Hypogonadism increases likelihood of hospitalization for men with COVID-19


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Dhindsa S, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.29747.

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Men with hypogonadism who contract COVID-19 are more likely to be hospitalized compared with those with normal testosterone levels, according to study findings published in JAMA Network Open.

“Historically, the screening for hypogonadism and treatment of testosterone is dependent upon the presence of symptoms such as decreased sexual desire and low energy,” Sandeep Dhindsa, MD, professor of medicine and chief of the division of endocrinology and metabolism at Saint Louis University, told Healio. “However, studies over the last decade have demonstrated that low testosterone adversely impacts metabolic health (such as increased risk of diabetes), and testosterone treatment decreases that risk. Our study brings forth another impact of low testosterone: decreased ability to overcome an illness such as COVID-19.”

Men with hypogonadism were more likely to be hospitalized or admitted to the ICU after being infected with COVID-19 compared with men with eugonadism. Data were derived from Dhindsa S, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.29747.

Dhindsa and colleagues conducted a retrospective cohort study of 723 adult men who had a history of COVID-19 infection and at least one testosterone concentration measurement from 2017 to 2021 (mean age, 55 years). Data were obtained from the electronic health records of two major health systems in St. Louis. Demographics, comorbidities, COVID-19 hospitalization and data on receipt of testosterone therapy were collected. Men were included in a testosterone therapy group if they had received testosterone for at least 6 months before their COVID-19 infection. For men hospitalized with COVID-19, duration of stay, ICU admission, ventilator use and mortality were collected. The lower limit of a normal testosterone level was 175 ng/dL to 300 ng/dL. Men were defined as having hypogonadism if their total testosterone was below the lower limit of normal.

Of the study cohort, 116 had hypogonadism, 427 had a normal testosterone level and 180 were receiving testosterone therapy. There were 134 participants hospitalized with COVID-19. Men in the hypogonadism group were more likely to be hospitalized with COVID-19 (45% vs. 12%) and be admitted to the ICU (9% vs. 3%) than those with normal testosterone levels. The risk for ventilator use and mortality was similar between those with hypogonadism and those with eugonadism.

After adjusting for confounders, men with hypogonadism were more likely to be hospitalized with COVID-19 (adjusted OR = 2.4; 95% CI, 1.4-4.4; P .003) compared with those with eugonadism. There was no difference between the two groups in ICU admission. No difference in hospitalization was found between the testosterone therapy and eugonadism groups. Older men (aOR = 1.03; 95% CI, 1.01-1.05; P = .02) and those who were immunosuppressed (aOR = 3.5; 95% CI, 1.5-7.8; P = .003) were also more likely to be hospitalized with COVID-19.

Hospitalization rates in the cohort increased with a testosterone concentration of less than 200 ng/dL. Of 32 men receiving androgen deprivation therapy for prostate cancer, 56% were hospitalized due to COVID-19 and 9% were admitted to the ICU.

Median testosterone concentrations in men receiving testosterone therapy were similar to men with eugonadism. Of the testosterone therapy group, 24% had subnormal testosterone concentrations. The odds for COVID-19 hospitalization were increased for men with subnormal testosterone levels receiving therapy compared with those with normal concentration while on testosterone therapy (aOR = 3.5; 95% CI, 1.5-8.6; P = .003).

“We were surprised to find that low testosterone actually increased the risk of hospitalization,” Dhindsa said. “This risk was independent of other known risk factors. The fact that testosterone treatment lowered the risk further solidified our finding that low testosterone should be considered a risk factor for hospitalization from COVID-19.”

Dhindsa said it is too early to recommend testosterone therapy as a method for preventing hospitalization from COVID-19 and other acute illnesses, but studies should investigate whether testosterone can have a beneficial effect.

For more information:

Sandeep Dhindsa, MD, can be reached at sandeep.dhindsa@health.slu.edu.

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