Testosterone and Coronavirus/Covid-19

Is there some kind of link between men’s levels of testosterone and Covid-19? Many men have started asking this after reading media articles saying there might be. Confusingly, they seem to report conflicting findings from recent medical research. The good news is that most experts are agreed: normal levels of testosterone help rather than hinder the fight against the virus. 

Low T linked to higher death rate

One piece of evidence comes from a study of 31 male patients treated in a respiratory intensive care unit in Mantua in Lombardy in northern Italy. The study found that lower baseline levels of total testosterone and calculated free testosterone predicted higher mortality in men infected with the virus admitted to intensive care.

Its findings were echoed by another study of 45 patients, including 35 men, in Hamburg in Germany. Researchers at the University Medical Centre Hamburg-Eppendorf found that more than two thirds of male Covid-19 patients admitted to intensive care showed low levels of testosterone, as did the majority of the Covid-19 patients who died.

Further confirmation of the link between Low T levels and increased severity and death from Covid-19 also comes from a study at Washington University School of Medicine in St Louis, Missouri. It found lower testosterone concentrations were associated with increased disease severity, inflammation and death from the virus.

Immune system ‘storm’

Low testosterone appears to allow the body’s immune system to go out of control, causing what is called a ‘cytokine storm’. This inflames the lungs, leading to acute respiratory distress and in many cases, death. Speaking to the Daily Mail, Professor Gülsah Gabriel from the Leibniz Institute for Experimental Virology in Hamburg, said: “Low testosterone levels in men seem to be a risk factor for severe and even fatal disease outcome in men upon infection with so-called ‘cytokine inducing’ respiratory viruses.”

On the other hand, another study from Italy looking at prostate cancer patients given testosterone-blocking drugs found they were less likely to die from Covid-19 than those not given the same therapy. 

Blocking testosterone ‘unthinkable’

However, commenting on the study, in an article in the Daily Mail, Professor Nick James of London’s Institute for Cancer Research, said using the drugs as a large-scale method of preventing the virus was unthinkable. “Being on these drugs is the male equivalent of going through the menopause. You would almost certainly cause more harm than good”.

The testes may also play a part in men’s vulnerability to Covid-19. The virus uses Angiotensin-converting enzyme 2 (ACE2), an enzyme attached to the cell membrane, as its main route to enter cells. ACE2 is more highly expressed in men, particularly, among other organs, in the testis and the prostate. This raises could mean that the testes may act as viral reservoirs, playing a role in how long the virus stays in the body. It may also harm the testes and so reduce serum testosterone levels, with a resulting negative impact on recovery.

Normal T levels are vital weapon

Experts in the field of testosterone are absolutely convinced that normal levels of the male hormone are vital weapon for men in fighting Coronavirus. Dr Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School and director of the Men’s Health Boston clinic, said: “Those suggesting that testosterone must be dangerous because men are more at risk than women obviously know nothing about testosterone. It is particularly low in the elderly men, who are at greatest risk.”

Find out more about checking your testosterone levels here

Fighting Covid-19 by lowering inflammation

It is the male hormone’s anti-inflammatory role that looks to be most important in combatting Coronavirus. In a recent article in the Telegraph newspaper, Professor Geoff Hackett, consultant in urology and professor in sexual medicine at Aston University, pointed to low testosterone as the culprit for the intensity of the inflammatory effects of the cytokine storm in destroying patients’ lungs and arteries. He concluded: “Of course we need a vaccine if we can get it. But it looks as though a man has a much greater chance of surviving this enemy and others if he goes into the battle with a normal testosterone level.”

What is testosterone replacement therapy (TRT) and what are its benefits?

Are you worried that you might be suffering from testosterone deficiency? Take the free online self test-questionnaire to see if you might be suffering from the symptoms.

If you’d like to discuss making an appointment for testosterone testing and treatment, please feel free to get in touch.

Testosterone and Covid-19 FAQs & References

Does low T mean I am more likely to die from Covid-19

Low testosterone levels have been linked in research both to admission to intensive care for the virus as well as to higher mortality once in intensive care. However, the connection to Low T is complex, as the virus itself may affect the testes and hence the secretion of testosterone.

References:

Low testosterone levels predict clinical adverse outcomes in SARS‐CoV‐2 pneumonia patients (https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.12821)

The majority of male patients with COVID-19 present low testosterone levels on admission to Intensive Care in Hamburg, Germany:

A retrospective cohort study.  (https://www.medrxiv.org/content/10.1101/2020.05.07.20073817v1.full.pdf)

Can TRT cure Covid-19?

No.  There is no evidence that it can. However, treatment with TRT to restore testosterone levels to normal has been shown to lead to a significant reduction in hospitalisation and mortality from all causes among men with health problems including coronary heart disease, type-2 diabetes and heart failure. TRT can also reverse progression to type-2 diabetes. Since older men with type-2 diabetes are more at risk from Covid-19, in the current context TRT may play a part in general health maintenance and preventive healthcare.

References:

Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes:

Eight-Year Data From a Registry Study (https://care.diabetesjournals.org/content/42/6/1104)

BSSM Position Statement on Hypogonadism and Covid 19 (http://www.bssm.org.uk/resources/)

Men are more likely to die from Covid-19. Is this because of testosterone?

While it is true that more men than women die of Covid-19, the reasons for this are complex. It is likely to be more due to their different biological vulnerabilities and other factors rather than to the simple fact that men have higher testosterone levels than women. Since those most at risk of dying of Covid-19 are elderly men with one or more underlying chronic diseases, who are also likely to suffer from hypogonadism (reduced function of the testes, causing lower testosterone production), testosterone alone is unlikely to be to blame for higher mortality among men.

References:

Worse progression of COVID-19 in men: Is testosterone a key factor? (https://onlinelibrary.wiley.com/doi/full/10.1111/andr.12836)

If I am worried about Covid-19, should I check my testosterone levels?

If you are worried about Covid-19, the most important thing is to follow current UK Government guidelines on reducing the risk of infection. However, monitoring and maintaining overall health is also very important and for many men this should include checking their testosterone levels.

If you are suffering from symptoms of Low T then TRT may be able to help resolve them. Take our free online self-test questionnaire

References

Low testosterone levels predict clinical adverse outcomes in SARS‐CoV‐2 pneumonia patients

Giulia Rastrelli,  Vincenza Di Stasi,  Francesco Inglese,  Massimiliano Beccaria and others.

https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.12821?campaign=wolacceptedarticle

The majority of male patients with COVID-19 present low testosterone levels on admission to Intensive Care in Hamburg, Germany:
a retrospective cohort study.

Maria Schroeder, BerfinTuku, Dominik Jarczak, Axel Nierhaus, Tian Bai , Henning Jacobsen, Martin Zickler, Zacharias Müller, Stephanie Stanelle-Bertram, Andreas Meinhardt, Jens Aberle, Stefan Kluge, Gülsah Gabriel.

https://www.medrxiv.org/content/10.1101/2020.05.07.20073817v1.full.pdf

COVID-19: biological factors in men’s vulnerability

Alan White, Mike Kirby

https://trendsinmenshealth.com/wp-content/uploads/sites/13/2020/07/COVID-19-mens-health-online.pdf