COVID-19 opened a whole new world of research including great effort into understanding why men fared worse than women with regard to disease severity. While women generally suffer from more autoimmune conditions, with this SARS CoV2 virus, men got the short straw. When this correlation for men continued to pop up from epidemiological studies, the obvious next step was to look for “why?”. Many questioned whether higher testosterone in men could explain the difference. This study does not fully answer why men get worse COVID, but it does indicate that higher testosterone actually protects men.
As men and women scurried to hide from COVID behind closed doors, even the brace hearted men asked “why” more were succumbing to COVID-19 than women. The most obvious difference was of course initially testosterone. Once puberty hits, men have several times the amount of testoteron coursing through their blood than women.
This study casts considerable doubt on the testosterone COVID risk hypothesis at least in its most basic form. Looking at 221 consecutive males with a confirmed diagnoses in an inpatient setting, they separated them into asymptomatic, hospitalized with symptoms, and ICU patients. Comparison revealed that higher disease severity correlated with lower testosterone levels. This does not prove a causal effect, but does encourage further research on potential mechanisms to explain the findings.
For the 24 patients who had testosterone lab results from before their COVID disease, levels decreased from an average of 458 to an average of 315 ng/dl. Beyond the indication that lower levels increased severity risk, the infection appeared to lower levels of testosterone. A quick review of Pubmed did not reveal much in terms of any prior research linking a viral infection and sex hormones changing besides for mumps and HIV. That make this mysterious change all the more interesting.
On a side note, if you asked 10 functional medicine practitioners if they are surprised by hormone levels changing during an illness, they (and myself included) would not be surprised. We know that inflammation both acute and chronic effect the hormones usually for the worse.
Further thoughts from a functional medicine perspective come from the average testosterone level in the study. We administer frequent hormone replacement therapy for men and women. In men, a level of 400 is adequate but far from optimal. I am very curious to know if men with prior testosterones over 600, even those closer to 800 fare even better with COVID. With that in mind, I would ask if pre-emptive testosterone therapy might lower men’s risk or if an exercise program that raises testosterone would be protective.
Even the authors posed the question concerning men hospitalized with COVID, whether or not they would be tested for testosterone and therapy considered. I would venture that many men would sign up for a study that offered testosterone dosing.
As we guide our patients with COVID prevention therapies, we can now consider whether their testosterone is optimal and whether we have another reason to prescribe replacement. Helping patient live healthier more abundant lives takes many forms.
Other COVID-19 articles by Dr. Potter:
Another New Word for 2020 – Syndemic
Is COVID Killing More Americans or Not?
Selahittin Çayan, Mustafa Uğuz, Barış Saylam, Erdem Akbay. Effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort study. The Aging Male, 2020; 1 DOI: 10.1080/13685538.2020.1807930
Thanks to Science Daily:
Taylor & Francis Group. “COVID-19 may deplete testosterone, helping to explain male patients’ poorer prognosis: Over half of male patients studied were found to have lower than their normal testosterone levels.” ScienceDaily. ScienceDaily, 28 September 2020. <www.sciencedaily.com/releases/2020/09/200928125024.htm>.
Other research connecting gender and immunity:
Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol. 2021 Jan 21;11:604000. doi: 10.3389/fimmu.2020.604000. PMID: 33584674; PMCID: PMC7873844.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.