A research conducted by a team of scholars of the Washington University School of Medicine in St. Louis and St. Louis University School of Medicine revealed that among men diagnosed with COVID-19, those with low testosterone levels are more likely to become seriously ill and end up in hospital than men with normal levels of the hormone.
The results of the study have been published in the scientific journal JAMA Network Open.
Low testosterone levels related to severe forms of Covid19: here’s what the new research has revealed
The team of scientists carefully studied the cases of 723 men who tested positive for COVID-19, mostly in 2020 before vaccines were available. The resulting information revealed that low testosterone is an independent risk factor for hospitalization for COVID-19, similar to diabetes, heart disease and chronic lung disease.
The researchers also found that men with low testosterone who developed COVID-19 were 2.4 times more likely to require hospitalization than men with hormone levels in the normal range. Additionally, men who were once diagnosed with low testosterone but successfully treated with hormone replacement therapy were no more likely to be hospitalized for COVID-19 than men whose testosterone levels had always been tested. in the normal range.
The results obtained through this new research have shown that treating men with low testosterone levels can help protect them from serious illness and reduce the burden on hospitals during the waves of COVID-19: COVID-19 is very likely to be here. to stay, ”said senior co-author Abhinav Diwan, MD, professor of medicine at Washington University. Diwan, who treats patients at Barnes-Jewish Hospital, is also a professor of cell biology and physiology and of obstetrics and gynecology.
“Hospital admissions with COVID-19 are still a problem and will continue to be a problem as the virus continues to develop 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 reduce hospitalizations, ”added Professor Abhinav Diwan.
Diwan and senior co-author Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, have previously shown that men admitted to hospital with COVID-19 have abnormally low testosterone levels.However, serious illness or traumatic injury can cause a decline. temporary hormone levels.
Data from men who are already hospitalized with COVID-19 don’t really answer the question of whether low testosterone is a risk factor for serious COVID-19 or a result of it. This is why the team of scholars needed to know if men with chronically low testosterone levels get sick more than men with normal levels.
Diwan, Dhindsa and colleagues, including co-author Cosette Champion, MD, a resident resident of Barnes-Jewish, conducted a patient record review of SSM Health and BJC HealthCare, two major hospital systems in the St. Louis area. Scientists 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 recovered from COVID-19. Because low testosterone is a chronic condition, men who tested low levels of the hormone a few months after recovering from COVID-19 likely had low levels even earlier.
The researchers identified 427 men with normal testosterone levels, 116 with low levels, and 180 who previously had low levels but had been successfully treated, meaning they were on HRT and their hormone levels were in the same range. normal range by the time COVID-19 developed.
“Low testosterone proved to be a risk factor for hospitalization for COVID, and treatment of low testosterone helped negate that risk,” Dhindsa said. “The risk really takes off below a level of 200 nanograms per deciliter, with a normal range of between 300 and 1,000 nanograms per deciliter. This is independent of any other risk factors we looked at: age, obesity, or other health conditions. But those people who were in therapy, their risk was normal ”.
Men with low testosterone levels can experience sexual dysfunction, depressed mood, irritability, difficulty concentrating and memory, fatigue, loss of muscle strength, and a reduced sense of general well-being. When a man’s quality of life is clearly reduced, he is usually treated with hormone replacement therapy. When symptoms are mild, however, doctors and patients may hesitate to treat.
The two main concerns related to testosterone therapy are an increased risk of prostate cancer and heart disease. Prostate cancer is common in older men and is often caused by the hormone in question. Increasing it could accelerate the growth of these tumors, making the disease worse. For heart disease, the evidence for risk is more ambiguous. A large clinical study on the relationship between heart health and testosterone supplementation is expected to be completed soon.
“In the meantime, our study would suggest that it would be prudent to look at testosterone levels, especially in people who have symptoms of a low hormone level, and then individualize treatment,” said Diwan, whose specialty is cardiology. “If they are indeed at high risk for cardiovascular events, the doctor could engage the patient in a discussion of the pros and cons of HRT, and perhaps reducing the risk of hospitalization could be on the list of potential benefits.”
It is important to specify that this study is observational, so it only suggests, does not prove, that increasing testosterone levels may help men avoid severe COVID-19, Professor Diwan explained. A clinical trial would be needed to conclusively demonstrate whether this strategy works.
According to ISS data in Italy: “The mean age of patients who died and positive for SARS-CoV-2 is 80 years (median 82, range 0-109, InterQuartile-IQR range (1st quartile = 74; 3rd quartile = 88)). The women who died are 60,201 (43.6%). The median age of SARS-CoV-2 positive deceased patients is approximately 40 years higher than that of infected patients (deceased patients: median age 82 years; infected patients: median age 43 years) “.
“Only in the age group ≥90 does the number of female deaths exceed those of males. This data is related to the fact that the population aged ≥90 in Italy is made up of approximately 72% of women. Overall, women who died after contracting SARS-CoV-2 infection are older than men (median age: women 85 years – men 80 years) “.
“The trend in the mean age of SARS-CoV-2 positive deceased patients by calendar week, starting from the 3rd week of February 2020 (8th week from the beginning of 2020 in Figure 3; the date of the first death dates back to February 20, 2020). The average age of weekly deaths has substantially increased up to 85 years (1st week of July 2020) and then dropped slightly; a further reduction in the average age of deaths was detected starting from February-March 2021 (80 years in the 2nd week of February 2021), up to 72 years in the 2nd week of July 2021 (25th week of 2021) “.
“This reduction in the mean age of deaths is likely a consequence of the protective effect of vaccinations in the older population which has been given priority under the“ National Strategic Vaccine Plan for the Prevention of SARS-CoV-2 Infections ”. From the second week of July 2021, the average age of deaths increased slightly, remaining however below 80 years. It should be noted that the data of the last weeks of observation must be consolidated and therefore could undergo variations “.
Another research developed by a team of scientists in China suggested that: “In a retrospective observational study (the researchers merely observe the phenomena that occurred), it was documented that in a critically ill patient population with SARS-CoV-2, 67% were male. According to Jin et al .’s team, which reviewed data from the first COVID-19 deaths in Wuhan, the mortality rate was higher in males than in females, as well as in SARS (acronym for Severe acute respiratory syndrome) in early 2003 ″.
“In a further retrospective study, which enrolled 47 patients suffering from a severe form of COVID-1928 patients (59.6%) were men, the mean age was 62 years and 30 (63.8%) had co-morbidities (other diseases besides respiratory syndrome caused by SARS-CoV-2 infection) “3”.
“During the two weeks of hospitalization, 5 (17.9%) men and 1 (5.3%) women worsened. Mortality recorded in men was 3.6% while in women it was 0%. Then analyzing the data of 1099 patients affected by SARS-CoV-2collected in 552 hospitals in 30 provinces of China, 58.1% were represented by male patients ”.
“Furthermore, among the 173 severe cases 57.8% were male. According to recent data by Jian-Min et al., Survival analysis showed that men had a significantly higher mortality rate than women. Males showed worse symptoms than women, regardless of age, symptoms and comorbidities “.
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