Does Testosterone Play a Role in the Rate of Negative COVID-19 Outcomes?
Although the words coronavirus, COVID-19, and pandemic have become permanent fixtures in every culture across the globe, there is still much we don’t know about the causes and effects of this illness. But, there’s one fact that the data has made clear:
When it comes to COVID-19, men have suffered far worse outcomes than women.
Research is pointing to testosterone, both as playing a role in that demographic disparity and predicting disease severity.
COVID-19 Outcomes by Gender: What the Research Reveals
Demographic studies conducted by the CDC of COVID-19 cases and fatalities in the United States show that men account for only 47.8% of the total known cases, but a significantly larger 54.2% of all attributed deaths.
Similar studies from other nations show an even greater disparity.
Emerging evidence provided by Chinese researchers suggests that coronavirus disease 2019 (COVID-19) is deadlier for infected men than women with a 2.8% fatality rate being reported in Chinese men versus 1.7% in women.
The data, collected worldwide, strongly indicates that men are likely to suffer worse outcomes from COVID-19 than women.
Testosterone’s Role Supported, But Still Unclear
Could testosterone, one of the major biochemical differences between men and women, play a role in outcomes and disease severity?
Yes, but it’s of course complicated. The mechanism behind the gender difference in COVID-19 outcomes remains something of a mystery.
The good news is that research, such as the following study conducted at Washington University School of Medicine in St. Louis, is making headway.
In a cohort study of 152 patients with COVID-19, including 143 patients who were hospitalized, researchers found that testosterone levels at admission and on day 3 of treatment were inversely associated with the severity of the disease and its circulating inflammatory cytokine concentrations in men, but not in women.
Blood analyses conducted during this study also revealed that the bodies of men with low testosterone responded by using their immune system to boost the function of genes responsible for responding to sex hormones. By making the immune system more sensitive to the hormones that were still circulating, the mens’ bodies increased the immune cells’ ability to make the best use of the limited testosterone.
This may represent the body’s response to a dire need for more testosterone for powering its critical functions in the face of severe illness, in this case COVID-19.
What remains unclear is whether low testosterone prior to infection leads to worse COVID-19 outcomes, or if a significant drop in testosterone production is a symptom of COVID-19 infection. There have been no studies yet that had access to patients’ testosterone levels prior to infection—information vital to clearing up this particular question.
Either way, lower testosterone levels seemed to predict which patients were likely to become very ill within a few days following hospital admission.
Another finding of interest from this study is this:
None of the hormones measured in women during this study were found to significantly affect COVID-19 severity in any way—another indication that testosterone in males is associated with negative outcomes.
Testosterone and COVID-19 Outcomes: Further Study Needed
The medical community needs more research to determine what actions are indicated now that they’re aware that testosterone is somehow connected to COVID-19 severity.
Abhinav Diwan, cardiologist and senior author of the study discussed above, has ideas about treatment for patients who continue to experience symptoms of COVID-19 for a longer period of time:
“We also are interested in whether men recovering from COVID-19, including those with long COVID-19, may benefit from testosterone therapy. This therapy has been used in men with low levels of sex hormones, so it may be worth investigating whether a similar approach can help male COVID-19 survivors with their rehabilitation,” .
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