In a new study from Washington University in St. Louis, researchers found that, among men, that low testosterone levels in the blood are linked to more severe disease.
It is possible that low testosterone is a cause of severe COVID-19, or low levels could serve as a marker of some other causal factors.
The researchers urge caution with ongoing clinical trials investigating hormonal therapies that block or lower testosterone or increase estrogen as a treatment for men with COVID-19.
In the study, the team measured several hormones in blood samples from 90 men and 62 women with symptoms of COVID-19 and who had confirmed cases of the illness.
Among women, the researchers found no correlation between levels of any hormone and disease severity.
Among men, testosterone levels were linked to COVID-19 severity. A blood testosterone level of 250 nanograms per deciliter or less is considered low testosterone in adult men.
At hospital admission, men with severe COVID-19 had average testosterone levels of 53 nanograms per deciliter; men with less severe disease had average levels of 151 nanograms per deciliter.
By day three, the average testosterone level of the most severely ill men was only 19 nanograms per deciliter. The lower the levels of testosterone, the more severe the disease.
For example, those with the lowest levels of testosterone in the blood were at the highest risk of going on a ventilator, needing intensive care or dying. Thirty-seven patients — 25 of whom were men — died over the course of the study.
The researchers noted that other factors known to increase the risk of severe COVID-19, including advanced age, obesity and diabetes, also are associated with lower testosterone.
They also found that those men with COVID-19 who were not severely ill initially, but had low testosterone levels, were likely to need intensive care or intubation over the next two or three days.
Lower testosterone levels seemed to predict which patients were likely to become very ill over the next few days.
In addition, the researchers found that lower testosterone levels in men also correlated with higher levels of inflammation and an increase in the activation of genes that allow the body to carry out the functions of circulating sex hormones inside the cells.
In other words, the body may be adapting to less testosterone circulating in the bloodstream by dialing up its ability to detect and use the hormone. The researchers don’t yet know the implications of this adaptation and are calling for more research.
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The study is published in JAMA Network Open. One author of the study is Abhinav Diwan, MD.
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