Hyperparathyroidism in men is frequently diagnosed later than in women and often causes more severe damage by the time it is identified.

Hyperparathyroidism in Men: Why It Is Missed, Dismissed, and Diagnosed Too Late

Men are more likely to be told their symptoms are due to aging, low testosterone, or stress, even when calcium levels are abnormal. When diagnosed and treated by a high-volume endocrine surgeon, hyperparathyroidism in men is curable with surgery and outcomes are excellent.

Quick Facts: Hyperparathyroidism in Men

• Hyperparathyroidism in men is less common but often more severe

• Men are frequently diagnosed years later than women

• Calcium levels above 10.0 mg/dL in adult men are a red flag

• Kidney stones are the most common presenting symptom in men

• Fatigue, mood changes, and sexual dysfunction are commonly missed symptoms

• Surgery is curative when performed by a high-volume parathyroid surgeon

What Is Hyperparathyroidism in Men?

Primary hyperparathyroidism is a disease in which one or more parathyroid glands produce too much parathyroid hormone (PTH), leading to elevated calcium levels in the blood.

While hyperparathyroidism is diagnosed more often in women, hyperparathyroidism in men is frequently more destructive because it is diagnosed later. Men often tolerate symptoms longer and are more likely to be reassured that their lab abnormalities are insignificant.

In our experience, and supported by our Research Institute database of more than 25,000 cases, men are often diagnosed only after a major event such as a kidney stone, fracture, or emergency room visit.

Why Is Hyperparathyroidism in Men Often Missed or Misdiagnosed?

The Aging Excuse

Symptoms of hyperparathyroidism in men are commonly attributed to aging, stress, or low testosterone.

• Fatigue and Low Energy
  Many men assume declining energy is due to work stress or “low T,” when the true cause is high calcium from a parathyroid tumor.

• Misleading Lab Reference Ranges
  Some laboratories list calcium as “normal” up to 10.4 or 10.6 mg/dL. In adult men, calcium above 10.0 mg/dL should prompt evaluation of PTH.

• Lack of Screening
  Men are far less likely to undergo bone density testing, which often leads to earlier diagnosis in women.

Symptoms of Hyperparathyroidism in Men

The classic teaching for hyperparathyroidism is “stones, bones, groans, and psychiatric overtones.” Men most commonly present with:

• Kidney Stones
  The most frequent emergency presentation. Any man with kidney stones has at least a 20 percent chance of having an underlying parathyroid tumor.

• Bone and Joint Pain
  Often dismissed as arthritis or prior injuries, but frequently driven by excess PTH pulling calcium from bone.

• Erectile Dysfunction and Low Libido
  High calcium suppresses normal nervous system signaling and is a frequently overlooked cause of sexual dysfunction.

• Irritability and Mood Changes
  Many spouses report dramatic personality improvement within 24 hours of surgery.

Severe psychiatric symptoms can occur. We have treated men hospitalized for psychosis with calcium levels exceeding 12 mg/dL.

Can Hyperparathyroidism in Men Affect Testosterone?

Parathyroid tumors do not directly lower testosterone, but chronic fatigue, sleep disruption, and depression caused by hypercalcemia can suppress testosterone production.

Many men are started on testosterone replacement therapy without evaluation of calcium and PTH levels. This treats symptoms while allowing the parathyroid disease to progress.

Our standard: calcium and PTH should be checked before initiating testosterone therapy.

Is Parathyroid Surgery Different in Men?

The goal is the same: identify and remove the abnormal gland or glands to achieve cure.

However, men often have:

• Greater muscle mass

• Deeper neck anatomy

• More posteriorly located tumors

Delayed diagnosis can also lead to larger or more adherent tumors. These factors make surgeon experience critical for successful outcomes in men.

Recovery After Parathyroid Surgery in Men

Using the Hospital for Endocrine Surgery standard:

• Most men resume light activity within 24 hours

• Normal routines within one week

• Full activity shortly thereafter

• Small incisions, often hidden in a natural skin crease or beard line

• Cognitive clarity often improves immediately

Why Men Should Choose the Hospital for Endocrine Surgery

• Safety: Leapfrog A designation and Healthgrades Patient Safety Excellence Award

• Efficiency: Fastest diagnostic-to-surgery pipeline in the country

• Research Leadership: Protocols guided by the HFES Research Institute led by Dr. Constantine Stratakis and Dr. Fabio Faucz

Patients frequently describe their experience as the best medical care they have ever received.

Bottom Line for Men (and Those Who Care About Them)

If you are a man over 35 with calcium above 10.0 mg/dL, hyperparathyroidism should be ruled out. Do not accept “watch and wait” while your body deteriorates.

Hyperparathyroidism in men is curable. Early diagnosis and expert surgery change lives.

Frequently Asked Questions: Hyperparathyroidism in Men

Is hyperparathyroidism in men different from women?
Yes. Men are often diagnosed later and present with more severe complications.

Are men less likely to have symptoms?
No. Symptoms are often misattributed to aging, stress, or low testosterone.

Can surgery cure hyperparathyroidism in men?
Yes. When performed by a high-volume surgeon, cure rates exceed 99 percent.

Should calcium be checked before testosterone therapy?
Yes. Calcium and PTH should always be evaluated first.

Written by: Drew Rhodes, DO, FACS, FACOS, Senior Surgeon at the Norman Parathyroid Center
Chief of Surgery, Hospital for Endocrine Surgery

Reviewed by: Nate Walsh, MD, FACS, Senior Surgeon at the Clayman Thyroid Center

References

Parathyroid.com. Norman Parathyroid Center. Comprehensive clinical education and patient outcomes data on hyperparathyroidism and parathyroid surgery.
https://www.parathyroid.com/

Hospital for Endocrine Surgery Research Institute (HFES internal clinical database)

Norman J, et al. Evaluation of 20,081 Consecutive Patients with Primary Hyperparathyroidism. Surgery. 2017.
https://pubmed.ncbi.nlm.nih.gov/28478807/