How Thyroid Disease Affects Men

In honor of Father’s Day, I want to recirculate my original Men’s Health article — with some updates. This article is dedicated to all of the special men in your life.

(I have some very special men in my life as well — my hubby Michael, my son Dimitry, my dad, my brother, my father-in-law, and some dear friends… Happy fourth Father’s Day, Michael!)

You may have seen this article last year, around this time — some things have changed! My baby, Dimitry, is now a three year old. I can’t believe this tiny little baby boy will one day be a man!

It may not come as a surprise to you to hear that thyroid disease affects women more frequently than men. After all, statistics state that five to eight women are diagnosed with Hashimoto’s thyroiditis, for every man who is diagnosed.

Hormones are thought to play a role in the development of Hashimoto’s, but I also think there are numerous other reasons why women may be more frequently affected. (I’ve written an entire article about my Safety Theory that explains why women have more thyroid disease.)

It’s no wonder that we often think of hypothyroidism as a woman’s disorder, but the truth is that there are many men out there, right now, who may be reading this and dealing with the many symptoms of thyroid disease.

In this article, I’d like to shed some light on the less-talked-about issue of Hashimoto’s and thyroid disease in men, including:

• Causes of thyroid dysfunction
• Symptoms specific to men
• Symptoms common in the greater population
• Thyroid testing
• Interventions to feel better

Thyroid Symptoms Specific to Men

There are two types of conditions that affect the thyroid’s ability to perform, both resulting from an autoimmune process in the body, when the immune system begins to recognize different parts of the thyroid gland as foreign invaders.

1. Graves’ disease is a condition that results in hyperthyroidism, or an overabundance of thyroid hormone. Classical symptoms include weight loss, palpitations, anxiety, eye bulging, tremors, irritability, hormonal disturbances, fatigue, heat intolerance, diarrhea, and increased appetite. Patients often experience hair loss. Men with this condition often report rapid unwanted weight loss/muscle loss, muscle pain, irritability, and mood changes as well.
2. Hashimoto’s disease is a common condition that results in hypothyroidism, or an underactive thyroid. Classical symptoms may include a slowed metabolism, weight gain, forgetfulness, feeling cold or cold intolerance, depression, fatigue, dry skin, constipation, loss of ambition, hair loss, muscle cramps, stiffness, joint pain, a loss of the outer third eyebrow, hormonal irregularities, infertility, and weakness.

In the case of hypothyroidism, there are several symptoms that will be most apparent in men:

Slowed Metabolism: Hypothyroidism slows down the metabolic rate and impairs the release of enzymes, leading the body to store more calories than it expends. Men are often frustrated seeing weight gain despite their usual food and fitness regimens, and will often have difficulty losing weight with diet and fitness changes alone.

Cold Intolerance: The thyroid acts as a thermostat, maintaining the body’s temperature. A slowed metabolism (as mentioned above) may result in less heat production and an overall slightly lower body temperature. Another side effect of turning down the metabolic fire is that the person becomes intolerant to cold temperatures. Many years ago, physicians used to diagnose hypothyroidism based on a person’s temperature, before more advanced and accurate screening tests became available.

Mental Impairment: Hypothyroidism causes a generalized slowing of metabolic processes and can affect cognition. While the mechanism is not clearly understood, some patients present with decreased blood flow and oxygen to the brain, and some research has suggested that neural pathways may be affected by thyroid disease as well. Symptoms may include impaired attention and concentration, memory loss, slowed perceptual and visuospatial function, and impaired language and executive function (multi-tasking abilities).

Dry Skin: As I mentioned in a Men’s Health article about thyroid disease, rough, cool, and pale skin are features of an underactive thyroid. This is partially due to decreased blood flow and a slower turnover of skin cells. People often see a reduction in sweating as the body’s metabolic fat burning is turned off. Meanwhile, some develop a yellowish tint to their skin, due to impaired conversion of vitamin A.

