Hormone-related risk: Men with low testosterone levels end up in hospital 2.4 times more often with a Covid 19 infection than those with normal hormone levels, according to a study. A successful adjustment of the values by hormone replacement therapy can apparently normalize the risk. The results suggest that low testosterone levels are an independent risk factor for severe COVID-19, the researchers say.
As is well known, infection with the Sars-CoV-2 coronavirus does not hit everyone equally hard: In addition to predispositions and previous illnesses, gender also plays a role, according to statistics: According to this, men are more likely to have severe courses of Covid-19 than women and end up more often in the hospital. Initially, this even led to the assumption that the effect of the male sex hormone testosterone could have an unfavorable effect on the course of the disease. But then, as early as 2021, a study by researchers led by Sandeep Dhindsa from Washington University in St Louis suggested that the opposite could be the case: it showed that men who were hospitalized with Covid-19 often had particularly low testosterone levels exhibit.
cause or effect?
However, in this study it remained unclear whether low testosterone levels are a risk factor for severe Covid 19 disease or a consequence of it. To separate cause and effect, the researchers needed information about the patients' baseline hormone levels. As part of the new study, Dhindsa and his colleagues have now provided this information. They analyzed the medical records of 723 men who had tested positive for Covid-19 in 2020 or 2021. The testosterone values of all of them were known from previous examinations. 427 men had normal levels, 116 had low levels and 180 were on hormone replacement therapy to maintain normal testosterone levels.
As the team reports, 134 of the 723 men were hospitalized as part of their Covid 19 disease. When comparing the medical records, certain pre-existing conditions again emerged as risk factors – as well as the testosterone factor: Men with low testosterone levels were more than twice as likely to have to go to the hospital because of Covid-19 as men with normal testosterone levels . "Low testosterone was shown to be a risk factor, and treating the low testosterone helped reduce that risk," says Dhindsa. Specifically, the risk increased significantly below a level of 200 nanograms of testosterone per deciliter, with the normal range being 300 to 1000 nanograms per deciliter. "This was independent of all other risk factors that we looked at: age, obesity or other health conditions," says Dhindsa.
A normal hormone level is favorable
What exactly is the factor that leads to the positive effect of the hormone remains unclear. However, some impairments of low testosterone levels are already known to be fairly common: up to a third of men over the age of 30 have low levels and the tendency increases with age. Among other things, this can lead to listlessness, loss of muscle strength and an overall reduced sense of well-being. When this significantly affects quality of life, the deficiency is often treated with testosterone replacement therapy. In the case of mild symptoms, however, doctors and patients hesitate because there are risks. Above all, the therapy can promote the emergence or development of prostate cancer, and a connection with heart disease is also currently being investigated.
It is therefore important to weigh up the pros and cons. "A doctor can discuss with the patient the pros and cons of hormone replacement therapy, and perhaps reducing the risk of Covid hospitalization could be on the list of possible benefits," says senior author Abhinav Diwan of Washington University. As the team concludes, however, further studies are now needed to examine the potential of testosterone therapy in terms of the risk of severe Covid 19 courses in more detail. But at least the initial assumption of some researchers is now off the table: "In 2020, at the beginning of the pandemic, it was thought that testosterone was a risk factor for Covid," says Dhindsa. “Some even suggested that testosterone-lowering drugs might be helpful in protecting people from hospitalization. However, this study shows the opposite,” the scientist sums up.
Source: Washington University School of Medicine, Saint Louis University, Article: JAMA Network Open, doi:10.1001/jamanetworkopen.2022.29747