For men, low testosterone means a high risk of severe COVID-19

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A new study from the University of Washington School of Medicine at St. Louis suggests that among men, low blood testosterone levels are related to more severe COVID-19. The study contradicts the widespread assumptions that higher testosterone may explain why men, on average, develop COVID-19 more severely than women. Credit: SARA MOSER

Throughout the pandemic, doctors have seen evidence that men with COVID-19 are worse, on average, than women with the infection. One theory is that hormonal differences between men and women can make men more susceptible to serious illness. And because men have much more testosterone than women, some scientists have speculated that high testosterone levels may be the culprits.

But a new study from the University of Washington School of Medicine at St. Louis suggests that, among men, the opposite may be true: so low in the blood are related to more serious diseases. The study could not prove so low is a serious cause of COVID-19; low levels could simply serve as a marker of some other causal factors. However, researchers call for caution with ongoing clinical trials investigating hormone therapies that block or reduce testosterone or increase estrogen as a treatment for men with COVID-19.

The study appears online May 25 a JAMA network open.

“During the pandemic, there has been a predominant idea that testosterone is bad,” said Abhinav Diwan, a doctor of medicine, professor of medicine. “But we found the opposite in men. If a man had low testosterone when he got to the hospital, his risk of having severe COVID-19, that is, the risk of requiring intensive care or dying, was very high. “higher compared to men who had more circulating testosterone. And if testosterone levels dropped even more during hospitalization, the risk would increase.”

The researchers measured several hormones in blood samples from 90 men and 62 women who arrived at Barnes-Jewish Hospital with symptoms of COVID-19 and who had confirmed cases of the disease. The researchers measured the 143 patients admitted to the hospital again on days 3, 7, 14, and 28, as long as patients remained hospitalized during these time periods. In addition to testosterone, the researchers measured levels of estradiol, a form of estrogen produced by the body, and IGF-1, a significant growth factor. which is similar to insulin and plays a role in maintaining muscle mass.

testosterone

Ball and stick model of the testosterone molecule, C19H28O2, as found in the crystal structure of testosterone monohydrate. Credit: Ben Mills / Wikipedia

Among women, the researchers found no correlation between any hormone levels and the severity of the disease. Among men, only testosterone levels were related to the severity of COVID-19. A blood testosterone level of 250 nanograms per deciliter or less is considered low in adult men. At hospital admission, men with severe COVID-19 had average testosterone levels of 53 nanograms per deciliter; men with less severe disease had average levels of 151 nanograms per deciliter. On the third day, the average testosterone level of the most severely ill men was only 19 nanograms per deciliter.

The lower the testosterone levels, the more severe the disease will be. For example, those with the lowest levels of testosterone in their blood had the highest risk of going with a ventilator, needing intensive care, or dying. Thirty-seven patients (25 of whom were men) died throughout the study.

The researchers noted that other factors known to increase the risk of severe COVID-19, including old age, obesity, and diabetes, are also associated with lower testosterone. “It was known that the groups of men who got sick had lower testosterone,” said the first author, Sandeep Dhindsa, MD, an endocrinologist at the University of Saint Louis. “We also found that those men with COVID-19 who were not seriously ill initially, but who did , they probably needed or intubation for the next two or three days. Lower testosterone levels seemed to predict which patients could suffer very badly over the next few days. “

In addition, the researchers found that lower testosterone levels in men also correlated with higher levels of inflammation and increased activation of genes that allow the body to perform the circulating functions of sex hormones in the inside of the cells. In other words, the body adapts to less testosterone circulating in the bloodstream marking its ability to detect and use the hormone. Researchers are not yet aware of the implications of this adaptation and call for more research.

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


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More information:
JAMA network open (2021). DOI: 10.1001 / jamanetworkopen.2021.11398

Citation: For men, low testosterone means a high risk of severe COVID-19 (2021, May 25) recovered on May 25, 2021 at https://medicalxpress.com/news/2021-05-men-testosterone- high-severe-covid-. html

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