Constipation: Hypothyroidism results in slowed and decreased gut motility, which often presents as constipation. Because of delayed gastric emptying and motility, about 50 percent of people with hypothyroidism may develop small intestinal bacterial overgrowth (SIBO), which may contribute to constipation, bloating and irritable bowel syndrome.

Hair Loss: Some men with hypothyroidism may experience hair loss, including loss of hair in the outer third eyebrow area, and difficulty growing facial hair, aka “I can’t grow a beard syndrome.” Hair may become more coarse, and the nails more brittle, due to slower turnover of cells, reduced blood flow, and access to nutrients.

Mood Challenges: Some individuals report that thyroid disorders can produce changes in mood, such as depression, irritability, aggression, and even mania. This could be due to the fluctuation of thyroid hormones, or due to the presence of thyroid antibodies.

Muscle and Joint Pain: Hypothyroidism can lead to numerous symptoms such as joint pain, weakness, aches, stiffness, muscle cramps, and carpal tunnel, as well as a higher incidence of gout, likely caused by reduced kidney function. Up to 79 percent of people with hypothyroidism may present with muscle complaints. This could be due to an abnormal accumulation of glycogen and changes in muscle enzymes activity due to the hypometabolic effects. At times, the muscle pains can be exacerbated by exercise.

Hormonal and Sexual Dysfunction: Hypothyroidism can have a direct effect on the hypothalamus or pituitary gland, interfering with testosterone production. This can lead to symptoms such as:

• Low libido
• Infertility
• Low testosterone
• Erectile dysfunction
• Reduced frequency of morning erections
• Reduced muscle mass

Thyroid issues can increase the decline in sex hormone production. Both our sex and thyroid hormones are part of an overall hormone communications network in our body, referred to as the HPA (Hypothalamic-Pituitary-Adrenal) axis. A sluggish thyroid can reduce the production of sexual hormones required for optimal sexual function and a healthy libido.

Many of the common symptoms of thyroid disease, such as hair loss and weight gain, can exacerbate the self-esteem, low energy, and sexual performance issues, often seen with low libido as well.

Studies have found that 64 percent of men with hypothyroidism presented with low libido, erectile dysfunction, sperm abnormalities, and delayed ejaculation. In men, free testosterone levels peak in their 20s and decline by about one percent per year in their 30s. Symptoms linked to low testosterone include low libido, as well as a number of symptoms that are also seen in menopause (such as mood swings, anxiety, and depression).

Men may suffer from erectile dysfunction (ED) as well. The good news is that most men’s testosterone levels and sperm morphology can normalize with proper treatment with thyroid hormones. I’ve also written an article on low libido and Hashimoto’s, which includes information for both men and women.

High Cholesterol: High cholesterol is found in 56 percent of people with hypothyroidism. One’s metabolism is responsible for eliminating triglycerides and cholesterol from the body — a process that is slowed in the case of hypothyroidism. This can result in elevated cholesterol and triglycerides. Treatment with thyroid hormones can aid with normalizing these levels, sometimes without the need to use additional cholesterol or lipid-lowering medications.

Causes of Thyroid Disorders in Men

There are many triggers for thyroid disorders that are common in all populations, including underlying infections, a stressful event, a compromised gut, and toxins. I encourage you to take a look at my book Hashimoto’s: The Root Cause for more information. But, there are a few root causes that may be specific to men and shouldn’t be ignored.

Testosterone Levels

Low testosterone could be a trigger, an exacerbating factor, and even a consequence, of thyroid disease.

Some symptoms of low testosterone may include fatigue, weight gain, irritability, overwhelm, hair loss, low libido, depression, loss of executive function, a reduced frequency of morning erections, difficulty in growing facial hair, erectile dysfunction, fertility issues, frequent muscle aches, as well as a loss of muscle mass.

A new onset of moodiness or worsening of moodiness may also be a sign that testosterone levels are off. “Irritable male syndrome” is a recently coined term that describes mood changes that occur in men with low testosterone.

