Males with low testosterone ranges and COVID-19 had been greater than twice as doubtless as males with regular concentrations to be hospitalized, however these handled with hormone alternative remedy weren’t at elevated danger, suggests an observational study at present in JAMA Community Open.
A workforce led by St. Louis College and Washington College researchers analyzed the digital well being data of 723 grownup male COVID-19 survivors with testosterone measurements from Jan 1, 2017, to Dec 31, 2021. Most had COVID-19 in 2020, earlier than vaccines had been obtainable.
The lads had their testosterone measured as a result of they’d signs of low testosterone (hypogonadism), which was outlined as a focus under 175 to 300 nanograms per deciliter (ng/dL), relying on the reference lab. Testosterone concentrations had been measured a median of seven months earlier than COVID-19 an infection in 73% of sufferers and a median of 6 months after restoration in 27%.
2.4 occasions the danger of hospitalization
Of the 723 individuals, common age was 55 years, common physique mass index was 33.5 kilograms per meter squared (overweight), 16% had hypogonadism, 60% had regular testosterone ranges (eugonadism), and 25% had been receiving testosterone remedy.
A complete of 134 males had been hospitalized with COVID-19, and these sufferers had been older (common age, 62 vs 53 years), had extra underlying medical situations (median Charlson Cormorbidity Index [CCI] rating, 2 vs 0), and had been extra more likely to have immune suppression (19% vs 4%) than nonhospitalized males.
Thirty-two males had been receiving medicine to decrease their testosterone ranges in an effort to impede the expansion of their prostate most cancers, and their median testosterone stage was 3.5 ng/dL. Eighteen of them (56%) had been admitted for COVID-19, and three (9%) required intensive care.
Within the unadjusted evaluation, males identified as having hypogonadism had been 3.6 occasions extra more likely to be hospitalized with COVID-19 than eugonadic males (52 of 116 [44.8%] vs 53 of 427 [12.4%]). However after adjusting for danger components, the danger was 2.4 occasions increased in these with hypogonadism.
Testosterone remedy recipients who nonetheless had low testosterone additionally had been extra more likely to be hospitalized (adjusted odds ratio [OR], 3.5). However males receiving ample testosterone remedy had been at an identical danger of hospitalization as eugonadic males (OR, 1.3).
After adjustment, relative to males with eugonadism, these with hypogonadism weren’t at increased danger of intensive care unit (ICU) admission (9% vs 3%; OR, 1.2), air flow (4% vs 2%), or loss of life (4% vs 2%). Outcomes had been related no matter whether or not testosterone ranges had been measured earlier than or after an infection.
There have been no variations among the many males with hypogonadism or eugonadism or these receiving testosterone remedy in median variety of days within the hospital (6 vs 6 vs 8 days, respectively), within the ICU (6 vs 4 vs 14 days), or on a ventilator (14 vs 8 vs 12 days). After adjustment, the danger components for hospitalization had been age (OR, 1.03), excessive CCI rating (OR, 1.3), and immunosuppression (OR, 3.5).
The commonest signs of hypogonadism had been fatigue (43%) and erectile dysfunction (30%). Different related situations included decreased libido (8%), gynecomastia (enlarged breasts; 5%), low temper (4%), opiate use (3%), pituitary adenoma (benign tumor of the pituitary gland; 3%), and weight problems (3%).
Function of hormone alternative remedy
The researchers famous that male hypogonadism has been tied to weight problems, metabolic syndrome, sort 2 diabetes, kidney illness, and persistent lung illness.
“Males with chronically low testosterone concentrations have decreased muscle mass and fewer power, each of which contribute to lowered lung capability and ventilator dependence,” they wrote. “Getting old and the presence of comorbid situations, that are danger components for hospitalization for COVID-19, are additionally related to hypogonadism.”
Additionally they stated that testosterone remedy could reduce the severity of COVID-19 by rising muscle mass and power and lowering irritation, an necessary consider males with hypogonadism, who’re in a generalized inflammatory state. Such remedy, nevertheless, carries an elevated danger of prostate most cancers and will improve the danger of coronary heart illness.
In a Washington College press release, senior creator Abhinav Diwan, MD, stated that low testosterone is quite common, affecting as much as a 3rd of males older than 30 years. Concentrations decline steadily at a price of 1% or 2% per yr.
“Our research would recommend that it might be prudent to have a look at testosterone ranges, particularly in individuals who have signs of low testosterone, after which individualize care,” he stated. “If they’re at actually excessive danger of cardiovascular occasions, then the physician might have interaction the affected person in a dialogue of the professionals and cons of hormone alternative remedy.”