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COVID-19 could deplete testosterone levels in men or cause testicular damage in men, these two clinical studies claim.

First study

COVID-19 could deplete male testosterone

Research experts from the University of Mersin and the Mersin City Education And Research Hospital in Turkey found that as men’s testosterone level at baseline decreases, the probability for them to be in the intensive care unit (ICU) significantly increased. Their results were published in the peer-reviewed journal, The Aging Male.

Lead author Selahittin Çayan, Professor of Urology, states that while it has already been reported that low testosterone levels could be a cause for poor prognosis following a positive COVID-19 test, this is the first study to show that COVID-19 itself depletes testosterone.

He hoped that the development could help to explain why so many studies have found that male prognosis is worse than females with COVID-19, and therefore discover a possible improvement in clinical outcomes using testosterone-based treatments.

Professor Çayan also explained that “Testosterone is associated with the immune system of respiratory organs, and low levels of testosterone might increase the risk of respiratory infections. And that low testosterone is also associated with infection-related hospitalization and can cause mortality in male ICU patients, so testosterone treatment may also have benefits beyond improving outcomes for COVID-19”

“In our study, he said, the mean total testosterone decreased, as the severity of the COVID-19 increased. The mean total testosterone level was significantly lower in the ICU group than in the asymptomatic group. In addition, the mean total testosterone level was significantly lower in the ICU group than in the Intermediate Care Unit group. While the mean serum follicle-stimulating hormone level was significantly higher in the ICU group than in the asymptomatic group.

“We found Hypogonadism – a condition in which the body doesn’t produce enough testosterone in 113 (51.1%) of the male patients.

“The patients who died had significantly lower mean total testosterone than the patients who were alive.

“However, even 65.2% of the 46 male patients who were asymptomatic had a loss of loss of libido.”

The study reported that the research team looked at a total of 438 patients. This included 232 males, each with laboratory-confirmed SARS-CoV-2 (COVID-19). All data were prospectively collected. A detailed clinical history, complete physical examination, laboratory, and radiological imaging studies were performed in every patient. All data of the patients were checked and reviewed by two physicians.

Then the cohort study was divided into three groups: asymptomatic patients (n: 46), symptomatic patients who were hospitalized in the internal medicine unit (IMU) (n: 129), and patients who were hospitalized in the intensive care unit (ICU) (n: 46).

In the patients who had pre-COVID-19 serum gonadal hormones test (n: 24), serum total testosterone level significantly decreased from a pre-COVID-19 level of 458?±?198?ng/dl to 315?±?120?ng/dl at the time of COVID-19 in the patients (p?=?0.003).

Death was observed in 11 of the male adult patients (4.97%) and 7 of the female patients (3.55%), revealing no significance between the two genders (p?>?0.05).

Commenting on the results of the study, Professor Çayan added: “It could be recommended that at the time of COVID-19 diagnosis, testosterone levels are also tested. In men with low levels of sex hormones who test positive for COVID-19, testosterone treatment could improve their prognosis. More research is needed on this.”

However, the study had some limitations because it did not include a control group of patients with conditions other than COVID-19. But they explained that it was due to the restrictions placed on the hospital that they were monitoring the patients in.

Second study

Covid-19 could cause male infertility by harming the cells of the testes.

The second study by Dr. Dan Aderka of Sheba Medical Centre Israel claimed that those who suffer from moderate or severe cases of COVID-19 could experience reduced fertility.

Aderka reported that not only was the virus found within the sperm of some 13% of screened male COVID-19 patients but that there was a 50% decrease in the sperm volume, concentration, and motility in patients with moderate disease even 30 days post-diagnosis.

Finally, post-mortem tests of 12 COVID-19 patients demonstrated moderate to severe changes in the testicular cells supporting sperm development and those producing testosterone, the hormone that induces sperm division and multiplication.

Aderka, whose research has not yet been published, told The Jerusalem Post that the cause for this phenomenon seems to be the presence of the angiotensin-converting enzyme receptor (ACE2) on the surface of the cell of the Sertoli and Leydig cells of the testis, the same receptors on the cells of lungs, kidneys, and hearts.

The Sertoli cells support sperm maturation. While Leydig cells produce testosterone.

He said the coronavirus binds to the ACE2 receptors and destroys the cells, which causes infertility.

“As normal sperm maturation takes 70 to 75 days, it is possible that if we are doing a sperm examination two and a half months after recovery, we may see even more reduced fertility,” Aderka said. “It could be even more detrimental.”

He added that it is also still unclear if the effects on the quality and quantity of the sperm are reversible or persistent.

He said doctors will need to examine these same patients six months and a year after recovery to see if the damage “stands the test of time.” This is something his team is planning to do.

Aderka said that there is another hypothesis that can now be explored, also as a result of his research: “Interestingly, an enzyme called TMPRSS2 assists the virus in binding to the ACE receptor, facilitating its internalization into the cells.”

TMPRSS2 is activated by testosterone.

“This phenomenon may explain the higher COVID-10 morbidity and mortality of men compared to women,” he told the Jerusalem Post, adding that it also may explain the lower morbidity and mortality of children, whose testosterone levels are low.

The Bottom line

The two studies concluded that COVID-19 could lead to male infertility, however more studies are required.

Nonetheless, wearing a face mask and obeying social distancing rules can reduce the severity, mortality, and ultimately reduce infertility says the research experts.