In some men with low testosterone, normalizing thyroid hormones can actually normalize testosterone levels. In some cases, prescription testosterone and/or DHEA may also be a beneficial therapy for reducing overall symptoms.

Male hormones are thought to play a protective role in the development of Hashimoto’s, and men with low testosterone are more likely to be diagnosed with Hashimoto’s, while men with hyperthyroidism are more likely to have elevated levels of testosterone.

Family History

Thyroid conditions do have a genetic component, and having a male parent with thyroid disease increases your likelihood of having a thyroid condition, even more so than having a female relative with thyroid disease. I have written an article on the role of genetics and thyroid disorders, if you’d like to explore this topic further.

Postpartum

New moms are a high risk group for developing thyroid issues. This is known as postpartum thyroiditis. Oddly enough (and far more rarely), new dads can develop postpartum thyroid issues as well. More accurately, they can develop “sympathetic” postpartum thyroiditis, where they will develop changes in thyroid function after the birth of their children.

A 2015 case report documented the thyroid labs of a man who had recurrent hyperthyroid episodes after three of his wife’s pregnancies! (His wife had Hashimoto’s.) The researchers concluded that: “Documented hormonal changes in men, during postpartum period, whether stress-related or evolutionary in nature, are suggestive of the diagnosis of ‘sympathetic’ postpartum thyroiditis.”

Selenium Deficiency

Selenium deficiency has been found to be a trigger for Hashimoto’s. Numerous studies have been done to support the use of selenium in Hashimoto’s, but there is conflicting data on the connection between selenium and prostate cancer. Some studies have shown that high selenium levels reduce the risk of prostate cancer and that selenium supplements can help prostate cancer; while others have stated that taking a selenium supplement can increase the risk of death in men with prostate cancer. The form of selenium may make a difference, as can the type of cancer.

I recommend annual PSA screenings and prostate exams for all men, starting at age 40. Dr. Geo Espinosa, my go-to prostate cancer doc who goes by the name “the Natural Urology Doctor,” recommends using a high selenized yeast form of selenium in men. I had the chance to talk to him about men’s health in this interview that you may wish to watch for more information.

Thyroid Testing

With thyroid issues (and autoimmunity as a whole) being less common in men, they are often overlooked by doctors. In fact, most men aren’t ever given a thyroid test or panel unless they specifically request the tests.

If you suspect that you may have a thyroid condition, the first step is to get the right tests.

There are many blood tests that can be done to assess thyroid function, and I have found the following tests to be the most useful: TSH, free T3, free T4, and thyroid antibodies, along with a thyroid ultrasound.

For an article on the most accurate tests to ask for, please read my article on the top 10 thyroid tests.

Interventions

Once a thyroid condition has been identified, the good news is that there are many interventions that can treat or bring the condition into remission.

Optimizing Thyroid Medication

Thyroid hormones can normalize testosterone levels for many men. In some cases, prescription testosterone and/or DHEA may also be a beneficial therapy for reducing symptoms and/or thyroid antibodies. DHEA has been found to reduce thyroid antibodies in women with PCOS, and another study found that DHEA can normalize abnormal immune cells that are present in Hashimoto’s and Graves’.

Addressing Food Sensitivities

Reactive foods trigger an inflammatory response in the GI tract, leading to malabsorption of nutrients (gluten sensitivity, in particular, has been implicated in causing a selenium deficiency, a well-known risk factor for Hashimoto’s), and can also produce intestinal permeability whenever they are eaten.

Most people will see a dramatic reduction in gut symptoms, brain symptoms, skin breakouts, and pain by eliminating the foods they are sensitive to. Some will also see a significant reduction in thyroid antibodies. An additional subset of people will be able to get their Hashimoto’s into complete remission just by getting off the foods they react to, and normalizing their thyroid antibodies. Some may even normalize their thyroid function!

Read more about the role of food sensitivities and the thyroid, including resources on testing for sensitivities.

