Celiac Disease and FSH Levels in Men
Yes, celiac disease can increase Follicle-Stimulating Hormone (FSH) levels in men. Research shows that approximately 26% of men with celiac disease have elevated basal serum FSH concentrations, which can persist even after treatment with a gluten-free diet 1.
Pathophysiological Mechanism
The relationship between celiac disease and elevated FSH in men appears to involve several mechanisms:
Androgen Resistance: Men with untreated celiac disease demonstrate a pattern of hormonal abnormalities indicative of androgen resistance, including:
- Increased plasma testosterone
- Reduced dihydrotestosterone (testosterone's potent peripheral metabolite)
- Raised serum luteinizing hormone (LH)
- Elevated FSH 2
Pituitary Dysregulation: There is evidence of derangement in pituitary regulation of gonadal function in men with celiac disease, which appears to be part of a wider disturbance of central regulatory mechanisms of endocrine function 1.
Exaggerated Gonadotropin Responses: 89% of men with celiac disease showing subtotal villous atrophy demonstrate exaggerated FSH responses to LHRH (luteinizing hormone-releasing hormone) stimulation, even when basal gonadotropin concentrations are normal 1.
Clinical Implications
The elevation of FSH in men with celiac disease has several important clinical implications:
Reproductive Health: Men with celiac disease have higher rates of infertility (19% of marriages) compared to the general population 3.
Sexual Function: Impotence and decreased sexual activity occur more commonly in men with celiac disease, with sexual activity appearing to improve after gluten withdrawal 3.
Semen Quality: Marked abnormalities in sperm morphology and motility are observed in men with celiac disease, with morphology potentially improving after gluten withdrawal 3.
Monitoring and Management
For men with celiac disease who present with reproductive concerns:
Hormone Evaluation: Consider measuring FSH, LH, testosterone, and dihydrotestosterone levels, particularly in men with:
- Infertility
- Sexual dysfunction
- Delayed puberty
Gluten-Free Diet: Strict adherence to a gluten-free diet is the primary treatment for celiac disease 4. While FSH elevations may persist, some hormonal parameters (like LH) appear to return toward normal after gluten withdrawal 1.
Nutritional Assessment: Evaluate and correct nutritional deficiencies that may contribute to reproductive dysfunction:
- Zinc
- Vitamin D
- B vitamins
- Iron 4
Important Considerations
The elevation of FSH in celiac disease appears to be relatively specific to this condition and cannot be explained merely by malnutrition or chronic illness 2.
Unlike FSH, elevated LH levels tend to normalize after gluten withdrawal, suggesting different mechanisms of dysregulation 1.
The hormonal abnormalities in celiac disease are not consistently associated with oligospermia, suggesting complex pathophysiology beyond simple hypogonadism 1.
Early diagnosis and treatment with a gluten-free diet are crucial, as reproductive alterations may be reversible with appropriate dietary management 5.