Although blamed for everything from road rage to hair loss, for severely ill COVID-19 patients testosterone may be the difference between life and death. In Germany, 45 patients with the novel coronavirus (COVID-19) were studied. Men with low testosterone levels had worse outcomes. Whether or not testosterone played a role in their survival remains an open question.
Testosterone levels fluctuate. Determining the hormone’s level only requires a simple blood test. Unfortunately, the same patient can have low testosterone one day and be in the normal range the next. As men age, testosterone levels drop. In healthy middle-aged men, they decline one to two percent a year. Over one third of men older than age 45 have below normal levels of testosterone. Although men with no other health issues often take testosterone, there is no clear evidence that the benefits outweigh the side effects. Perhaps most challenging of all is that gender specific-studies and treatments were fairly rare until recently.
Testosterone and Immunity
It’s a myth that testosterone plays a role in violent behavior. There is some connection between the hormone and male pattern baldness. Still, most research on the negative effects of elevated testosterone examined athletes taking it to gain a competitive advantage. Artificially elevating testosterone levels to several times the normal amount can bring a host of side effects––from acne to heart and liver disease.
Still, when it is produced naturally, testosterone does much more good than harm. In men, the pituitary gland regulates the hormone by sending signals to the testes to increase or decrease production. For women, testosterone is produced in the ovaries and adrenal gland. Testosterone isn’t just responsible for boys becoming men during puberty. It also plays a role in muscle size and bone growth. Perhaps most surprising, it helps control immune response. Low testosterone level is linked to cytokine storms––an overreaction to pathogens where the patient’s body attacks itself in addition to the foreign agent.
Because testosterone can stimulate the prostate gland, men undergoing treatment for prostate cancer are often given medications that reduce testosterone levels. Although there is no clear connection between testosterone treatment and cancer, reducing the level of the hormone can leave patients vulnerable to a host of infections.
Uncertainty and Hormones
Because they are facing a new virus, doctors and scientists are exploring contradictory treatments. In May, researchers at Columbia University Irving Medical Center launched a new study involving COVID-19 patients at Veterans Affairs hospitals in New York City, Los Angeles, and Seattle. Using the prostate cancer drug degarelix, male patients will have their testosterone temporarily lowered. Researchers think this will reduce the production of TMPRSS2 in lung tissue which could keep the virus from penetrating lung cells. In Italy, doctors noticed that prostate cancer patients receiving androgen-deprivation therapy (ADT) had lower rates of COVID-19 infections. This may indicate that blocking production of androgens like testosterone and androstenedione can protect men from the virus. The same month as the VA study, doctors in Long Island began treating male patients with estrogen hoping that it will elevate their immune systems. Generally seen as a female sex hormone, the potential lifesaving benefit of estrogen probably outweighs side effects like hot flashes. Yet the therapy has been called into question because elderly women are outliving elderly men despite lowered estrogen levels.
It isn’t just unfamiliarity with the virus driving the contradictory, gender-specific treatments. Up until recently, whether or not someone is a biological male or female played a limited role in how new treatments were studied. Only five years ago, the National Institutes of Health began requiring that sex difference data be collected on all newly funded preclinical research grants. Women and men can interact with drugs differently; they can have worse or better outcomes depending on the treatment. Ironically, focusing on male test subjects for decades may be one reason male COVD-19 patients are so vulnerable.
Regardless of whether or not testosterone levels ultimately affect COVID-19 survival, there is another reason men are dying at far higher rates than women. It isn’t because of hormones. It’s because of behavior. Statistically, men drink and smoke more. They wash their hands less. And they are more likely to delay seeking medical treatment. With so much about this virus out of our control, men have an opportunity to reduce their risk exponentially––just by making a few simple lifestyle changes.
Written by John Bankston
- The majority of male patients with COVID-19 present low testosterone levels on admission to Intensive Care in Hamburg, Germany.
- Testosterone — What It Does And Doesn’t Do.
- The Pathogenesis and Treatment of the `Cytokine Storm’ in COVID-19.
- Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study.
- VA launches clinical trial for Veterans with COVID-19 based on prostate cancer drug.
- Consideration of Sex as a Biological Variable in NIH-funded Research.
Steven N. Gange, MD
Founding Medical Partner
Dr. Gange is a board certified urologist and Director of Education at Summit Urology Group. Dr. Gange is a Founding Medical Partner and Medical Director of the Men's Health Channel at Doctorpedia.