Low testosterone may make men susceptible to Covid hospitalisation

WASHINGTON: Researchers from Washington University School of Medicine in St. Louis and Saint Louis University School of Medicine found that males with COVID-19 who had low testosterone levels are likelier than those with normal levels to experience acute illness and require hospitalisation.

723 individuals who tested positive for COVID-19, largely in 2020 before vaccinations were available, were studied in the study.

The data show that low testosterone, like diabetes, heart disease, and chronic lung disease, is an independent risk factor for COVID-19 hospitalisation.

They discovered that COVID-19-positive men with low testosterone were 2.4 times more likely to need hospitalisation than COVID-19-positive men with hormone levels within the normal range.

Additionally, men whose testosterone levels had historically tested within the normal range but who had undergone successful hormone replacement therapy were not any more likely to be hospitalised for COVID-19 than were men whose testosterone levels had consistently tested within the normal range.

The findings, which were released on September 2 in JAMA Network Open, indicate that treating low testosterone in males may help shield them from serious illness and lessen the strain on hospitals during COVID-19 waves.

COVID-19 is most likely here to stay, according to co-senior author and Washington University professor of medicine Abhinav Diwan, MD. Diwan is a physician at Barnes-Jewish Hospital as well as a professor of obstetrics and gynaecology and cell biology & physiology.

"COVID-19 hospitalizations are still an issue and will be a concern since the virus keeps mutating new forms that bypass immunity based on vaccination. Up to one-third of males over 30 have low testosterone, which is a relatively prevalent condition. Our research highlights the significance of this risk factor and the necessity of addressing it as a means of reducing hospitalizations. Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, and co-senior author Diwan have previously demonstrated that men hospitalised with COVID-19 have abnormally low testosterone levels. However, a serious sickness or traumatic accident may temporarily lower hormone levels. Whether low testosterone is a risk factor for severe COVID-19 or a consequence of it is a subject that has not been particularly well-resolved by data from men who have already been hospitalised with the disease. The researchers wanted to discover if individuals with chronically low testosterone levels were more susceptible to illness than those with normal levels.

Co-author Cosette Champion, MD, a Barnes-Jewish internal medicine resident, and colleagues Diwan and Dhindsa reviewed patient charts at SSM Health and BJC HealthCare, two significant hospital systems in the St. Louis region. They located 723 men with reported COVID-19 cases in 2020 or 2021 and testosterone levels measured between January 1, 2017, and December 31, 2021. After the patient recovered from COVID-19, testosterone levels were sometimes checked. Men who tested low a few months after recovering from COVID-19 likely had low testosterone levels earlier as well, according to Dhindsa, since low testosterone is a chronic disorder. The study found that 427 men with normal testosterone levels, 116 with low levels, and 180 who had previously had low levels but were successfully treated. These men were receiving hormone replacement therapy, and their testosterone levels were within the normal range at the time they developed COVID-19. Low testosterone was found to be a risk factor for COVID hospitalisation, but therapy reduced that risk, according to Dhindsa. "Below 200 nanograms per deciliter, where the typical range is 300 to 1,000 nanograms per deciliter, the risk dramatically increases. Age, obesity, and other health issues that we looked at as risk factors have no bearing on this. However, the risk for those receiving therapy is as usual. Sexual dysfunction, low mood, irritability, memory loss, exhaustion, loss of muscle mass, and a generalized decreased sense of well-being are all symptoms of low testosterone in men. When a man's quality of life is obviously suffering, testosterone replacement treatment is usually used to treat him. But when the symptoms are slight, medical professionals and patients might be hesitant to treat. Prostate cancer and heart disease risk are the two main issues with testosterone therapy. Older men frequently develop prostate cancer, which is frequently fueled by testosterone. Increasing testosterone may accelerate the development of certain malignancies, aggravating the condition. The risk evidence for heart disease is less clear. It is anticipated that a sizable scientific investigation on the connection between testosterone supplements and heart health will soon be finished. "Our findings would suggest that it would be good to look at testosterone levels, especially in those who have low testosterone symptoms, and then individualise care," said Diwan, a cardiologist by training. "If they have a particularly high risk of cardiovascular events, the doctor could talk to the patient about the advantages and disadvantages of hormone replacement treatment, and potentially one of the potential benefits would be a reduced risk of COVID hospitalisation."

As an observational study, Diwan advised that it cannot be concluded that increasing testosterone levels will prevent men from developing severe COVID-19. A clinical trial would be required to demonstrate unequivocally whether such an approach is effective.