How does the sex hormone testosterone influence the course of COVID-19 disease? At a “Round Table” organized by the German Society for Men and Health e. V. (DGMG), experts addressed this question.

Even though men and women get COVID-19 in roughly equal numbers, there are also differences. DGMG President Prof. Frank Sommer, MD, summarized the situation as follows: “However, men suffer significantly more severe disease courses or die more often than women as a result of their COVID-19 disease. But what is the reason for this?

Male testosterone came into focus early on, but the exact relationships need further investigation. One of the reasons seems to be that low testosterone levels are associated with numerous comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, and COPD. All of these diseases also increase the risk for severe COVID-19 disease progression; in addition, in men, low testosterone appears to be associated with proinflammatory status.

Studies suggest that men with lower testosterone levels appear to be at increased risk for severe courses of COVID-19.

Study from the U.S.A.

In Missouri, researchers examined the hormone levels of 90 men and 62 women who were hospitalized for severe infections with SARS-CoV-2. While the doctors found no correlation between the severity of the course and the testosterone level in women, there was clearly a correlation in men. Men with low testosterone levels more often had to be treated and ventilated in intensive care and had an increased risk of dying as a result of the disease!

Study from Milan

A study from Milan was presented at the European Association of Urology (EAU)2021 Congress. Researchers compared testosterone levels in 286 male COVID-19 patients and 305 healthy male volunteers. The differences were also clear when age, preexisting conditions, and BMI were taken into account. 90% of the patients had low testosterone levels below 9.2 nmol/l, whereas only 17% of healthy volunteers and patients with mild symptoms had higher testosterone levels than those who had to be admitted to the intensive care unit or died from the disease.

Conclusion of the round

As a result, the expert panel agreed that:

• Men become more severely ill and die more frequently from COVID-19.
• Men with low testosterone levels suffer more severe courses of COVID-19 disease.
• Men who are overweight are more likely to suffer from a testosterone deficiency at the same time and therefore also suffer more severely from COVID-19. Obesity very likely causes functional hypogonadism in these men. This in turn favors a more severe COVID-19 course, the experts hypothesized.

Sources:

1. Deutsche Gesellschaft für Mann und Gesundheit e. V.
2. https://www.der-niedergelassene-arzt.de/suche/ergebnis/suche/die-rolle-von-testosteron-bei-covid-19
3. Dhindsa S. et al. JAMA Netw Open. 20213;4(5):e2111398.
4. Andrology. 2021 Feb 26;10.1111/andr.12993.
5. Washington University School of Medicine in St. Louis, USA
6. European Association of Urology (EAU)