Covid-19 may deplete testosterone, say scientists

The covid-19 disease might deteriorate men's testosterone levels, according to a new study that says low levels of the hormone could be a cause for poor prognosis following a positive test for the novel coronavirus.

The research, published in the journal The Aging Male, noted that as the testosterone level at baseline decreases in men, the probability for them to be in the intensive care unit (ICU) significantly increases.

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According to the study lead author Selahittin Cayan, Professor of Urology at the University of Mersin, while it has already been reported that low testosterone levels could be a cause for poor prognosis following a positive SARS-CoV-2 test, this is the first study to show that Covid-19 itself depletes testosterone.

The scientists believe the findings could explain why prognosis is worse in men than in women with Covid-19, and therefore help discover possible improvement in clinical outcomes using testosterone-based treatments.

They said testosterone is associated with the immune system of respiratory organs, with low levels of the hormone likely to increase the risk of respiratory infections.

"Low testosterone is also associated with infection-related hospitalisation and all-cause mortality in males in ICU patients, so testosterone treatment may also have benefits beyond improving outcomes for Covid-19," Cayan explained.

The study found that the mean total testosterone decreased, as the severity of the Covid-19 increased.

"The mean total testosterone level was significantly lower in the ICU group than in the asymptomatic group. In addition, the mean total testosterone level was significantly lower in the ICU group than in the Intermediate Care Unit group," Cayan said.

The researchers said the mean serum follicle stimulating hormone level was significantly higher in the ICU group than in the asymptomatic group.

"We found, Hypogonadism -- a condition in which the body doesn't produce enough testosterone -- in 113 (51.1 per cent) of the male patients," Cayan said.

According to the researchers, the patients who died, had significantly lower mean total testosterone than the patients who were alive.

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However, they said even 65.2 per cent of the 46 male patients who were asymptomatic had a "loss of loss of libido."

The scientists assessed a total of 438 patients, including 232 males, each with laboratory-confirmed SARS-CoV-2.

They conducted a detailed analysis of the patients' clinical history, conducted a complete physical examination, and also performed laboratory and radiological imaging studies in every patient.

The cohort study was divided into three groups -- asymptomatic patients (46), symptomatic patients who were hospitalised in the internal medicine unit (129), and patients who were hospitalized in the intensive care unit (ICU) (46).

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In the patients who had pre-Covid-19 serum gonadal hormones test (24), the scientists said the serum total testosterone level significantly decreased from pre-Covid-19 levels.

"It could be recommended that at the time of Covid-19 diagnosis, testosterone levels are also tested. In men with low levels of sex hormones who test positive for Covid-19, testosterone treatment could improve their prognosis. More research is needed on this," Cayan said.

Citing the limitations of the study, the researchers said it did not include a control group of patients with conditions other than Covid-19.

They said this was due to the restrictions placed on the hospital that they were monitoring the patients in.

According to the researchers, future studies should look at the concentration levels of ACE2 (Angiotensin-converting enzyme 2) -- an enzyme attached to the cell membranes of cells located in the intestines -- in relationship with the total testosterone levels.