Men with low testosterone levels are more prone to severe COVID-19

During the pandemic, doctors saw evidence that men with COVID-19 are on average worse off than women with the infection. One theory suggests that hormonal differences between men and women can make men more prone to serious illness. And since men have a lot more testosterone than women, some scientists have speculated that high testosterone levels could be to blame.

However, a new study from the Washington University School of Medicine in St. Louis suggests that the opposite may be the case in men: low levels of testosterone in the blood are linked to more severe illnesses. The study failed to prove that low testosterone levels are a cause of severe COVID-19; Low values ​​could simply serve as markers for some other causal factors. Still, researchers advise caution in ongoing clinical trials examining hormone therapies that block or lower testosterone or increase estrogen as a treatment for men with COVID-19.

The study will appear online on May 25th in JAMA Network Open.

“During the pandemic, the prevailing belief was that testosterone was bad,” said senior author Abhinav Diwan, MD, professor of medicine. “But we found the opposite in men. If a man had low testosterone levels at the start of his hospitalization, his risk for severe COVID-19 – meaning he was at risk of intensive care or death – was much higher compared to men who had more circulating testosterone. And if testosterone levels continued to drop during the hospital stay, the risk increased. “

The researchers measured several hormones in blood samples from 90 men and 62 women who came to Barnes-Jewish Hospital with symptoms of COVID-19 and had confirmed cases of the disease. In the 143 patients admitted to the hospital, the researchers measured hormone levels again on days 3, 7, 14 and 28 as long as the patients remained in the hospital for that period.

In addition to testosterone, researchers measured levels of estradiol, a form of estrogen produced by the body, and IGF-1, an important growth hormone similar to insulin that plays a role in maintaining muscle mass.

In women, the researchers found no correlation between hormone levels and the severity of the disease. In men, only testosterone levels were linked to the severity of COVID-19. A blood testosterone level of 250 nanograms per deciliter or less is considered a low testosterone level in adult men.

At hospitalization, men with severe COVID-19 had an average testosterone level of 53 nanograms per deciliter; Men with less severe illness had average values ​​of 151 nanograms per deciliter. On the third day, the average testosterone level of the most seriously ill men was only 19 nanograms per deciliter.

The lower the testosterone levels, the more severe the disease. For example, those with the lowest levels of testosterone in their blood had the highest risk of using a ventilator, needing intensive care, or dying. Thirty-seven patients -; 25 of them were men -; died in the course of the study.

The researchers found that other factors known to increase your risk for severe COVID-19, including advanced age, obesity, and diabetes, are also linked to lower testosterone levels.

The groups of men who got sick were known to have less testosterone across the board. We also found that men with COVID-19 who were not initially seriously ill but had low testosterone levels are likely to need intensive care or intubation for the next two or three days. Lower testosterone levels seemed to predict which patients were likely to get very sick in the next few days. “

Sandeep Dhindsa, MD, Study F.first A.uthor and E.Ndocrinologist, Saint Louis University

In addition, the researchers found that lower testosterone levels in men also correlated with higher levels of inflammation and an increase in the activation of genes that allow the body to perform the functions of circulating sex hormones in cells.

In other words, the body can adapt to less testosterone circulating in the bloodstream by increasing its ability to detect and use the hormone. The researchers are not yet aware of the effects of this adaptation and are calling for further research.

“We are now investigating whether there is a link between sex hormones and cardiovascular outcomes in long-term COVID-19 when symptoms persist for many months,” said Diwan, a cardiologist. “We are also interested in whether men who are recovering from COVID-19, including those with long-term COVID-19, can benefit from testosterone therapy. This therapy has been used in men with low sex hormone levels, so it may be worth investigating whether a similar approach can aid male COVID-19 survivors with their rehabilitation. “

This study used Washington University’s COVID-19 biorepository and was conducted in collaboration with the university’s Institute of Clinical and Translational Sciences (ICTS), which also includes the Saint Louis University School of Medicine.

The 1,500 faculty physicians at Washington University School of Medicine are also medical staff at Barnes-Jewish and St. Louis Children’s Hospitals. The School of Medicine is a leader in medical research, teaching, and patient care and is consistently one of the best medical schools in the country according to the US News & World Report. The School of Medicine is affiliated with BJC HealthCare through its affiliation with the Barnes-Jewish and St. Louis Children’s Hospitals.


Washington University Medical School in St. Louis

Journal reference:

Dhindsa, S. et al. (2021) Association of circulating sex hormones with inflammation and disease severity in COVID-19. JAMA network open.

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