Low testosterone levels in men may result in severe form of COVID-19

A single center cohort study from the United States, involving 152 patients with COVID-19, who presented to Barnes-Jewish Hospital in St Louis, Missouri from March to May 2020, has shown an association between low testosterone levels and increased disease severity and inflammation and poor outcomes in men with Covid-19 but not in women.

Twenty-four men included in the study had mild Covid-19 infection, while 66 men had severe illness. Of these, 31 men had severe Covid-19 at the time of hospitalization, while 35 men developed severe disease within three days of their hospital stay. Men with severe COVID-19 were older and also had more comorbidities. 

Baseline testosterone levels were found to be much lower in men with severe infection compared to men with the mild disease; 53 ng/dL vs 151 ng/dL, respectively (p=0.01). The testosterone levels declined further in men with severe Covid-19 and were the lowest by the third day of the illness; 19 ng/dL vs 111 ng/dL (p=0.006). On the seventh day of the illness, the testosterone levels were 20 ng/dL vs 180 ng/dL. Testosterone continued to remain low in these patients during the length of their hospital stay and returned to baseline levels by day 28.

Men with lower baseline testosterone levels were also more likely to need intensive care or be intubated. The risk increased with further decrease in testosterone.

  • Testosterone level in men who were in intensive care was 49 ng/dL vs 142 (83-221) ng/dL in men who did not need intensive care. On Day 3, testosterone level was 17 ng/dL vs 104 ng/dL in men with and without ICU admission.
  • Testosterone level in men who required artificial ventilation was 38 ng/dL vs 104 ng/dL among men who did not need artificial ventilation. On Day 3, testosterone level was 12 vs 60 ng/dL in men with and without ventilator use.
  • Testosterone level in men who died was 42 ng/dL vs 108 ng/dL among those who survived the disease. On Day 3, testosterone level was On Day 3, testosterone level was15 vs 49 ng/dL among men who died and survived.

Also, men with high testosterone levels had significantly lower levels of interleukin (IL)-6, C-reactive protein (CRP), IL 1 receptor antagonist, hepatocyte growth factor, and interferon γ-inducible protein 10.

The authors concluded that lower testosterone levels during hospital admission were associated with disease severity, inflammation and mortality in men with COVID-19. This study has opened up a possibility of the use of testosterone therapy in rehabilitation of male Covid-19 patients, although this needs to be studied in separate studies.

The study is published in the journal JAMA Network Open.

(Source: Dhindsa S, et al. Association of circulating sex hormones with inflammation and disease severity in patients with COVID-19. JAMA Netw Open. 2021;4(5):e2111398).

 Dr Surya Kant,

Professor and Head, Dept. of Respiratory Medicine, KGMU, UP, Lucknow.

National Vice Chairman IMA-AMS.

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