Supplementing for Nutrient Depletions

Nutrient depletions are always a factor in Hashimoto’s. In fact, I would argue that due to our current farming practices and Western diet, nutrient depletions are a factor for most people!

Eating conventionally grown foods, taking medications and having food sensitivities, gut inflammation, altered gut flora, poor digestion, malabsorption issues, gut infections, and even hypothyroidism in itself, can lead to nutrient depletions.

Even people who are eating organic, nutrient-dense diets are at risk for nutrient deficiencies, as factors like low stomach acid, fat malabsorption, and a deficiency in digestive enzymes will result in many of us not being able to properly break down the nutrients from the foods that we’re eating.

The most common nutrient depletions in Hashimoto’s are selenium, vitamin D, B12, ferritin (the iron storage protein), thiamine, and magnesium.

I recommend that everyone with Hashimoto’s test their vitamin D, B12 and ferritin levels, and address any deficiencies accordingly.

Please note, while deficiencies in ferritin and iron are more common in women of childbearing age than men (women lose iron with menstruation, pregnancy, and childbirth), I do recommend that men test for ferritin as well. Men too, may be deficient in ferritin, and they are at greater risk of elevated ferritin or iron overload, which can cause inflammation.

Selenium, thiamine, and magnesium deficiencies are NOT reliably found on blood testing, and I do not recommend testing before you supplement.

As mentioned above, selenium deficiency, in particular, can be a factor for men with hypothyroidism. Selenium plays a very important role in thyroid function, including acting as a catalyst to convert the inactive T4 to the biologically active T3, and preventing oxidative damage from hydrogen peroxide to the thyroid cells, by forming selenoproteins.

However, there are some precautions to be aware of before you begin supplementing with selenium, and a screening for prostate cancer is generally recommended. A selenized yeast form of selenium is recommended for men who are at risk for prostate cancer.

You can read more about nutrient deficiencies and supplementing, and take a more in-depth look at the role of selenium in thyroid function, in these articles.

Mitigating the Stress Response

When you experience stress, your body goes into “fight or flight response” mode, diverting its attention from healing and digestion, and pumping your body full of adrenaline to prepare it to survive what your body perceives to be a life threatening event. Many people cite a traumatic incident in their lives as the precursor to when their Hashimoto’s symptoms began.

There are three potential stages of adrenal dysfunction:

Stage I – In Stage I, there will generally be too much cortisol production. Your total cortisol level is going to be elevated throughout the day.

Stage II – In this stage, the total cortisol level will be normal, but there will be some abnormalities where it might be high in the morning, then too low in the afternoon, and then high again in the evening. This can produce some annoying symptoms like blood sugar swings, irritability, or an afternoon crash.

Stage III – This is an advanced stage where the adrenals become depleted and do not produce enough cortisol. You’ll be running on empty and have very low levels of cortisol throughout the day. This often leads to chronic fatigue. You can reset your adrenals by getting more rest, limiting caffeine intake, and getting your daily dose of the ABC’s: adrenal adaptogens, B vitamins and vitamin C. The supplement Adrenal Support by Rootcology contains all three of these adrenal tonics that can balance out the adrenals, whether they are over or underactive.

Here are some additional ways to mitigate stress:

• Do your best to eliminate, simplify, delegate, and automate.
• Be more resilient by being more flexible. Bruce Lee once said: “Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind.”
• Do the things that you like.
• Orderliness and predictability are your friends. Catch up your long to-do lists. Make sure you schedule downtime as well.
• Avoid burning the candle at both ends.
• Massage, acupuncture, meditation, or tai chi may help you relax.
• Avoid multitasking. Do one thing at a time and keep your full attention on it before you move on to the next task. Take a small break in between tasks.
• Start a journal, and be mindful of what makes you feel better and what makes you feel worse.

Identifying Chronic Infections

Chronic infections are the Hashimoto’s triggers that get the least amount of attention, yet identifying and treating them can result in a complete remission of Hashimoto’s. Unfortunately, some of the infections can be progressive, leading to more and more symptoms, if not identified and treated accordingly.

