens and thyroid hormones play roles in regulating metabolism, energy, and reproductive function. Research suggests that individuals with low testosterone who receive testosterone therapy may experience a decrease in thyroid autoimmunity antibodies. This suggests that testosterone therapy might be supportive in those with thyroid autoimmunity (28).
Impact of Thyroid Dysfunction on Androgen Levels and Health Outcomes
Having too much or too little thyroid hormone can affect the amount of circulating testosterone, the main androgen in our body. Testosterone is produced in response to the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland in the brain in both men and women (in different amounts between genders). A small percentage of testosterone is known as free testosterone, which works directly on the body to support metabolism and muscle mass. The majority of testosterone is bound to sex hormone-binding globulin (SHBG) (24, 33).
SHBG is a key factor in the interaction between androgen production and thyroid hormone. Thyroid hormone is known to affect SHBG concentrations. Research has shown that individuals with hypothyroidism may have lower levels of SHBG, resulting in lower levels of total serum testosterone. Conversely, hyperthyroidism may result in an elevation of mean total testosterone and SHBG, leading to a decrease in free testosterone (23).
Women with thyroid-androgen imbalance may have an increased risk of other endocrine issues such as PCOS. Research suggests that women with hypothyroidism may have an increased risk of developing cystic ovaries due to elevated TSH and prolactin levels. When prolactin increases, it can affect ovulation and increase adrenal DHEA production, contributing to the formation of polycystic ovaries. As we can see, the impact of thyroid dysfunction on androgen levels is complex and can result in several other endocrine issues (42).
Identifying Signs of Androgen-Thyroid Imbalance in Patients
Signs & symptoms of androgen-thyroid imbalance may include: (28, 31, 45)
- Fatigue
- Decreased sex drive
- Depression
- Infertility
- Decrease in hair growth
- Decrease in muscle mass
- Development of breast tissue (gynecomastia) in men
- Difficulty concentrating and hot flashes
- Erectile dysfunction in men
- Osteoporosis
- Menstrual abnormalities in women
Etiology of Androgen-Thyroid Imbalance: A Clinical Perspective
Androgen-thyroid imbalance can result from various factors. Two common autoimmune disorders that impact the thyroid are Hashimoto’s Thyroiditis, which can lead to hypothyroidism, and Graves’ Disease, which can lead to hyperthyroidism. Both of these conditions can result in an imbalance of thyroid hormone in the body, affecting androgen levels (37).
What causes thyroid autoimmunity? Research currently points towards several environmental factors and endocrine disruptors that may contribute to thyroid autoimmunity. There is a higher prevalence of autoimmune thyroid disorders among individuals living near chemical plants or exposed to organochlorine pesticides, aluminum, mercury, and vanadium (4).
Diagnostic Approaches to Androgen-Thyroid Imbalance
Diagnosing imbalances in androgen and thyroid hormones requires an integrative approach consisting of blood tests, patient history analysis, and sometimes imaging studies. To accurately assess a thyroid hormone imbalance, a healthcare provider may run a complete thyroid panel, which includes TSH, T4 & T3 (total and free), and antithyroglobulin and thyroid peroxidase antibodies (13).
Diagnosis of androgen imbalance is conducted by measuring free and total testosterone, DHEA-S, and SHBG. To gain the best insight into a patient's hormonal status, LH, FSH, progesterone, and prolactin may be ordered to rule out other causes of hormonal imbalance (18).
In cases where possible thyroid issues are suspected, physicians can order a thyroid uptake and a scan to help differentiate between toxic goiter, Graves’ disease, and thyroid cancer. (26)
Clinical Management of Androgen-Thyroid Imbalance
Management of patients with androgen-thyroid imbalances involves a multidisciplinary approach. Starting with lifestyle, research suggests individuals with poor sleep quality and smoking may have an increased chance of developing autoimmune thyroid conditions, which could lead to an imbalance in androgen levels (52).
If a patient is diagnosed with hypothyroid or hyperthyroid disorders with androgen imbalance, treating them with the appropriate medication to achieve a balanced thyroid state may help bring testosterone levels back into a typical range. (24)
It is important to educate patients with thyroid-androgen imbalance that thyroid conditions can respond well to appropriate treatment. Patients should understand the goal of treatment is to align their androgen and thyroid levels within the reference range to help alleviate symptoms (34).
Monitoring Hormonal Health: A Guide for Practitioners
When undergoing hormone therapy, it is crucial to have continued hormone monitoring to ensure the treatment prescribed is effective in supporting hormonal balance. It is common when treating hormones to need to adjust the dosage to avoid unnecessary side effects caused by improper hormone levels.
When treating hypothyroidism, it is suggested for adults taking levothyroxine to receive laboratory work (thyroid panel) every 3 months until symptoms have stabilized. Patients with hyperthyroidism on antithyroid drugs are advised to receive a thyroid panel every 6 weeks until labs are within the reference range and then every 3 months for continued treatment. When working with patients who have androgen imbalance as a result of thyroid conditions, physicians will monitor androgen levels alongside thyroid hormones to ensure treatment is progressing in the correct direction (35).
Challenges in Clinical Management of Hormonal Imbalances
Diagnosis of androgen-thyroid imbalance is complex due to variations in patient presentation. Patients presenting with androgen-thyroid imbalance may exhibit a wide range of symptoms, requiring practitioners to rule out other endocrine issues. Patients with abnormal androgen and thyroid levels may need further evaluation to rule out pituitary issues such as prolactinoma or adrenal disorders such as Cushing disease (17).
Supporting Hormonal Balance Through Lifestyle Interventions
Lifestyle factors such as diet, sleep, stress, and exercise can contribute to hormonal balance. While conventional doctors may prescribe medication, there are several lifestyle interventions that may support hormone balance. Research suggests that participating in stress reduction therapies such as yoga, cold immersion baths, and meditation can help support hormone balance. Additionally, including dietary antioxidants such as zinc, selenium, vitamin C, carotenoids, and CoQ10 may be effective in supporting hormone levels (20, 34)
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Key Takeaways
Managing patients with androgen-thyroid imbalances presents complex challenges, and a thorough evaluation is needed to rule out all possible endocrine issues.
In patients with androgen and thyroid imbalance, an in-depth physical exam, clinical history, and evaluation to rule out pituitary dysfunction, adrenal disease, and genetic factors are crucial.
It is important for patients to be under the care of a trained healthcare provider when undergoing hormone therapy.
For healthcare providers, staying up to date on the current guidelines for androgen-thyroid imbalance is important due to new and ongoing research in this area.
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