Men with symptomatic COVID-19, who have low testosterone following hospitalization, were more likely to develop severe infection and die from the disease, suggests a new study.
The study, conducted in Milan during the first wave of the pandemic in 2020, revealed that the lower the levels of testosterone, the higher the likelihood that male patients would need intensive care, be intubated on a ventilator and remain in hospital over a longer period.
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Their likelihood of dying increased six-fold.
Professor Andrea Salonia and his colleagues from the San Raffaele University Hospital in Italy compared 286 male Covid patients, who were admitted to the emergency room, with 305 healthy male volunteers, who went to the hospital to give blood between Feb and May 2020.
The team checked both patients and volunteers for levels of male hormones, including testosterone.
Testosterone is measured in nanomoles per litre (nmol/l) and 9.2 or below is deemed the threshold for low testosterone, termed hypogonadism.
Nearly 90 per cent of the patients had testosterone below this level, compared to just 17 per cent of the healthy volunteers.
Furthermore, testosterone levels in the patients were also significantly below the threshold, averaging around 2.5 nmol/l.
Those patients who had mild symptoms or were admitted to hospital had slightly higher testosterone levels (between 3-4 nmol/l) than those admitted to ICU or those who died of the disease (just 0.7-1.0 nmol/l).
Even when age, pre-existing conditions and body mass index (BMI) – the universally recognised measure of healthy weight – were taken into account, the differences in hormonal profiles and clinical outcomes were still stark.
Commenting on the findings, Professor Salonia, a specialist in urology and endocrinology at San Raffaele Hospital, said:
At the start of the Covid pandemic, we were seeing far more men than women coming to hospital and suffering very severe forms of the disease. We immediately thought this might be related to male hormone levels, particularly testosterone.
But we never expected to see such a high proportion of Covid patients with these extremely low levels of testosterone, in comparison to a similar group of healthy men.
Prof Salonia added:
The relationship is very clear: the lower the testosterone, the higher the severity of the condition and likelihood of death. I’ve never seen anything like it in my 25 years in the field.
Because the team does not have data on the testosterone levels in the patients before they contracted COVID-19, they cannot say whether low testosterone was a pre-existing long-term condition that exacerbated the disease or whether it was caused by the SARS-COV2 virus (the virus that causes COVID-19).
However, other research has shown that some receptors for the virus, including the enzyme TMPRSS2, are linked to male hormones and that the virus reduces the number of Leydig cells in the body, which produce testosterone.
We simply don’t have the data to know which came first in these patients, the low testosterone levels or the Covid
explained Professor Salonia.
Testosterone does play a role in protecting men from disease. However, it’s also possible that the virus itself is able to induce an acute reduction in testosterone levels, which then predisposes these men to a worse outcome. We’re now following up these patients over a longer time period, to see how their hormone levels change over time, so we can try and answer these questions.
Professor Jens Sonksen, an executive member of the EAU (Europe’s biggest urology conference), said:
The SARS-CoV-2 pandemic has had a tremendous impact on global health since the virus first started spreading in early 2020. We have learned a lot about the virus and possible health consequences from COVID-19 since those early days, but there is much still to learn.
This is highlighted by this new research, which found a surprisingly low level of total testosterone in men with COVID-19 compared to healthy controls.
Symptomatic COVID-19 patients with low testosterone were also more likely to become critically ill from COVID-19. Additional research on potential impacts from COVID-19 on men’s health is definitely needed.
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The American Urology Association (AUA) identifies low blood testosterone symptoms as the following:
- Low sex drive
- Fatigue
- Reduced lean muscle mass
- Irritability
- Erectile dysfunction
- Depression.
The health body adds:
There are many other possible reasons for these symptoms, such as: opioid use, some congenital conditions (medical conditions you are born with), loss of or harm to the testicles, diabetes, and obesity (being overweight). See your doctor if you have any of these symptoms.
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