May 27, 2021 – While men have been shown to have a higher risk of COVID-19 disease than women, new study shows that the lower the testosterone level in men, the greater the likelihood of COVID disease -19 severe is high.
“During the pandemic, there was a dominant notion that testosterone is bad,” said senior author Abhinav Diwan, MD, professor of medicine at Washington University St. Louis School of Medicine, in a statement.
“But we found the opposite in men,” he said.
“If a man had low testosterone when he first arrived at the hospital, his risk of having severe COVID-19 – that is, his risk of requiring intensive care or to die – was much higher compared to men who had more circulating testosterone.
Testosterone in the very sick
For the study, published this week in JAMA network open, Diwan and his colleagues examined 152 patients, including 90 men and 62 women, who were treated for COVID-19 between March and May 2020 at Barnes-Jewish Hospital in Saint-Louis. Of these patients, 143 were hospitalized for COVID-19.
Among the 66 men in the group who had severe COVID-19, the median testosterone levels on the day of admission and on day 3 were about 65% to 85% lower than those of the 24 men who had milder disease .
And overall, the vast majority – 89% – of men infected with COVID-19, including those with mild illness, have shown testosterone levels below what is considered the normal range when they were admitted to the hospital.
The men in the current study with severe COVID-19 had average blood testosterone levels of just 53 ng / dL when they entered the hospital. Any testosterone level of 250 ng / dL or less is considered “low” in adult men.
On the third day of hospitalization, their average testosterone level dropped again – to just 19 ng / dL.
In addition, the testosterone level in men admitted to an ICU was 49 ng / dL, compared to 142 ng / dL in men not placed in an ICU.
In general, the lowest testosterone levels were associated with the highest risks of requiring mechanical ventilation, ICU admission, or dying.
“Groups of men who were getting sicker were known to have lower testosterone across the board,” said study author Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University.
“We also found that men with COVID-19 who were not critically ill initially, but had low testosterone levels, likely needed intensive care or intubation over the next 2-3 days. Lower testosterone levels seemed to predict which patients were likely to become very ill over the next few days. “
Hormonal effect observed in men only
Scientists looked at other hormones, but found that only testosterone levels were linked to the severity of COVID-19 disease in men. In women, there was no difference in hormone levels depending on the severity of the COVID-19 disease, including levels of testosterone (women have small amounts of testosterone) or estrogen.
Testosterone concentrations in men with severe illness were not affected by other known risk factors for severity of COVID-19, including age, body mass index, sub-conditions. underlying issues such as diabetes or heart disease, smoking, and race.
However, low testosterone levels significantly followed signs of inflammation.
But it’s important to note that the results don’t necessarily prove that a lack of testosterone causes more severe cases of COVID-19, the researchers said.
They note that testosterone levels are known to drop by as much as 50% when men are admitted to hospital, even for routine elective surgeries.
Testosterone drops are also normal after a head injury and heart attack.
To further test the relationship between testosterone and COVID-19, researchers are now focusing on the hormone’s effects on long-term symptoms of COVID-19.
“We are currently investigating whether there is an association between sex hormones and cardiovascular outcomes in the ‘long COVID-19’, when symptoms persist for several months,” said Diwan, a cardiologist.
In the meantime, the results should give researchers a break studying whether hormone therapy can help fight COVID-19. For example, one study looked at the administration of estrogen to men with COVID-19.
“These data suggest that caution should be exercised with approaches that antagonize testosterone signaling or supplement estrogen to treat men with severe COVID-19,” the authors point out.
“The results of our study suggest that, contrary to popular belief, testosterone may not be a propagator of the severity of COVID-19 in both sexes,” they conclude. “On the contrary, it can be protective in men.”
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