Molecular mimicry is one of the leading theories of autoimmune disease. In very simple terms, this theory means that our immune system begins to attack our thyroid gland because we are infected with a pathogenic organism (like a bacteria, parasite, or virus), that looks similar to components of the thyroid gland. The immune system remembers isolated protein sequences on the pathogen (rather than the entire DNA sequence of the pathogen) and then looks for similar-looking proteins as targets for an attack. If the proteins on the thyroid match the proteins the immune system remembered, then the thyroid will be targeted for attack as well. Therefore, the immune system attacks our thyroid glands due to a case of mistaken identity, when it is trying to attack an infection.

The good news is that, once identified, most infections are treatable. Talk to your doctor about testing, or self-order a test.

Take a look at this article for more information about some of the common infections connected to thyroid disorders.

Removing Toxins

Unfortunately, escaping toxins in our environment can be challenging — they’re everywhere! In fact, in 2006, the Centers for Disease Control reported that the average American has 116 out of the 148 commonly tested synthetic compounds in their body.

Whatever we inhale, ingest, and absorb into our skin, eventually ends up circulating in our body. From our cosmetics and skin products to pesticides and exhaust fumes, we’re exposed to thousands of chemicals a day — many of which are especially detrimental to our thyroid health.

Xenoestrogens such as BPA, soy, phthalates, and parabens, for example, are chemicals that mimic the effects of estrogen. These chemicals may increase TSH and perpetuate the autoimmune attack on the thyroid. BPA, found in plastic containers and even store receipts, antagonizes T3 receptors in the thyroid. Xenoestrogens can be found in personal care products, plastics, and foods.

Triclosan, found in antibacterial soaps, toothpaste, deodorants, and hair sprays, has a structure that resembles that of thyroid hormones and has recently been banned by the FDA from being used in certain products, due to an inability to prove its safety.

Furthermore, halogens like bromide and chloride may take up receptor sites in the thyroid gland, build up in thyroid tissue, and lead to inflammation and thyroid cell death, as they are structurally similar to iodine. This can lead to the development of autoimmune thyroiditis.

Studies have shown that those exposed to high levels of halogen-containing substances have been found to have a higher incidence of thyroid antibodies. These halogens can be found in swimming pools, baked goods, and even our mattresses. (They’re everywhere!)

Fluoride is another halogen that can wreak havoc on the thyroid. Common sources of fluoride include supplements, bottled beverages, toothpaste, black and red tea, canned foods, chewing tobacco, black/red rock salt, and certain medications. Fluoride has been added to most water supplies in the United States, Canada, and some parts of the UK, to prevent dental decay. However, it is also an endocrine disruptor.

Those with an autoimmune disease, and Hashimoto’s in particular, are especially prone to liver congestion. This risk can increase when one’s intestines are damaged, allowing for irritating molecules and substances to “leak” into the bloodstream. Intestinal permeability (also known as leaky gut) can result in the absorption of potentially problematic substances and lead to impaired detox abilities.

Additionally, the decreased ability to sweat out toxins (common with Hashimoto’s), decreased nutrient absorption, and food sensitivities, all place an extra toxic load on the liver and cause people with thyroid disorders to be particularly prone to a backlog of toxins.

So how do you go about detoxing a congested liver?

The first step is to remove as many of the toxins in your life as possible. Potential solutions include installing a water filter, swapping out personal care items for less toxic versions, testing for food sensitivities, and installing an air filter.

I would recommend supporting your liver by following the two-week Liver Support Protocol in my book, Hashimoto’s Protocol.

There are four steps to my Liver Support Protocol:

1. Remove potentially triggering foods.
2. Add supportive foods.
3. Reduce toxic exposure.
4. Support both detoxification pathways.

Many people, after following this two-week protocol to relieve their congested liver, have reported that they feel so much better and that many of their symptoms had drastically improved!

