Male pituitary-gonadal axis dysfunction in post-acute COVID-19 syndrome-Prevalence and associated factors: A
Oscar Moreno-Perez1,2, Esperanza Merino3, Rocio Alfayate4
1Endocrinology and Nutrition Department, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
Objective:
Severe acute respiratory syndrome coronavirus 2 through angiotensin-converting enzyme 2 receptor can harm testes function. The objectives were to analyse the prevalence of low serum testosterone (LT) and impaired fertility potential (Leydig and Sertoli cells dysfunction, respectively) in coronavirus disease 2019 (COVID-19) male survivors and to evaluate acute infection-related associated factors. Also, we explore its association with post-acute COVID-19 syndrome (PCS) and quality of life (QOL).
Materials And Methods:
Male adults recovered from polymerase chain reaction-confirmed COVID-19 were offered a structured evaluation 8-12 weeks after recovery. The main outcome measure(s) were as follows: LT, defined as total testosterone (TT) < 2 ng/ml or if TT levels 2-4 ng/ml as calculated free testosterone < 6.36 ng/dl; Sertoli cell dysfunction was defined as inhibin-B < 89 pg/ml. Secondary outcome-associated factors were analysed by multiple logistic regression (odds ratio; 95% confidence interval [CI]). QOL was evaluated by SF-36 v.2.
Results:
One hundred and forty-three patients were evaluated at a median (interquartile range) of 77 days (72-83) after disease onset; 72% of them recovered from severe pneumonia. LT was detected in 41 patients (28.7%; 95% CI: 21.8-36.5). Low levels of inhibin-B were detected in 25 patients (18.1%; 95% CI: 12.5-25.3). After multivariate adjustment, obesity and hypokalaemia were associated with LT, whereas age more than 65 was an independent predictor of Sertoli cell dysfunction. LT or Sertoli cell dysfunction was not associated with PCS. Patients with LT had a lower score in four domains of QOL.
Conclusions:
Prevalence of male LT and impaired fertility potential in COVID-19 survivors is high in the medium term. Traditional risk factors and severity markers for COVID-19 could be predictive.
Insights
COVID-19 survivors, particularly men, show a high prevalence of low testosterone and impaired fertility weeks after recovery. Obesity and hypokalemia are linked to low testosterone, while older age predicts Sertoli cell dysfunction.
Area of Science:
- Endocrinology
- Virology
- Reproductive Health
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can impact male reproductive health via the angiotensin-converting enzyme 2 receptor.
- Understanding the long-term effects of coronavirus disease 2019 (COVID-19) on male fertility and testosterone levels is crucial.
Purpose of the Study:
- To determine the prevalence of low serum testosterone (LT) and impaired fertility potential in COVID-19 male survivors.
- To identify factors associated with these conditions and explore links to post-acute COVID-19 syndrome (PCS) and quality of life (QOL).
Main Methods:
- A cohort of 143 male adults recovered from COVID-19 were evaluated 8-12 weeks post-recovery.
- Low testosterone was defined by specific total or calculated free testosterone levels; Sertoli cell dysfunction was indicated by low inhibin-B.
- Associations with risk factors, PCS, and QOL (SF-36 v.2) were analyzed.
Main Results:
- 28.7% of survivors had low testosterone, and 18.1% showed Sertoli cell dysfunction.
- Obesity and hypokalemia were associated with LT; age over 65 predicted Sertoli cell dysfunction.
- No association was found between LT/Sertoli cell dysfunction and PCS, but LT correlated with lower QOL scores.
Conclusions:
- Male hypogonadism and impaired fertility are prevalent in COVID-19 survivors in the medium term.
- Predictive factors for these reproductive issues may include traditional COVID-19 risk factors and severity markers.
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