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Low testosterone in men might increase the risk of severe COVID

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Low testosterone in men might increase the risk of severe COVID

Many people know that Testosterone Replacement Therapy (TRT) delivers many benefits: Larger muscles, increased strength, skyrocketing energy, enhanced libido, melting fat, easing joint aches and pains, better sleep, mood boost, and sharper thinking.

But did you know that TRT might protect against severe COVID-19?

That’s right. A study conducted at St. Louis University and Washington University by a team of researchers concluded that men diagnosed with hypogonadism (aka “Low-T”) were 3.6 times more likely to be hospitalized with severe illness from COVID-19 than men with normal testosterone levels.

The research team looked at the health records of 723 adult men infected with COVID to determine their testosterone levels between Jan.1, 2014, to Dec. 31,2021. Most survey subjects had caught COVID in 2020 before the COVID vaccines were developed.

The team defined low testosterone as below 175 to 300 nanograms per deciliter (ng/dl). The measurements were taken around 7 months before the COVID virus in 73% of the participants, and an average of approximately 6 months after recuperating for 27% of the men.

The results were surprising.

Here is the data on the 723 research subjects:

  • Average age: 55

  • Average Body Mass Index (BMI): 33.5 kilograms per meter squared (obese)

  • 60% had standard testosterone levels

  • 16% had Low-T

  • 25% were undergoing TRT

  • 134 men were hospitalized. These subjects were older (62 vs. 53 average age), suffered from more comorbid conditions, and were more prone to have weakened immune systems (19% vs. 4% of the non-hospitalized participants).

  • 32 of the study participants were undergoing androgen deprivation therapy, a form of chemical castration intended to impede prostate cancer growth. This group's average testosterone level was an anemic 3.5 ng/dl. 18 of these men required hospitalization, and 3 required intensive care.

Let’s make sense of these numbers.

Without considering risk factors, the men suffering from andropause (aka male menopause, another name for Low-T) WITH COVID were 3.6 times more apt to require hospital admission for their virus treatment. The risk was 2.4 times more than the standard testosterone group when the underlying, preexisting medical problems were considered.

Subjects receiving TRT that still had Low-T were more likely to be hospitalized. But men responding to TRT favorably had a comparable risk of requiring a hospital stay as men with average testosterone levels.

After adjusting for risk factors, the Low-T group was at a slightly higher risk of hospital admission: intensive care unit (ICU) admission: 9% Low-T vs. 3% standard testosterone levels; ventilator: (4% vs. 2%), or death (4% vs. 2%). The results were consistent if testosterone levels were checked before or after the COVID contagion.

When tracking time spent in the hospital, the team divided the men into three groups: Hypogonadism,

normal testosterone levels, and those currently undergoing TRT. Here are the results with the sequence of Low-T, average T, and receiving TRT:

  • The average number of days hospitalized: (6 vs. 6 vs. 8 days)

  • ICU: (6 vs. 4 vs. 14)

  • On a ventilator: (14 vs. 8 vs. 12)

Why TRT is so crucial

Here is a reminder of the debilitating symptoms and effects of Low-T:

  • Accumulating fat, especially belly fat

  • Shrinking muscle

  • Weakened bones that may lead to osteoporosis

  • Chronic fatigue

  • Compromised immune system

  • Elevated blood pressure

  • Higher LDL cholesterol levels (The “bad cholesterol”)

  • Poor sleep quality

  • Depression

  • Mental fog and confusion

  • Increased joint aches and pains

  • Metabolic syndrome

  • Type 2 diabetes

  • A lower sense of well-being and reduced quality of life

  • Kidney disease and lung impairments

  • And more health issues that make men with Low-T sitting ducks for the dreaded COVID.

Some of these conditions are nearly identical to the effects of COVID. This results in a “double-whammy” for hypogonadal sufferers.

The team wrote: "Men with chronically low testosterone concentrations have decreased muscle mass and less strength, both of which contribute to reduced lung capacity and ventilator dependence. Aging and comorbid conditions, which are risk factors for hospitalization for COVID-19, are also associated with hypogonadism." 

They added that testosterone therapy might ease the ferocity of COVID-19 by boosting muscle mass and strength and reducing inflammation, precisely what men with low-T need. Such therapy, however, carries an increased risk of prostate cancer and may increase the risk of heart disease.

In a Washington University press release, senior author Abhinav Diwan, MD, a professor of medicine at Washington University, stated that low testosterone is widespread and growing, affecting up to a third of men over 30. The manly hormone drops steadily at around 10% per decade if left untreated.

It is very likely that COVID-19 is here to stay,” according to Diwan, who added, “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.”

Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, and co-senior author Diwan have previously found that men hospitalized with COVID-19 have unusually low testosterone levels.

However, severe sickness or traumatic accidents may temporarily lower hormone levels. Whether low testosterone is a risk factor for severe COVID-19 or a consequence of it is a subject that has not been particularly well-resolved by data from men who have already been hospitalized with the disease.

The researchers wanted to discover if individuals with chronically low testosterone levels were more prone to sickness than those with normal levels.

Low testosterone was a risk factor for COVID hospitalization, but TRT reduced that risk, as per Dhindsa. "Below 200 nanograms per deciliter, where the typical range is 300 to 1,000 nanograms per deciliter, the risk dramatically increases. Age, obesity, and other health issues that we looked at as risk factors have no bearing on this. However, the risk for those receiving therapy is as usual.”

Dhindsa says their work confirmed low counts of the hormones did mean a higher risk of hospitalization.

Diwan concluded that “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.”

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.”

What about the risk of Testosterone Replacement Therapy?

As with all treatments, TRT is not risk-free. Two significant concerns are an increased risk of prostate cancer and heart disease. The link to heart disease has not been proven, and a clinical trial is in progress to determine if TRT causes heart problems.

The link between TRT and prostate cancer has been greatly exaggerated. The entire "testosterone causes prostate cancer" myth started in 1941 based on a study by Dr. Charles B. Huggins that turned out to be severely flawed.

Several recent studies have concluded that men with Low-T who received TRT had lower rates of prostate cancer antigen (Pca), a test used to predict prostate cancer based on a genetic analysis of cells found in urine. Other studies have concluded that severe prostate cancer is directly connected to low testosterone, contrary to long-held medical beliefs.

The conclusions of this study indicate that when applied correctly, TRT could offer significant protection from the ravages of COVID and help ease the burden of overcrowded, understaffed hospitals made worse by the COVID tsunami.

The study results were featured in JAMA Network Open.

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