Low testosterone may increase risk of COVID-19 hospitalization for men: Boosting testosterone in men with low levels may reduce serious illness

Among men diagnosed with COVID-19, those with low testosterone levels are more likely to become seriously ill and end up in the hospital than men with normal levels of the hormone, according to a study by researchers at Washington University School of Medicine in St. Louis and Saint Louis University School of Medicine.

The team analyzed the cases of 723 men who tested positive for COVID-19, mostly in 2020 before vaccines were available. The data indicate that low testosterone is an independent risk factor for COVID-19 hospitalization, similar to diabetes, heart disease and chronic lung disease.

They found that men with low testosterone who developed COVID-19 were 2.4 times more likely to require hospitalization than men with hormone levels in the normal range. Further, men who were once diagnosed with low testosterone but successfully treated with hormone replacement therapy were no more likely to be hospitalized for COVID-19 than men whose testosterone levels had always tested in the normal range.

The findings, published Sept. 2 in JAMA Network Open, suggest that treating men with low testosterone may help protect them against severe disease and reduce the burden on hospitals during COVID-19 waves.

“It is very likely that COVID-19 is here to stay,” said co-senior author Abhinav Diwan, MD, a professor of medicine at Washington University. Diwan, who treats patients at Barnes-Jewish Hospital, is also a professor of cell biology & physiology, and of obstetrics & gynecology. “Hospitalizations with COVID-19 are still a problem and will continue to be a problem because the virus keeps evolving new variants that escape immunization-based immunity. Low testosterone is very common; up to a third of men over 30 have it. Our study draws attention to this important risk factor and the need to address it as a strategy to lower hospitalizations.”

Diwan and co-senior author Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, previously had 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 really 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.

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