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Low Testosterone, PICS, and Long COVID
Don't Overlook the Symptoms

Post Intensive Care Syndrome

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Low Testosterone Levels Tied to More Severe COVID in Men

Sept. 5, 2022, at 9:00 a.m.

By By Cara Murez HealthDay Reporter, HealthDay Reporter




MONDAY, Sept. 5, 2022 (HealthDay News) -- Men with low testosterone levels may be more likely to have more severe illness when infected with COVID-19, according to a new study.

Treating men who have low testosterone with hormone therapy may reduce their risk of serious illness from COVID, researchers said, but it comes with other risks that doctors and patients will need to weigh.


The investigators analyzed the cases of more than 700 men who tested positive for COVID -- most before vaccines were available.


Men with low testosterone (low-T) who contracted the virus were 2.4 times more likely to require hospitalization than men with normal hormone levels. But men who had been treated successfully for low-T before catching COVID were not more likely to be hospitalized.


"Low testosterone is very common; up to a third of men over 30 have it," said study co-author Dr. Abhinav Diwan, a professor at Washington University School of Medicine in St. Louis.

"Our study draws attention to this important risk factor and the need to address it as a strategy to lower [COVID] hospitalizations," Diwan said in a school news release.


Researchers had previously found that men hospitalized with COVID had abnormally low levels of the male hormone. But they didn't know whether low-T is a risk factor for severe COVID or a result of it.

For that, they needed to find out whether men with chronically low testosterone levels -- before illness or after recovering -- were getting sicker than men with normal levels.


From two hospital systems in the St. Louis area, researchers found 723 men with COVID whose testosterone levels were on record. They identified 427 men with normal testosterone levels; 116 with low levels; and 180 who were being successfully treated for low levels.


They had confirmed cases of COVID in 2020 or 2021 and low-T either before or after their infection.

"Low testosterone turned out to be a risk factor for hospitalization from COVID, and treatment of low testosterone helped to negate that risk," said co-author Dr. Sandeep Dhindsa, an endocrinologist at Saint Louis University.


Dhindsa noted that the risk "really takes off" when levels of testosterone in the blood are below 200 nanograms per deciliter. The normal range is 300 to 1,000.

Low testosterone level is a common finding in critically ill patients with trauma, shock, and sepsis. However, its prevalence and outcomes in patients with primary acute respiratory failure is unknown; low testosterone could contribute to respiratory muscle weakness and further compromise ventilation in these patients.

Correlation of serum testosterone with severity of critical illness

The serum testosterone concentration on admission (left panel) and the nadir level in the hospital (right panel) in men with critical illness according to disease severity as measured by the APACHE score. Men with increasingly severe illnesses have lower serum testosterone concentrations. To convert serum testosterone values to ng/dL, divide by 0.0347.

APACHE: Acute Physiology and Chronic Health Evaluation.


Redrawn from Spratt DI, Cox P, Orav J, et al. Reproductive axis suppression in acute illness is related to disease severity. J Clin Endocrinol Metab

1993; 76:1548.


Graphic 51402 Version 2.0

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How Testosterone Affects Health

Testosterone makes a man look and feel like a man. In a man, this hormone helps:

  • Keep bones and muscles strong

  • Determine hair growth and where fat is on the body

  • Make sperm

  • Maintain sex drive and erections

  • Make red blood cells

  • Boost energy and mood


Causes of Low Testosterone

Beginning around age 30 to 40, testosterone levels may start to slowly decrease. This occurs naturally.


Other causes of low testosterone include:

  • Medicine side effects, such as from chemotherapy.

  • Testicle injury or cancer.

  • Problems with glands in the brain (hypothalamus and pituitary) that control hormone production.

  • Low thyroid function.

  • Too much body fat (obesity). Ask your doctor whether you need a test called free testosterone.

  • Other disorders, chronic diseases, treatments, or infection.



Some men with low testosterone do not have any symptoms. Others may have:

  • Low sex drive

  • Problems having an erection

  • Low sperm count

  • Sleep problems such as insomnia

  • Decrease in muscle size and strength

  • Bone loss

  • Increase in body fat

  • Depression

  • Trouble concentrating


Treatment Options

Your provider will likely have you get a blood test to check your testosterone level. You will also be checked for other causes of your symptoms. These include medicine side effects, thyroid problems, or depression.

If you have low testosterone, hormone therapy may help. The medicine used is man-made testosterone. This treatment is called testosterone replacement therapy, or TRT. TRT can be given as a pill, gel, patch, injection, or implant.

TRT may relieve or improve symptoms in some men. It may help keep bones and muscles strong. TRT seems to be more effective in young men with very low testosterone levels. TRT can also be helpful for older men.

TRT has risks. These may include:

At this time, it is unclear whether TRT increases the risk of heart attack, stroke, or prostate cancer.

Talk with your provider about whether TRT is right for you. If you do not notice any change in symptoms after treatment for 3 months, it is less likely that TRT treatment will benefit you.

If you decide to start TRT, be sure to see your provider for regular checkups.

When to Call the Doctor

Call your provider if:

  • You have symptoms of low testosterone

  • You have questions or concerns about treatment

Alternative Names

Male menopause; Andropause; Testosterone deficiency; Low-T; Androgen deficiency of the aging male; Late-onset hypogonadism

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