The findings, published Sept. 2 in JAMA Network Open, suggest that treating men with low testosterone could help protect them from serious illness and reduce the burden on hospitals during waves of COVID-19.
Diwan and co-lead author Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, previously showed that men hospitalized with COVID-19 have abnormally low testosterone levels. However, a serious illness or traumatic injury can cause a temporary drop in hormone levels. Data from men previously hospitalized with COVID-19 don’t really answer the question of whether low testosterone is a risk factor for severe COVID-19 or a consequence of it. To do this, the researchers needed to know whether men with chronically low testosterone levels are sicker than men with normal levels.
Diwan, Dhindsa and their colleagues — including co-author Cosette Champion, MD, an internal medicine resident at Barnes-Jewish — conducted an analysis of patient records from SSM Health and BJC HealthCare, two large hospital systems in the area. Saint Louis. They identified 723 men whose testosterone levels were measured between January 1, 2017 and December 31, 2021, and who had documented cases of COVID-19 in 2020 or 2021. In some cases, testosterone levels were measured after the patient has recovered from COVID-19. Since low testosterone is a chronic condition, men who tested low a few months after recovering from COVID-19 likely had low levels before too, Dhindsa said.
Researchers identified 427 men with normal testosterone levels, 116 with low testosterone levels and 180 who previously had low levels but were successfully treated, i.e. were on hormone replacement therapy. and that 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 hospitalization for COVID, and treatment for low testosterone reversed that risk. The risk actually increases below a level of 200 nanograms per deciliter, with the normal range being 300 to 1,000 nanograms per deciliter. This result is independent of all the other risk factors we looked at: age, obesity or other health conditions. But people who were on treatment, their risk was normal. »
Sandeep Dhindsa, MD, endocrinologist at Saint Louis University
Men with low testosterone may experience sexual dysfunction, depressed mood, irritability, difficulty concentrating and remembering, fatigue, loss of muscle strength, and a reduced sense of general well-being. . When a man’s quality of life is clearly diminished, he is usually treated with testosterone replacement therapy. In contrast, when symptoms are mild, doctors and patients may be hesitant to treat them.
The two main concerns with testosterone therapy are an increased risk of prostate cancer and heart disease. Prostate cancer is common in older men, and it is often caused by testosterone. The increase in testosterone could accelerate the growth of these cancers and worsen the disease. For heart disease, the evidence for risk is more ambiguous. A large clinical trial investigating the relationship between heart health and testosterone supplementation is expected to be completed soon.
“In the meantime, our study suggests it would be prudent to examine testosterone levels, particularly in people who have symptoms of low testosterone, and then individualize care,” said Diwan, whose specialty is cardiology. “If they’re at really high risk for cardiovascular events, then the doctor could engage the patient in a discussion about the pros and cons of hormone replacement therapy, and maybe reducing the risk of hospitalization for cause of COVID could be on the list of potential benefits. »
This study is observational, it only suggests — not proves — that boosting testosterone levels can help men avoid severe COVID-19, Diwan warned. A clinical trial would be needed to conclusively demonstrate whether such a strategy works.
Source :
Journal reference:
Dhindsa, S., et al. (2022) Association of male hypogonadism with risk of hospitalization for COVID-19. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.29747.