Though thyroid disorders are certainly more common in women than in men, it is important for men to understand the signs of a potential thyroid condition and advocate for testing and the proper interventions.

As a recap, I wanted to go over the top eight things to look out for regarding men’s health and thyroid disorders:

1. Pay attention to your symptoms – Slowed metabolism, cold intolerance, mental impairment and dry skin, are just some of the common symptoms of thyroid conditions. Paying attention to your symptoms is your first line of diagnosis that something is not working efficiently in your body.
2. Look at your family history – If you have a family history of thyroid conditions, it increases your likelihood of having a thyroid condition.
3. Be aware of the postpartum period – Men can develop postpartum thyroid issues (commonly known as postpartum thyroiditis) as well.
4. Check for a selenium deficiency – A deficiency in this important mineral has been found to be a trigger for Hashimoto’s.
5. Identify food sensitivities – If you are sensitive to foods (such as gluten), it can cause an inflammatory response in the GI tract, leading to malabsorption of nutrients (such as selenium) and Hashimoto’s.
6. Address adrenal fatigue – The fight-or-flight response is activated when we are in a fatigued state of our adrenals. This can lead to our body constantly being in “emergency mode”, and creates a feeling of not being safe. Many people have noted an onset of Hashimoto’s after a traumatic event in their life.
7. Test for chronic infections – Identifying and treating chronic infections can result in a complete remission of Hashimoto’s.
8. Eliminate toxins – Specifically, halogens (found in the forms of fluoride, bromide and chloride) can take up receptor sites in the thyroid gland, which can then cause inflammation and thyroid cell death, and lead to the development of autoimmune thyroiditis.

For more information on interventions to bring you back to health, I encourage you to take a look at my book, Hashimoto’s Protocol. In it, you’ll find a step-by-step guide to addressing thyroid symptoms for both men and women.

I hope this information helps you take charge of your health — and encourages the men in your life to take charge of their health as well!

For more information on resolving your thyroid symptoms, download my free Thyroid Symptom Hacker eBook below!

P.S. You can also download a Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter of my first book for free! You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook and Instagram, too!

