Summary: A new cohort study indicates that COVID-19 may lower testosterone levels in men, and that lower testosterone is linked to more severe disease. Men who died had significantly lower mean total testosterone than survivors. Even among asymptomatic men, 65.2% reported reduced libido.
Source: Taylor & Francis Group
New evidence from hospitalized patients suggests COVID-19 can reduce serum testosterone in men and that low baseline testosterone is associated with worse outcomes.
Researchers from the University of Mersin and Mersin City Education and Research Hospital in Turkey report in the peer-reviewed journal The Aging Male that lower total testosterone measured at baseline correlates with an increased likelihood of intensive care unit (ICU) admission and higher mortality among men with laboratory-confirmed SARS-CoV-2 infection.
Lead author Selahittin Çayan, Professor of Urology, notes that while prior studies suggested pre-existing low testosterone might predict poorer COVID-19 prognosis, this cohort study is among the first to show that the infection itself appears to decrease testosterone levels in male patients.
The investigators propose that these findings could help explain why men frequently experience worse outcomes than women with COVID-19 and raise the possibility that testosterone-based interventions might improve clinical trajectories for some patients. Professor Çayan adds that testosterone is involved in lung immune responses, and low levels have been linked previously to increased risk of respiratory infection, infection-related hospitalization, and higher all-cause mortality in critically ill men.
Key findings reported by the authors include a stepwise decline in mean total testosterone as disease severity increased. Mean total testosterone was significantly lower in the ICU group than in the asymptomatic group and was also lower in the ICU group compared with patients cared for in the intermediate care/internal medicine unit. The study also found higher mean follicle-stimulating hormone (FSH) in the ICU group versus asymptomatic patients, and hypogonadism (insufficient testosterone production) in 113 of 221 male patients (51.1%).
Among the 24 patients who had pre-COVID-19 gonadal hormone measurements available, mean serum total testosterone fell from 458 ± 198 ng/dl before infection to 315 ± 120 ng/dl during COVID-19 (p = 0.003), supporting the conclusion that the illness itself can lower testosterone levels.
“Even among asymptomatic men, 65.2% of the 46 male patients reported a loss of libido.”
The prospective cohort included 438 patients in total, of whom 232 were male with confirmed SARS-CoV-2 infection. All patients underwent comprehensive clinical history, physical examination, laboratory testing, and radiological imaging; data were reviewed by two physicians. The male cohort analyzed for testosterone and related parameters comprised 221 consecutive adult men (>18 years) hospitalized with COVID-19 and divided into three groups: asymptomatic (n = 46), hospitalized in the internal medicine unit (IMU) (n = 129), and admitted to the ICU (n = 46).
Death occurred in 11 male patients (4.97%) and 7 female patients (3.55%), with no statistically significant difference between genders (p > 0.05) in this series.
Professor Çayan recommends that clinicians consider measuring testosterone at the time of COVID-19 diagnosis, particularly for men presenting with low sex-hormone levels. He suggests that testosterone therapy could have a role in improving prognosis for selected patients, but he emphasizes that further research and controlled trials are needed to evaluate safety and effectiveness before routine therapeutic use is recommended.
The authors acknowledge limitations in their study, including the absence of a non-COVID-19 control group due to hospital restrictions during the monitoring period. They also call for future research to explore the relationship between testosterone and molecular factors such as ACE2 (angiotensin-converting enzyme 2) expression, which is relevant to SARS-CoV-2 cell entry, to better understand underlying mechanisms.
About the research
Source:
Garvan Institute of Medical Research
Contacts:
Simon Wesson – Taylor & Francis Group
Image Source:
The image is in the public domain.
Original Research: Open access
“Effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort study” by Selahittin Çayan et al. The Aging Male.
Abstract
Effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort study
Objective
To evaluate how serum total testosterone and related laboratory parameters relate to clinical prognosis in adult men infected with SARS-CoV-2.
Methods
This prospective cohort included 221 consecutive hospitalized men (>18 years) with laboratory-confirmed SARS-CoV-2. Participants were grouped as asymptomatic (n = 46), hospitalized in the internal medicine unit (IMU) (n = 129), or admitted to the intensive care unit (ICU) (n = 46). Clinical, laboratory, and imaging data were systematically collected and reviewed.
Results
Lower baseline serum total testosterone was associated with a higher probability of ICU admission (p = 0.001) and increased mortality risk (p = 0.002). In the subgroup with pre-infection hormone values (n = 24), mean total testosterone fell significantly from 458 ± 198 ng/dl before COVID-19 to 315 ± 120 ng/dl during infection (p = 0.003).
Conclusions
COVID-19 may reduce serum testosterone in infected men, and low baseline total testosterone is significantly associated with increased risk of ICU admission and mortality. Larger controlled studies are required to confirm these findings and to investigate whether testosterone testing and targeted treatment could improve outcomes in men with COVID-19.