Post Intensive Care Syndrome

Low Testosterone Levels Tied to More Severe COVID in Men

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

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By By Cara Murez HealthDay Reporter, HealthDay Reporter

(HEALTHDAY)

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.

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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.

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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.

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"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.

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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.

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Correlation of serum testosterone with severity of critical illness

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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.

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