Drop in testosterone levels may explain disease severity

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posted on 09/29/2020 06:00 / updated on 09/29/2020 06:24


(credit: AFP / Ozan KOSE)

A series of scientific researches shows that men have worse prognosis when infected by the coronavirus, when compared to women. But the reasons for this differentiation are little known. A study by Turkish scientists provides a possible explanation for the phenomenon. The researchers observed lower levels of the hormone testosterone in patients in more severe states of covid-19, in addition to loss of libido in most of those analyzed. The authors of the work, published in the latest issue of the journal The Aging Male, believe that the data can help to improve the treatment of individuals with this profile.

The scientists analyzed a group of 221 men, all with covid-19 confirmed by PCR. Those analyzed were divided into three groups: asymptomatic patients (46), symptomatic patients admitted to intermediate care units (129) and patients assisted in intensive care units (46). The entire group underwent a detailed survey of the clinical history, as well as a complete physical examination and laboratory and radiological imaging studies. The material was checked and reviewed by two doctors.

Based on the information collected, the researchers observed a relationship between lower testosterone levels and an aggravated state of Sars-CoV-2 infection. “In our analysis, we found that the average total testosterone decreased as the severity of covid-19 increased. The mean level of total testosterone was significantly lower in the ICU group than in the asymptomatic group and in those undergoing intermediate care ”, explains, in a statement, Selahittin Çayan, professor of urology at the University of Mersin, Turkey, and one of the authors of the study.

The researchers also noted that 65.2% of the 46 asymptomatic patients had a loss of libido. Of the total group, 51.1% (113) were diagnosed with hypogonadism – a condition in which the body does not produce enough testosterone. During the survey, 11 patients (4.97%) died. “These people had significantly lower mean total testosterone than patients who were alive,” says Selahittin Çayan.

The scientist explains that the main male sex hormone is associated with the immune system of Organs respiratory organs. “Low testosterone levels can increase the risk of respiratory infections. They are also associated with hospitalization related to infection of any kind and mortality for practically all illnesses in patients treated at the ICU ”, he details.

For the team, assessing hormone levels during the first care of those infected with coronavirus can be a positive measure. “We believe that a good recommendation to doctors is that, when diagnosing this disease, testosterone levels are also tested. In men with low levels of sex hormones tested positive for covid-19, treatment based on testosterone may be indicated, with great chances of improving the prognosis. But it is clear that we believe that more research is needed on this topic ”, ponders Selahittin Çayan.

Aging

Thiago Napoli, an endocrinologist at the Brazilian Society of Endocrinology and Regional Metabology of São Paulo (SBEM-SP), estimates that the Turkish study presents interesting data, but that he sins when using a small group of patients with a wide age range. “A small number of men were analyzed, and we also see that the age difference is large. In the asymptomatic group, we have people in their 40s. In the ICU, we have men around 70 years old. This makes us believe that the issue of aging weighs more, not least because older men also have a naturally occurring reduction in testosterone, ”he explains.

The Brazilian doctor believes that more research needs to be done, especially analyzes that consider another factor that is also related to the possible association between covid-19 and testosterone. “The virus uses the ECA2 enzyme and a protein, also produced by the human body, to infect the body. And that protein is stimulated by testosterone. Let’s say the first is the door and the second is the doorknob. This may be one explanation for why men suffer from more severe forms of covid-19 than women, ”he says.

According to the endocrinologist, studies and clinical practice have shown that many glands suffer from covid-19, such as the thyroid and the pancreas. “Therefore, the relationship between this disease and hormones is something that needs to be better studied. Especially in the case of testosterone, since, to notice changes related to it, it is much more difficult than a case of diabetes ”, he compares. “Another point to be noted is whether there is a reduction in testosterone levels also after discharge from patients with covid-19. This problem can be a kind of side effect ”, he thinks.

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Different reactions

In July, a study published in the journal Nature, with data from 17 million Britons, provided details about the link between gender and covid-19 mortality. Of these patients, 10,926 died. In the analyzes, the researchers showed that men are up to 1.59 times more likely to die due to infection caused by the coronavirus.

A Chinese study released in April brought similar results. The research, published in the journal Frontiers in Public Health, analyzed 1,056 infected cases. The team noted that the death rate among men was 2.5 times higher. Another study published in Nature in August shows that men and women have different immune reactions to covid-19. Looking at data from 98 people, researchers at Yale University in the United States saw that females had a greater response from the body’s defense cells.

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