Male hypogonadism associated with risk of hospitalization for COVID-19

Men with low testosterone levels are more likely to require hospitalization after COVID-19 infection than men with normal levels or those on testosterone therapy, according to Saint Louis University School of Medicine and Washington University School of Medicine in St. Louis researchers. This contrasts with a widely held notion that men are more likely than women to be admitted for COVID-19 because they have higher circulating testosterone levels.

The study, "Association of Male Hypogonadism with Risk of Hospitalization from COVID-19," was published online Sept. 2 in JAMA Network Open.

Sandeep Dhindsa, M.D., a professor of medicine and the director of SLU's Division of Endocrinology, Diabetes and Metabolism, is first author on the paper.

Abhinav Diwan, M.D., a cardiologist and professor of medicine at Washington University, is the study's senior author. Cosette Champion, M.D., an internal medicine resident at Barnes-Jewish Hospital, an affiliate of Washington University, is second author on the paper.

Dhindsa and Diwan had previously shown that men hospitalized 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 are already hospitalized with COVID-19 doesn't answer the question of whether low testosterone is 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 get sicker than men with normal levels.

The cohort study looked at COVID-19 patients hospitalized at regional SSM Health and BJC Health Care facilities between Jan. 1, 2017, and Dec. 31, 2021. Researchers collected data on demographics (age, BMI, race, ethnicity), medical conditions, hospitalization due to COVID-19, and the presence of testosterone therapy.

In the study, 134 out of 723 men were hospitalized due to COVID-19. Men who required hospitalization were older, had more preexisting medical conditions, and were more likely to be immunosuppressed than men who were not hospitalized. Men with low testosterone were twice more likely to require hospitalization from COVID as compared to men with normal testosterone levels. Additionally, the hospitalization risk of men treated with testosterone therapy was similar to men with normal testosterone levels.

In 2020, at the outset of the pandemic, people thought testosterone was a risk factor for COVID. A few investigators surmised that drugs should be administered to lower testosterone levels to protect people from hospitalization due to COVID. However, this study shows the opposite. Low testosterone is linked to COVID-related hospitalizations."

Sandeep Dhindsa, M.D., professor of medicine and director of SLU's Division of Endocrinology, Diabetes and Metabolism

Men with chronically low testosterone have weaker muscle mass and strength, which contribute to reduced lung capacity and ventilator dependence. Dhindsa says prospective clinical trials are needed to explore the efficacy of testosterone therapy in preventing hospitalizations after COVID and similar respiratory illnesses in men with hypogonadism.