May 27, 2021 — While men have been shown to have a higher risk of COVID-19 illness than women, a new study suggests that the lower the testosterone levels in men, the greater the chance of serious COVID-19 illness Will be
“During pandemic“There has been a prevailing belief that testosterone is bad,” senior author Abhinav Dewan, MD, professor of medicine at Washington University School of Medicine in St. Louis, said in a statement.
“But we found the opposite in men,” he said.
“If a man had it” low testosterone When he first came to the hospital, his risk of having severe COVID-19 – meaning the risk of requiring intensive care or dying – was much higher than men who had more circulating testosterone. “
Testosterone in the very sick
For the study published this week Jama Network Open, Dewan and his colleagues looked at 152 patients, including 90 men and 62 women, who were treated for COVID-19 between March and May 2020 at Barnes-Jewish Hospital in St. Louis. 143 of those patients were hospitalized for COVID-19.
Among the 66 men in the group who had severe COVID-19, average testosterone levels on the day of admission and on day 3 were about 65% to 85% lower than in the 24 men who had mild disease.
And overall, the vast majority – 89% – of COVID-19-infected men, including those with mild disease, showed testosterone levels below the normal range when they were hospitalized.
The mean blood level of testosterone at hospital admission of men in the current study with severe COVID-19 was only 53 ng/dL. Any testosterone level of 250 ng / dL or less is considered ‘low’ in adult males.
By the third day of hospitalization, his average testosterone level had dropped even further – to just 19 ng/dL.
In addition, men admitted to the ICU had a testosterone level of 49 ng/dL, compared to 142 ng/dL in men not in the ICU.
In general, the lowest testosterone levels were associated with the highest risks of mechanical ventilation, ICU penetration or the need to die.
“The group of men who were getting sick were known to have low testosterone across the board,” said study author Sandeep Dhindsa, MD, an endocrinologist at St. Louis University.
“We also found that men with COVID-19 who were not initially critically ill but were low testosterone Levels that were likely to require intensive care or intubation In the next 2 or 3 days. Low testosterone levels predicted which patients could become very ill in the next few days. “
Hormone effects seen only in men
Scientists looked at other hormones but found that only testosterone levels in men were linked to the severity of COVID-19 disease. In women, there was no difference in the levels of any of the hormones according to the severity of the COVID-19 disease, including testosterone levels (women have low levels of testosterone), or estrogen.
Testosterone concentrations in men with severe disease were not affected by other known risk factors for COVID-19 severity, including age, body mass index, underlying conditions such as Diabetes Or heart disease, smoking and running.
Importantly, however, the results do not necessarily prove that testosterone deficiency is causing more severe cases of COVID-19, the researchers said.
They note that testosterone concentrations have been known to drop by as much as 50% when men are hospitalized, even for routine elective surgery.
A drop in testosterone is also common after traumatic brain injury and heart attack.
To further test the relationship between testosterone and COVID-19, researchers are now focusing on the hormone’s effects on the long-term symptoms of COVID-19.
“We are now investigating whether there is an association between sex hormones and cardiovascular outcomes in ‘long COVID-19’ when symptoms persist for several months,” said cardiologist Dewan.
Meanwhile, the results should pause for researchers who are studying whether hormonal treatment can help fight COVID-19. For example, one study was considering giving 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 emphasize.
“Our study results suggest that, contrary to popular belief, testosterone may not be a broadcaster of COVID-19 severity in either sex,” they conclude. “Conversely, it may be protective in men.”