ST. LOUIS — Men with low testosterone levels see their risk of hospitalization due to COVID-19 more than double, according to a new study.
Compared to men with regular testosterone levels, men with low counts of the sex hormone were 2.4 times more likely end up in the hospital with severe coronavirus symptoms. However, if they received successful hormone replacement therapies, patients recovered quickly.
This joins a list of other symptoms and pre-existing conditions connected to COVID, including sexual dysfunction, depressed mood, irritability, difficulty with concentration and memory, fatigue, loss of muscular strength, and a reduced sense of well-being overall.
Study authors suggest that this discovery means men with low testosterone should receive testosterone supplementation to protect them from suffering severe infection from the virus. Researchers at Washington University School of Medicine in St. Louis and Saint Louis University School of Medicine add that preventing severe disease would reduce the burden on hospitals during new waves of COVID-19.
“It is very likely that COVID-19 is here to stay,” says co-senior author Abhinav Diwan, MD, a professor of medicine at Washington University, in a media release.
“Hospitalizations with COVID-19 are still a problem and will continue to be a problem because the virus keeps evolving new variants that escape immunization-based immunity. Low testosterone is very common; up to a third of men over 30 have it. Our study draws attention to this important risk factor and the need to address it as a strategy to lower hospitalizations.”
When do testosterone levels reach a danger point?
Dr. Diwan’s research follows on previous research that men hospitalized with the disease have abnormally low testosterone levels. However, those previous results were limited because severe illness or traumatic injury can cause hormone levels to temporarily drop, making it unclear as to whether the findings were a cause or effect.
To find out, the study in JAMA Network Open investigated whether men with chronically low testosterone levels get sicker than men with regular levels. By documenting 723 men examined between January 2017 and December 2021, and who had COVID-19 in either 2020 or 2021, they succeeded.
Results show 427 patients had regular testosterone levels, 116 had low levels, and 180 previously had low levels but received hormone replacement treatment and were back to normal.
Co-senior author Dr. Sandeep Dhindsa says their work confirmed low counts of the hormones did mean a higher chance of hospitalization.
“Low testosterone turned out to be a risk factor for hospitalization from COVID, and treatment of low testosterone helped to negate that risk,” Dhindsa reports. “The risk really takes off below a level of 200 nanograms per deciliter, with the normal range being 300 to 1,000 nanograms per deciliter. This is independent of all other risk factors that we looked at: age, obesity or other health conditions. But those people who were on therapy, their risk was normal.”
Testosterone therapy comes with risks
Though they recommend hormone replacement therapy, the team notes that there are concerns related to the treatment, including a risk of prostate cancer and heart disease. Prostate cancer is often the result of testosterone problems and boosting those levels could speed up the growth of tumors.
The link to heart disease is less clear, but a clinical trial is ongoing to uncover the apparent connection.
“In the meantime, our study would suggest that it would be prudent to look at testosterone levels, especially in people who have symptoms of low testosterone, and then individualize care,” concludes Diwan, whose specialty is cardiology. “If they are at really high risk of cardiovascular events, then the doctor could engage the patient in a discussion of the pros and cons of hormone replacement therapy, and perhaps lowering the risk of COVID hospitalization could be on the list of potential benefits.”
South West News Service writer Pol Allingham contributed to this report.