Vol 72, No 5 (2021)
Original paper
Published online: 2021-08-04

open access

Page views 7377
Article views/downloads 911
Get Citation

Connect on Social Media

Connect on Social Media

The impact of levothyroxine on thyroid autoimmunity and hypothalamic–pituitary–thyroid axis activity in men with autoimmune hypothyroidism and early-onset androgenetic alopecia

Robert Krysiak1, Karolina Kowalcze2, Bogdan Marek34, Bogusław Okopień1
Pubmed: 34378784
Endokrynol Pol 2021;72(5):498-504.


Introduction: Administration of testosterone or dehydroepiandrosterone to subjects with low levels of these hormones was found to reduce thyroid antibody titres. Male-pattern baldness is accompanied by mildly increased androgen levels. The present study was aimed at investigating whether early-onset androgenetic alopecia determines the impact of exogenous levothyroxine on thyroid autoimmunity and hypothalamic–pituitary–thyroid axis activity in young men with autoimmune hypothyroidism.

Material and methods: The study included 2 thyroid-antibody-matched groups of men with autoimmune hypothyroidism: subjects with early-onset androgenetic alopecia (group 1; n = 24) and subjects with no evidence of hair loss (group 2; n = 24). All patients were treated with exogenous levothyroxine. Circulating titres of thyroid peroxidase and thyroglobulin antibodies, as well as levels of thyrotropin, free thyroxine, free triiodothyronine, prolactin, total testosterone, calculated bioavailable testosterone, dehydroepiandrosterone-sulphate, and oestradiol were measured before levothyroxine treatment and 6 months later.

Results: In both study groups, levothyroxine decreased thyroid antibody titres, reduced thyrotropin levels and increased free thyroid hormone levels. However, these effects were less pronounced in the men with early-onset male-pattern baldness than in the control men. The degree of reduction in antibody titres and thyrotropin levels correlated with baseline levels of total and calculated bioavailable testosterone, as well with baseline insulin sensitivity and treatment-induced improvement in insulin sensitivity. Concentrations of the remaining variables remained unchanged throughout the study period.

Conclusions: The results of the current study suggest that the benefits of levothyroxine therapy in men with autoimmune hypothyroidism are less pronounced in individuals with early-onset androgenetic alopecia.

Article available in PDF format

View PDF Download PDF file


  1. Gessl A, Lemmens-Gruber R, Kautzky-Willer A. Thyroid disorders. Handb Exp Pharmacol. 2012(214): 361–386.
  2. Bajuk Studen K, Biček A, Oblak A, et al. Hypothyroidism is associated with higher testosterone levels in postmenopausal women with Hashimoto's thyroiditis. Endokrynol Pol. 2020; 71(1): 73–75.
  3. Rao A, Jain D, Aggarwal HK, et al. An enigmatic trio of Klinefelter's syndrome, autoimmune hypothyroidism and nephrotic syndrome. J R Coll Physicians Edinb. 2017; 47(2): 143–145.
  4. Chen Yi, Chen Y, Xia F, et al. A Higher Ratio of Estradiol to Testosterone Is Associated with Autoimmune Thyroid Disease in Males. Thyroid. 2017; 27(7): 960–966.
  5. Doukas C, Saltiki K, Mantzou A, et al. Hormonal parameters and sex hormone receptor gene polymorphisms in men with autoimmune diseases. Rheumatol Int. 2013; 33(3): 575–582.
  6. Krysiak R, Kowalcze K, Okopień B. The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels. J Clin Pharm Ther. 2019; 44(5): 742–749.
  7. Krysiak R, Szkróbka W, Okopień B. Impact of dehydroepiandrosterone on thyroid autoimmunity and function in men with autoimmune hypothyroidism. Int J Clin Pharm. 2020 [Epub ahead of print].
  8. Krysiak R, Kowalcze K, Okopień B. The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency. Pharmacol Rep. 2019; 71(5): 798–803.
  9. Kelly Y, Blanco A, Tosti A. Androgenetic Alopecia: An Update of Treatment Options. Drugs. 2016; 76(14): 1349–1364.
  10. Lolli F, Pallotti F, Rossi A, et al. Androgenetic alopecia: a review. Endocrine. 2017; 57(1): 9–17.
  11. Cannarella R, Condorelli RA, Mongioì LM, et al. Does a male polycystic ovarian syndrome equivalent exist? J Endocrinol Invest. 2018; 41(1): 49–57.
  12. Sanke S, Chander R, Jain A, et al. A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women. JAMA Dermatol. 2016; 152(9): 986–991.
  13. Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951; 53(3): 708–728.
  14. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975; 68(11): 1359–1365.
  15. Krysiak R, Szkróbka W, Okopień B. The impact of atorvastatin on cardiometabolic risk factors in brothers of women with polycystic ovary syndrome. Pharmacol Rep. 2021; 73(1): 261–268.
  16. Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev. 2001; 22(5): 605–630.
  17. Hughes T, Fulep E, Juelich T, et al. Modulation of immune responses by anabolic androgenic steroids. Int J Immunopharmacol. 1995; 17(11): 857–863.
  18. Krysiak R, Okopien B. The effect of levothyroxine and selenomethionine on lymphocyte and monocyte cytokine release in women with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2011; 96(7): 2206–2215.
  19. Keevil BG, Adaway Jo. Assessment of free testosterone concentration. J Steroid Biochem Mol Biol. 2019; 190: 207–211.
  20. Ho CKM, Stoddart M, Walton M, et al. Calculated free testosterone in men: comparison of four equations and with free androgen index. Ann Clin Biochem. 2006; 43(Pt 5): 389–397.
  21. Liu J, Duan Y, Fu J, et al. Association Between Thyroid Hormones, Thyroid Antibodies, and Cardiometabolic Factors in Non-Obese Individuals With Normal Thyroid Function. Front Endocrinol (Lausanne). 2018; 9: 130.
  22. Krysiak R, Kowalcze K, Marek B, et al. Cardiometabolic risk factors in women with non-classic congenital adrenal hyperplasia. Acta Cardiol. 2020; 75(8): 705–710.
  23. Meng X, Xu S, Chen G, et al. Metformin and thyroid disease. J Endocrinol. 2017; 233(1): R43–R51.
  24. Vilar L, Vilar CF, Lyra R, et al. Pitfalls in the Diagnostic Evaluation of Hyperprolactinemia. Neuroendocrinology. 2019; 109(1): 7–19.
  25. De Bellis A, Bizzarro A, Pivonello R, et al. Prolactin and autoimmunity. Pituitary. 2005; 8(1): 25–30.
  26. Shelly S, Boaz M, Orbach H. Prolactin and autoimmunity. Autoimmun Rev. 2012; 11(6-7): A465–A470.
  27. Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol. 2005; 34(1): 215–220.
  28. Szybiński Z. Polish Council for Control of Iodine Deficiency Disorders. Work of the Polish Council for Control of Iodine Deficiency Disorders, and the model of iodine prophylaxis in Poland. Endokrynol Pol. 2012; 63(2): 156–160.
  29. Klapcinska B, Poprzecki S, Danch A, et al. Selenium Levels in Blood of Upper Silesian Population: Evidence of Suboptimal Selenium Status in a Significant Percentage of the Population. Biol Trace Elem Res. 2005; 108(1-3): 001–016.
  30. Filipowicz D, Majewska K, Kalantarova A, et al. The rationale for selenium supplementation in patients with autoimmune thyroiditis, according to the current state of knowledge. Endokrynol Pol. 2021; 72(2): 153–162.