References

1. Caturegli P, De Remigis, A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity Reviews. 2014;13(4-5), 391-397.
2. Gupta V, Lee M. Central hypothyroidism. Indian Journal of Endocrinology and Metabolism. 2011;15(Suppl2):S99.
3. Kostoglou-Athanassiou I, Ntalles K. Hypothyroidism-new aspects of an old disease. Hippokratia. 2010;14(2):82.
4. Kramer CK, von Mühlen D, Kritz-Silverstein D, Barrett-Connor E. Treated hypothyroidism, cognitive function, and depressed mood in old age: the Rancho Bernardo Study. European Journal of Endocrinology. 2009;(161):917-921.
5. Safer JD. Thyroid hormone action on skin. Dermato-endocrinology. 2011;3(3): 211-215.
6. Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian Journal of Endocrinology and Metabolism. 2014;18(3):307.
7. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. South African Family Practice. 2012;54(5):384-390.
8. Duyff RF, Van den Bosch J, Laman DM, van Loon BJP, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery & Psychiatry. 2000;68(6):750-755.
9. Chen Y, Chen Y, Xia F et al. A Higher Ratio of Estradiol to Testosterone is associated with Autoimmune Thyroid Disease in Males. Thyroid. 2017. doi:10.1089/thy.2016.0661.
10. Olivo J, Southren AL, Gordon GG, Tochimoto S. Studies of the protein binding of testosterone in plasma in disorders of thyroid function: effect of therapy. The Journal of Clinical Endocrinology & Metabolism. 1970;31(5):539-545.
11. Krysiak R, Szkróbka W, Okopień B. The effect of l -thyroxine treatment on sexual function and depressive symptoms in men with autoimmune hypothyroidism. Pharmacological Reports. 2017;69(3):432-437. doi:10.1016/j.pharep.2017.01.005.
12. Kellman, Raphael. Low Thyroid in Men: Not Just A Women’s Issue. US News & World Report website. https://health.usnews.com/health-news/patient-advice/articles/2015/07/21/low-thyroid-in-men-not-just-a-womans-issue. Accessed 16 June 2017.
13. Panicker V. Genetics of thyroid function and disease. The Clinical Biochemist Reviews. 2011;32(4):165.
14. Belokovskaya R, Levine AC. Recurrent Episodes of Thyrotoxicosis in a Man following Pregnancies of his Spouse with Hashimoto’s Thyroiditis. Case Rep Endocrinol. 2015;2015:940241. doi:10.1155/2015/940241
15. Solerte S, Precerutti S, Gazzaruso C et al. Defect of a subpopulation of natural killer immune cells in Graves’ disease and Hashimoto’s thyroiditis: normalizing effect of dehydroepiandrosterone sulfate. European Journal of Endocrinology. 2005;152(5):703-712. doi:10.1530/eje.1.01906.
16. Ott J, Pecnik P, Promberger R et al. Dehydroepiandrosterone in women with premature ovarian failure and Hashimoto’s thyroiditis. Climacteric. 2013;17(1):92-96. doi:10.3109/13697137.2013.800040.
17. Wortsman J, Moses H, Dufau M. Increased incidence of thyroid disease among men with hypergonadotropic hypogonadism. The American Journal of Medicine. 1986;80(6):1055-1059. doi:10.1016/0002-9343(86)90665-0.
18. Wortsman J, Rosner W, Dufau M. Abnormal testicular function in men with primary hypothyroidism. The American Journal of Medicine. 1987;82(2):207-212. doi:10.1016/0002-9343(87)90057-x.
19. Gärtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. The Journal of Clinical Endocrinology & Metabolism. 2002;87(4):1687-1691.
20. Harrison, Pam. More Evidence Of Harm From Selenium In Prostate Cancer. Medscape Medical News. January 8, 2015.
21. Cui Z, Liu D, Liu C, Liu G. Serum selenium levels and prostate cancer risk. Medicine. 2017;96(5):e5944. doi:10.1097/md.0000000000005944.
22. Outzen M, Tjønneland A, Larsen E et al. Selenium status and risk of prostate cancer in a Danish population. British Journal of Nutrition. 2016;115(09):1669-1677. doi:10.1017/s0007114516000726.
23. Hurst R, Hooper L, Norat T et al. Selenium and prostate cancer: systematic review and meta-analysis. American Journal of Clinical Nutrition. 2012;96(1):111-122. doi:10.3945/ajcn.111.033373.
24. Goswami R, Marwaha RK, Gupta N, Tandon N, Sreenivas V, Tomar N, et al. Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. British Journal of Nutrition. 2009;102(3): 382-386.
25. Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 12(10): 867-878.
26. Costantini A, Pala MI. Thiamine and Hashimoto’s thyroiditis: a report of three cases. The Journal of Alternative and Complementary Medicine. 2014;20(3):208-211.
27. Paur I, Lilleby W, Bøhn S et al. Tomato-based randomized controlled trial in prostate cancer patients: Effect on PSA. Clinical Nutrition. 2017;36(3):672-679. doi:10.1016/j.clnu.2016.06.014.
28. Belokovskaya R, Levine A. Recurrent Episodes of Thyrotoxicosis in a Man following Pregnancies of his Spouse with Hashimoto’s Thyroiditis. Case Reports in Endocrinology. 2015;2015:1-4. doi:10.1155/2015/940241.
29. Saied NM, Hassan WA. Long-term exposure to xenoestrogens alters some brain monoamines and both serum thyroid hormones and cortisol levels in adult male rats. The Journal of Basic & Applied Zoology. 2014;67(5):205-211.
30. Irritability in Men and Mood Swings in Men. BodyLogicMD website. https://www.bodylogicmd.com/for-men/irritable-men-syndrome. Accessed March 28, 2018.

Note: Originally published in June 2018, this article has been revised and updated for accuracy and thoroughness.