Low testosterone levels are highly prevalent among men at the time of hospital admission for COVID-19, and it is associated with more severe clinical outcomes, including death, investigators reported during the 36th annual European Association of Urology congress (EAU21).
In a case-control study that compared 286 men hospitalized with COVID-19 during the first wave of the pandemic with a control group of 281 healthy blood donors, investigators led by Andrea Salonia, MD, of San Raffaele University Hospital in Milan, Italy, found that 257 (89.8%) of the patients with COVID-19 had hypogonadism at hospital admission compared with 42 (14.9%) of health controls.
The investigators defined hypogonadism as a total testosterone (TT) level less than 9.2 nmol/L (265.1 ng/dL).
On multivariable analysis, infection with SARS-CoV-2, the novel coronavirus that causes COVID-19, was significantly associated with nearly 6-fold increased odds of hypogonadism. After accounting for disease severity, hypogonadism was significantly associated with 33% increased odds of death. The lower the TT levels, the greater the risk of death.
Results also showed that the lower the TT levels, the higher the likelihood patients would need intensive care, be intubated and put on a ventilator, and remain in a hospital over a longer period.
“At the start of the [COVID-19] pandemic, we were seeing far more men than women coming to hospital and suffering very severe forms of the disease,” Dr Salonia said in an EAU21 press release. “We immediately thought this might be related to male hormone levels, particularly testosterone. But we never expected to see such a high proportion of [COVID-19] patients with these extremely low levels of testosterone, in comparison to a similar group of healthy men. The relationship is very clear: the lower the testosterone, the higher the severity of the condition and likelihood of death. I’ve never seen anything like it in my 25 years in the field.”
The investigators did not have data on TT levels in patients prior to contracting COVID-19, so they could not determine whether low TT was a pre-existing long-term condition that exacerbated the disease or whether it was caused by SARS-COV-2.
Capogrosso P, Pontillo M, Gregori S, et al. Severely low testosterone in men with COVID-19: A case-control study. Presented at: EAU 2021, held July 8-12. Abstract P0528.