Is it true that men are more adversely affected by COVID-19?
Yes! And testosterone may be the missing link
It’s a fact. Men are hit harder than women when it comes to the devastating effects of the COVID-19 virus. According to the New York City health department, on April 7th, 2020, 2232 men had died of the virus in New York City compared to 1,309 women,
At that time, more than 40,000 male patients were sick enough from the virus to be hospitalized, compared to around 34,000 women. The Coronavirus death rate per 100,000 in the city was 55 men and less than 30 for women.
Fast-forward to August 27th. At that time, the city’s health department concluded that 11,389 men had died of the virus as opposed to 7,646 women.
And it’s not just New York City where this difference occurred
China reported that the COVID-19 mortality rate for men was 2.8% compared to 1.7% for women. Italy declared a similar gap: 72% of deaths from the virus were men, and another study found an even higher number of 80% men dying vs. 20% women...a 4-1 ratio!
Why is there such a difference in fatalities from the Coronavirus between the genders? Is it that men engage in more reckless behavior such as not wearing masks, not keeping social distance, smoking and drinking alcohol more than women, and putting off going to the doctor when they are not feeling well?
Perhaps. But there may be another answer: the COVID-19 virus may deplete testosterone level in men, causing a condition called “Low-T.”
To answer that question, let’s take a look at what the recent studies have concluded.
In a recent significant study in Turkey on patients hospitalized due to Covid-19, the researchers concluded that the disease might lower men's testosterone levels.
The findings, published in the journal The Aging Male, determined that, as men's testosterone level at baseline plummets, their likelihood for to be admitted to the intensive care unit (ICU) significantly increases.
While it has already been reported that low testosterone levels may be linked to a poor prognosis following a positive SARS-CoV-2 test, this is the first study to show that Covid-19 itself lowers testosterone.
Researchers measured levels of 200 men hospitalized after testing positive for Covid-19.
More than half (51 percent) had developed a condition called hypogonadism, in which their bodies did not produce enough testosterone. On average, participants' levels were decimated by 30 per cent after the virus hit to marginal unhealthy levels.
Hypogonadism is also called “Low-T.”
"Testosterone is associated with the immune system of respiratory organs, and low levels of testosterone might increase the risk of respiratory infections," said study author Selahittin Cayan from the University of Mersin in Turkey.
"Low testosterone is also associated with infection-related hospitalization and all-cause mortality in the male in ICU patients, so testosterone treatment may also have benefits beyond improving outcomes for Covid-19," she added.
The study consisted of 438 patients. This included 232 males, each with laboratory-confirmed SARS-CoV-2.
All data were prospectively collected. A detailed clinical history, complete physical examination, laboratory, and radiological imaging studies were performed in every patient. All data of the patients were checked and reviewed by the two physicians.
Results showed these patients saw their levels drop by a third, on average, from 458 anagrams per deciliter (ng/dl) to 315 ng/dl.
A healthy level of testosterone is usually considered to be above 300 ng/dl.
The study was divided into three groups: asymptomatic patients (46), symptomatic patients who were hospitalized in the internal medicine unit (IMU) (29), and patients who were hospitalized in the intensive care unit (ICU) (46). In this study, 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. Also, the mean total testosterone level was significantly lower in the ICU group than in the Intermediate Care Unit group. The mean serum follicle-stimulating hormone level was considerably 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 51.1 per cent of the male patients," Cayan said"
“The patients who died had significantly lower mean total testosterone than the patients who were alive. However, even 65.2 per cent of the 46 asymptomatic male patients had a loss of libido. In our study, the mean total testosterone decreased, as the severity of the Covid-19 increased” Cayan added.
Even among men who showed no symptoms of the virus, two-thirds reported having a lowered sex drive, which is a sure sign of low testosterone.
As well as being essential in the development of sex organs and muscle growth, testosterone also helps regulate the immune responses, including fighting viral infections.
Low levels of the hormone have been linked to an increased risk of dying from the flu, as well as inflammation, heart disease, fatigue, muscle weakness, joint aches and pains, and high blood pressure.
Death was observed in 11 of the male adult patients (4.97%) and 7 of the female patients (3.55%), revealing no significance between the two genders (p?>?0.05).
Commenting on the study results, Professor Çayan added: "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."
The authors state 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 – concerning the total testosterone levels.
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.
The researchers are now calling for all men hospitalized with Covid-19 to have their testosterone levels checked upon admission.
They say testosterone replacement therapy (TRT) – a relatively safe treatment for men suffering from Low-T – be considered as a treatment option for the virus.
Professor Çayan admits the team's study was limited because it did not include a control group of patients with conditions other than Covid-19 to compare with.
This was due to the hospital's restrictions they were monitoring the patients in, she said. It comes after a study in May found men with low testosterone levels who contract Covid-19 are at far greater risk of dying from the virus.
In another study, medics at the University Medical Center Hamburg-Eppendorf in Germany looked at 45 laboratory-confirmed COVID-19 patients admitted to ICU.
Thirty-five were men, and 10 were women, with seven patients requiring oxygen and 33 of them needing ventilation. Nine men and three women died.
Each patient's hormone levels were assessed on their first day in ICU before they had received any invasive procedures.
Samples from the COVID-19 patients were tested for 12 hormones, including testosterone and dihydrotestosterone.
Of the male COVID-19 patients sent to ICU at the German hospital, more than two thirds (68.6 percent) recorded low testosterone levels. In contrast, the majority of female patients (60 percent) had elevated testosterone levels.
In a third study conducted in America, researchers concluded that the Coronavirus might cause men's testicles to swell and lead to infertility. More than a dozen symptoms of COVID-19 have been reported since the pandemic began, including a dry cough, fever, and loss of taste or smell.
Doctors have told men to be extra vigilant of the virus after a 37-year-old patient was taken to A&E with swelling and 'discomfort' in his scrotum.
The patient had already been suffering from the more common signs of COVID, including a cough and fever, for a week before going to the hospital.
Doctors from the San Antonio Uniformed Services Health Education Consortium in Texas said the virus had damaged his spermatocytes, which keep sperm healthy.
They warned the damage caused by Covid-19 could have ‘a future impact on male fertility’.
Similar reports of testicular pain in Covid-19 patients have been reported previously, but there has been no real research into the link. Doctors who treated him believe the virus entered the body using ACE2 receptors on Leydig cells present in the testes.
Writing in the American Journal of Medicine, they admit that such cases are rare. But they hope raising awareness about them will help other medics 'identify this disease at the earliest junction and trigger appropriate treatment, quarantine, and fertility follow-up.'
The patient spent a night in the hospital before being discharged and prescribed antibiotics and painkillers. His pain is said to have eased slightly, but the case report did not say whether his condition improved in the weeks after.
It is hoped that the development could explain why so many studies have found that male prognosis is worse than those females with COVID-19, and therefore to discover a possible improvement in clinical outcomes using testosterone-based treatments.
The results and conclusions from these studies are a solemn reminder to all men of the critical role testosterone plays in their overall health. If you are suffering from Low-T, or think you are, contact us for a free, no-obligation discussion.
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