Testosterone Deficiency Is a Risk Factor for Severe COVID-19

Area of Science:

• Endocrinology
• Infectious Diseases
• Immunology

Background:

• Male sex is associated with higher COVID-19 severity and fatality rates.
• Infections are equally distributed between men and women, suggesting hormonal factors influence disease progression.

Purpose of the Study:

• To investigate the impact of sex hormones on disease progression in men with COVID-19.
• To analyze the relationship between sex hormones and immune activation in male COVID-19 patients.

Main Methods:

• Retrospective analysis of 377 patients (230 men, 147 women) with confirmed SARS-CoV-2 infection.
• Measurement of serum total testosterone (tT), luteinizing hormone (LH), and estradiol (E2) levels.
• Correlation analysis of hormone levels with disease severity markers like C-reactive protein (CRP) and interleukin-6 (IL-6).

Main Results:

• Men exhibited more severe COVID-19 and higher immune activation compared to women.
• Severe COVID-19 cases in men were linked to lower total testosterone (tT) levels.
• Low tT levels (<100 ng/dL) were associated with an over eighteen-fold increased in-hospital mortality risk.

Conclusions:

• Hospitalized men with COVID-19 often have low testosterone levels, correlating with heightened immune activation and severe outcomes.
• Potential mechanisms include infection-induced hypogonadism and inflammation-related cholesterol reduction.
• Low testosterone may significantly increase the risk of ICU admission and death in male COVID-19 patients.