Interplay between male testosterone levels and the risk for subsequent invasive respiratory assistance among COVID-19 patients at hospital admission

Abstract Purpose: to evaluate the prognostic value of male serum total testosterone (TT) levels among COVID-19 patients requiring an invasive respiratory assistance at hospital admission.Methods: 29 men with full haemato-chemical blood sample panel at hospital admission for COVID-19 related respiratory syndrome were retrospectively reviewed. Multivariable logistic regression model was implemented to test the predictive role of TT levels and subsequent risk for invasive oxygenation after adjusting for age, comorbidities and life-style related confounders. Results: higher serum TT levels (ng/mL) were found independently associated with a lower odd of invasive oxygenation (Odds ratio [OR]: 0.43, 95%CI: 0.23-0.85; p=0.016). Significant negative correlation was found between TT and C-reactive protein, pH, Interleukine-6 and D-Dimer while positive correlation was established among TT levels and Monocytes (x109/L).Conclusion: low testosterone levels may play a relevant role in the natural history of COVID-19 respiratory syndrome by making a patient with comorbidities and higher baseline levels of pro-inflammatory cytokines more susceptible to a potentially fatal clinical course at the moment of infection progression.

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Testosterone Deficiency Is a Risk Factor for Severe COVID-19

Frontiers in Endocrinology ◽

10.3389/fendo.2021.694083 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lukas Lanser ◽

Francesco Robert Burkert ◽

Lis Thommes ◽

Alexander Egger ◽

Gregor Hoermann ◽

...

Keyword(s):

Hospital Admission ◽

Sex Hormones ◽

Immune Activation ◽

Clinical Manifestations ◽

Morbidity And Mortality ◽

University Hospital ◽

Testosterone Levels ◽

Immune System Activation ◽

Increased Risk ◽

The Impact

BackgroundMale sex is related to increased COVID-19 severity and fatality although confirmed infections are similarly distributed between men and women. The aim of this retrospective analysis was to investigate the impact of sex hormones on disease progression and immune activation in men with COVID-19.Patients and MethodsWe studied for effects of sex hormones on disease severity and immune activation in 377 patients (230 men, 147 women) with PCR-confirmed SARS-CoV-2 infections hospitalized at the Innsbruck University Hospital between February and December 2020.ResultsMen had more severe COVID-19 with concomitant higher immune system activation upon hospital admission when compared to women. Men with a severe course of infection had lower serum total testosterone (tT) levels whereas luteinizing hormone (LH) and estradiol (E2) levels were within the normal range. tT deficiency was associated with elevated CRP (rs = - 0.567, p < 0.001), IL-6 levels (rs = - 0.563, p < 0.001), lower cholesterol levels (rs = 0.407, p < 0.001) and an increased morbidity and mortality. Men with tT levels < 100 ng/dL had a more than eighteen-fold higher in-hospital mortality risk (OR 18.243 [95%CI 2.301 – 144.639], p = 0.006) compared to men with tT levels > 230 ng/dL. Moreover, while morbidity and mortality showed a positive correlation with E2 levels at admission, we detected a negative correlation with the tT/E2 ratio upon hospital admission.ConclusionHospitalized men with COVID-19 present with rather low testosterone levels linked to more advanced immune activation, severe clinical manifestations translating into an increased risk for ICU admission or death. The underlying mechanisms remain elusive but may include infection driven hypogonadism as well as inflammation mediated cholesterol reduction causing gonadotropin suppression and impaired androgen formation. Finally, in elderly late onset hypogonadism might also contribute to lower testosterone levels.

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