Low testosterone may increase risk of Covid-19 hospitalisation in men, says study

The researchers found that men with low testosterone who developed Covid-19 were 2.4 times more likely to require hospitalisation than men with hormone levels in the normal range.

Further, men who were once diagnosed with low testosterone but then successfully treated with hormone replacement therapy were no more likely to be hospitalised for Covid-19 than men whose testosterone levels had always tested in the normal range.

“It is very likely that Covid-19 is here to stay,” co-author Dr Abhinav Diwan, a professor of medicine at Washington University, who has done his MD from AIIMS in Delhi, said in a statement.

“Hospitalisations with Covid-19 are still a problem and will continue to be a problem because the virus keeps evolving new variants that escape immunisation-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 hospitalisations,” said Diwan.

He and co-author Dr Sandeep Dhindsa, an endocrinologist at Saint Louis University, had previously shown that men hospitalised with COVID-19 have abnormally low testosterone levels. However, severe illness or traumatic injury can cause hormone levels to drop temporarily.

Data from men who were already hospitalised with Covid-19 did not really answer the question of whether low testosterone was a risk factor for severe Covid-19 or a result of it. For that, the researchers needed to know whether men with chronically low testosterone levels got sicker than men with normal levels.

Researchers identified 723 men whose testosterone levels had been measured between 1 January, 2017, and 31 December, 2021, and who had documented cases of Covid-19 in 2020 or 2021. In some cases, testosterone levels were measured after the patient recovered from Covid-19.

Since low testosterone is a chronic condition, men who tested low a few months after recovering from Covid-19 probably had low levels before as well, Dhindsa said.

The researchers identified 427 men with normal testosterone levels, 116 with low levels, and 180 who previously had low levels but were being successfully treated, meaning that they were on hormone replacement therapy and their testosterone levels were in the normal range when they developed Covid-19.

“Low testosterone turned out to be a risk factor for hospitalisation from Covid-19, and treatment of low testosterone helped to negate that risk,” Dhindsa said in a statement.

“The risk really takes off below a level of 200 nanograms per deciliter, with the normal range being 300 to 1,000 nanograms per deciliter. This is independent of all other risk factors that we looked at: age, obesity or other health conditions. But those people who were on therapy, their risk was normal,” said Diwan.

The researchers added that men with low testosterone levels could experience sexual dysfunction, depressed mood, irritability, difficulty with concentration and memory, fatigue, loss of muscular strength, and a reduced sense of well-being overall.

When a man’s quality of life is clearly diminished, he is typically treated with testosterone replacement therapy. When the symptoms are mild, though, doctors and patients may hesitate to go down that path of treatment.

This study is observational, so it only suggests — not proves — that boosting testosterone levels may help men avoid severe Covid-19, Diwan cautioned.

A clinical trial would be needed to demonstrate conclusively whether such a strategy works.