Men with low testosterone may be more likely to require hospitalisation for COVID-19

Researchers from Saint Louis University School of Medicine and Washington University School of Medicine in St. Louis discovered that guys with COVID-19 who had low testosterone levels were more likely to have severe illness and need hospitalisation than those with normal levels.

The study looked at 723 people who tested positive for COVID-19, mostly in 2020 before vaccines were available. According to the findings, low testosterone is an independent risk factor for COVID-19 hospitalisation, just like diabetes, heart disease, and chronic lung disease. They found that males who tested positive for COVID-19 and had low testosterone were 2.4 times more likely to require hospitalisation than men who tested positive for COVID-19 and had hormone levels that were within the normal range.

Men who had successfully had hormone replacement therapy but had testosterone levels that had traditionally tested within the normal range were not any more likely to be hospitalised for COVID-19 than were men whose testosterone levels had consistently tested within the normal range.

The findings suggest that treating low testosterone in boys may protect them from serious disease and minimise the burden on hospitals during COVID-19 waves. They were published on September 2 in JAMA Network Open.

Abhinav Diwan, MD, a co-senior author and professor of medicine at Washington University, believes that COVID-19 is most likely here to stay. Diwan practises medicine at Barnes-Jewish Hospital and teaches cell biology and physiology and obstetrics and gynaecology.

Hospitalizations due to COVID-19 are still a problem and will continue to be so as long as the virus keeps evolving novel forms that circumvent vaccination-based immunity. Low testosterone is a moderately common disorder that affects up to one-third of guys over the age of 30. Our study emphasises the importance of this risk factor and the need to address it in order to decrease hospitalizations.

Prior research by senior author Diwan and co-author Sandeep Dhindsa, an endocrinologist at Saint Louis University, has shown that males hospitalised with COVID-19 have abnormally low testosterone levels. A severe illness or stressful event, however, may momentarily reduce hormone levels.

Data from men who have already been hospitalised with the disease have not been very helpful in determining whether low testosterone is a risk factor for severe COVID-19 or its effect. The goal of the study was to determine whether those with chronically low levels of testosterone were more prone to disease than people with normal amounts.

Co-author Cosette Champion, MD, a Barnes-Jewish internal medicine resident, together with colleagues Diwan and Dhindsa, reviewed patient records at two important hospital systems in the St. Louis area: SSM Health and BJC HealthCare. They discovered 723 males who had their testosterone levels checked between January 1, 2017, and December 31, 2021, and who had COVID-19 instances that had been reported in 2020 or 2021.

The patient’s testosterone levels were occasionally assessed after COVID-19 recovery. According to Dhindsa, since low testosterone is a chronic condition, men who tested low a few months after recovering from COVID-19 likely had low testosterone levels earlier as well.

The study discovered 180 men who had previously had low testosterone levels but had been effectively treated, 116 men with low testosterone levels, and 427 men with normal testosterone levels. At the time they developed COVID-19, these guys were getting hormone replacement treatment, and their testosterone levels were within the normal range.

According to Dhindsa, low testosterone was discovered to be a risk factor for COVID hospitalisation, however therapy decreased that risk.

“The risk drastically increases below 200 nanograms per deciliter, while the normal range is 300 to 1,000 nanograms per deciliter. Age, obesity, and the other conditions we examined as risk factors have no impact on this. The risk for those receiving therapy, however, is constant.

Men who have low testosterone may experience sexual dysfunction, low mood, irritability, memory loss, weariness, loss of muscular mass, and a generalised diminished sense of well-being. Male patients are typically treated with testosterone replacement therapy when their quality of life is plainly suffering. However, people and medical professionals may be reluctant to treat when the symptoms are mild.

The two primary problems with testosterone therapy are the risk of heart disease and prostate cancer. Prostate cancer, which is typically driven by testosterone, frequently strikes older men. Increasing testosterone may hasten the onset of some cancers, worsening the illness. Less is known about heart disease risk factors. A significant scientific study on the relationship between testosterone supplements and heart health is expected to be completed soon.

According to Diwan, a trained cardiologist, “our findings would suggest that it would be prudent to look at testosterone levels, especially in patients who have low testosterone symptoms, and then individualise care.”

The doctor could discuss the benefits and drawbacks of hormone replacement therapy with the patient if they have a particularly high risk of cardiovascular events. One possible benefit could be a decreased risk of COVID hospitalisation.

Diwan cautioned that as the research was observational, it is not possible to draw any conclusions about whether raising testosterone levels can save men from getting severe COVID-19. To conclusively show whether such a method is beneficial, a clinical trial would be necessary.