Is SARS‐CoV‐2‐induced disease a decisive factor influencing testosterone in males? Findings from a case‐control ex post facto study

Abstract

AbstractBackgroundWhether the observed lower total testosterone (tT) levels in male patients with COVID‐19 are caused by a direct impact of SARS‐CoV‐2 infection or are collateral phenomena shared by other systemic inflammatory conditions has not yet been clarified.ObjectivesTo investigate the independent role of COVID‐19 in reducing circulating tT levels in men.Materials and methodsWe compared demographic, clinical, and hormonal values of patients with laboratory confirmed COVID‐19 admitted during the first wave of the pandemic with a cohort of consecutive male patients admitted to the intensive care unit (ICU) of the same academic center because of severe acute respiratory distress syndrome (ARDS) but without SARS‐CoV‐2 infection and no previous history of COVID‐19. Linear regression model tested the independent impact of COVID‐19 on circulating tT levels. Logistic regression model was used to test predictors of death in the entire cohort.ResultsOf 286 patients with COVID‐19, 70 men had been admitted to the ICU ( = cases) and were compared to 79 patients equally admitted to ICU because of severe ARDS but negative for SARS‐CoV‐2 infection and without previous history of COVID‐19 ( = controls). Controls were further grouped into noninfective (n = 49) and infective‐ARDS (n = 30) patients. At baseline, controls were older (p = 0.01) and had more comorbidities (p < 0.0001). Overall, cases admitted to ICU had significantly lower circulating tT levels compared to controls (0.9 nmol/L vs. 2.1 nmol/L; vs. 1.2 nmol/L; p = 0.03). At linear regression, being negative for COVID‐19 was associated with higher tT levels (Coeff: 2.13; 95% confidence interval ‐ CI 0.71‐3.56; p = 0.004) after adjusting for age, BMI, comorbidities and IL‐6 levels. Only age and IL‐6 levels emerged to be associated with higher risk of death regardless of COVID‐19 status.ConclusionsThis case‐control ex post facto study showed lower tT levels in men with COVID‐19 compared to those without COVID‐19 despite both groups have been equally admitted to ICU for severe ARDS, thus suggesting a possible direct impact of SARS‐CoV‐2 infection toward circulating tT levels and a consequent more severe clinical outcome.