New Research Shows Men With Low Testosterone Are More Likely to Die From COVID-19

Men with symptomatic COVID-19, who were found to have low testosterone after hospitalization, were more likely to become seriously ill and die from the disease, new research finds.

The study, conducted in Milan during the first wave of coronavirus in 2020, found that the lower the levels of testosterone, the more likely male patients are to require intensive care, be intubated on a ventilator and stay in hospital longer. period. Their chance of dying increased sixfold.

The findings will be presented at the European Association of Urology Congress, EAU21, taking place this week from July 8-12.

Professor Andrea Salonia and his colleagues from San Raffaele University Hospital in Milan compared 286 male Covid patients, who came to the emergency department, with 305 healthy male volunteers, who went to the hospital to donate blood between February and May 2020.

The team monitored both patients and volunteers for levels of male hormones, including testosterone. Testosterone is measured in nanomoles per liter (nmol/L) and 9.2 or lower is considered the threshold for low testosterone, called hypogonadism.

Nearly 90 percent of the patients had testosterone below this level, compared with just 17 percent of the healthy volunteers. In addition, the patients’ testosterone levels were also significantly below the threshold, averaging around 2.5 nmol/L.

The patients with mild symptoms or who were hospitalized had slightly higher testosterone levels (between 3-4 nmol/L) than those who were admitted to the ICU or who died of the disease (only 0.7-1.0 nmol/L). /l).

Even when age, pre-existing conditions and body mass index (BMI) were taken into account, the differences in hormonal profiles and clinical outcomes were still large.

Professor Salonia, a specialist in urology and endocrinology at San Raffaele Hospital, says:

“At the beginning of the Covid pandemic, we saw far more men than women coming to hospital and suffering from very severe forms of the disease. We immediately thought that this could be related to male hormone levels, especially testosterone.

“But we never expected to see such a high percentage of COVID patients with these extremely low levels of testosterone, compared to a comparable group of healthy men. The relationship is very clear: the lower the testosterone, the higher the severity of the condition and the risk of death. I have never seen anything like it in my 25 years in the field.”

Because the team has no 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.

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 just don’t have the data to know which came first in these patients, the low testosterone levels or the Covid,” explains Professor Salonia. “Testosterone plays a role in protecting men from disease. However, it’s also possible that the virus itself could cause an acute drop in testosterone levels, leaving these men more susceptible to a worse outcome. We are now following these patients over a longer period of time to see how their hormone levels change over time so that we can try to answer these questions.”

The annual EAU conference is Europe’s largest urology conference, bringing together clinicians, scientists and patients to discuss the latest research and medical developments related to the urinary tract and the male reproductive system. EAU21 will take place virtually this year, due to Covid restrictions.

Professor Jens Sonksen, member of the EAU Executive, said: “The SARS-CoV-2 pandemic has had a huge impact on global health since the virus first started spreading in early 2020. We learned a lot about the virus and possible health problems. consequences of COVID-19 since those early days, but there is still much to learn. This is highlighted by this new study, which found surprisingly low total testosterone levels in men with COVID-19 compared to healthy controls. Symptomatic COVID-19 patients with low testosterone were also more likely to become seriously ill from COVID-19. Additional research into possible effects of COVID-19 on men’s health is absolutely necessary.”

Meeting: Congress of the European Association of Urology, EAU21