Keywords: Covid 19, Low T, Low Testosterone Risk factor for Covid 19.
COVID-19 is a novel respiratory virus that has been to have shown to affect men more than women. Men who contract the COVID-19 virus have worse clinical outcomes compared to women. More men have been admitted the hospital for Covid 19 symptoms compared to women. A possible etiology that has been investigated for this gender difference in COVID-19 health outcomes are sex hormones, specifically testosterone and its immunologic protection it may impart against Covid 19 outcomes. Men who have Low Testosterone (Low T) and who contract the Covid 19 virus are found to have 1) worse clinical outcomes 2) higher risk of death 3) higher rate of ICU admission 4) higher risk of intubation in the ICU and 5) longer hospital stays.
Androgens and their role in the COVID -19 disease process is spurring more research to illicit any protective mechanism that testosterone replacement therapy (TRT) may provide in preventing severe Covid 19 symptoms. Much of the current research suggest that a low serum testosterone level increases the risk of developing severe COVID- 19 symptoms. In several studies, men with Low Testosterone (Low -T), and who contracted COVID-19, were more likely to be admitted to the ICU and have increased mortality (death) from the virus.
Low T was found to be present in approximately 90% of patients admitted to the hospital for Covid-19.
Testosterone plays an integral part in modulating the human immune system. Men who have Low T exhibit a pro-inflammatory state characterized by a higher level of inflammatory markers that include C reactive protein, IL-1, IL-2 and TNF – Alpha. The COVID 19 virus damages tissues in the body by causing an extreme release of these inflammatory markers, called a cytokine storm resulting in tissue, vessel and lung damage. Elevated levels of testosterone suppress cytokine activity and production which may protect the body from a cytokine storm.
In addition, studies have shown that testosterone replacement therapy (TRT) may suppress a pro-inflammatory state. Androgen receptors are prevalent on white blood cells, promulgating the theory that testosterone acts as a signal to modulate the immune system. IL-6 is a pro inflammatory biomarker that is elevated in patients who contract COVID-19. Testosterone down regulates IL-6 expression and protects against immune modulated diseases. Patients who have preexisting low serum testosterone level (Low T) have higher than normal IL-6 level and often have more severe COVID-19 symptoms and adverse health outcomes.
More research is needed to further illicit the exact role testosterone replacement therapy (TRT) may have to benefit males who contract COVID-19 and prevent severe health outcomes.