According to a recent German study, men with low testosterone may be more susceptible to COVID-19.
This research likely comes as a shock to the medical community, as it directly contradicts some recent assumptions about the relationship between testosterone and the virus.
Men and COVID: Weighing the Evidence
The idea that low testosterone in men is associated with reduced immune performance is not a new concept. This pre-COVID study demonstrated that men on dialysis with lower testosterone were significantly more likely to require hospitalization for infections.
So why do some physicians and researchers believe that testosterone may enhance the virus?
One simple reason is that, according to the epidemiological data, COVID-19 disproportionately affects men. An Italian study of over 1500 people found that 82% of the patients admitted to the ICU were male, and—despite the fact that men and women seem equally likely to contract it—males are much more likely to die from it.
This data has lead to a few hypotheses regarding the effects of androgens like testosterone and dihydrotestosterone (DHT) on the virulence of SARS-CoV-2, and a few new ideas about how to test these theories out.
The U.S. Department of Veterans Affairs (VA) has, based on the concept that testosterone feeds the virus, launched a new clinical trial in which they will be experimentally lowering the testosterone of veterans with COVID-19 using a drug called degarelix, a type of hormonal chemotherapy agent which can block the pituitary gland’s production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and therefore reduce the body’s testosterone synthesis to near-zero.
According to the FDA, the side effects of degarelix include:
“Hot flashes, flushing of the skin, increased weight, decreased sex drive, and difficulties with erectile function”
Of course, as this drug is a temporary immunological stopgap to help a man fighting for his life, those side effects may be acceptable, but what are the chances that this intervention will have any beneficial effects whatsoever for these veterans-turned-guinea-pigs?
In light of this more recent evidence out of Germany, the probability that this sort of therapy will help these patients is low, as it now seems more likely that the increased severity of COVID-19 in men may be due to lifestyle factors such as smoking, drinking, and poor nutrition, rather than the natural differences in circulating testosterone between men and women.
After analyzing patients’ sex hormones as well as cytokine and chemokine responses (a measure of immune system and inflammatory activity), the authors of the study conclude:
“Critically ill male COVID-19 patients suffer from severe testosterone and dihydrotestosterone deficiencies. Both androgens are required to mount antiviral immune responses to combat infection in males.”
As a small critique on this study, it should be pointed out that these measurements of circulating androgens were taken after they contracted the disease, and thus could represent an acute phase change rather than a preexisting condition.
In other words, the body may temporarily lower testosterone because of the infection, so it’s a chicken-and-egg type of scenario.
Adequate testosterone is of course critical for quality of life, putting on lean muscle mass, sexual health, and mood regulation, but none of these are needed when a man is on a ventilator in the ICU fighting for his life.
It may be that testosterone is simply a waste of precious resources when one is critically ill, and that the body naturally lowers it until it has recovered and can go back to normal functionality.
Further, it doesn’t make biological sense for the body to promote reproductive behavior when you’re hosting a deadly infection, as that will increase the chances that it will spread and negatively impact the survival of the species.
Because SARS-CoV-2 uses the testicles as a kind of viral reservoir, it seems even more likely that decreased production of testosterone and reduced sexual behavior may be a direct consequence of the disease rather than a primary predisposing factor.
In order to truly evaluate whether testosterone affects susceptibility to severe COVID-19, we would need to measure plasma androgens before the disease was contracted rather than after, and this study has yet to be conducted, although it’s likely in the works as there are thousands of clinical trials going on right now to help us better understand how SARS-CoV-2 walks and talks.
Zinc: the common thread between Testosterone and Coronavirus?
A critical testosterone cofactor that’s also required for immunocompetence, zinc has been demonstrated to inhibit viral replication of the original SARS-CoV and has been proposed to help with prevention and treatment of COVID-19.
In fact, the drug hydroxychloroquine–which is undergoing clinical trials for the treatment of COVID-19–is a zinc ionophore, meaning that it transports zinc ions inside the cell, where they can effectively limit viral replication.
It’s then probable that higher zinc levels are helping men both fight the virus and stave off testosterone deficiency at the same time, and that means that lower zinc levels may be predictive of both low testosterone and a poorer outcome in coronavirus patients.
What can we make of all of this?
With all this contradictory and very preliminary data, the only thing we can conclude for now is that it’s too early to responsibly state with confidence whether or not testosterone has significant effects on men’s susceptibility to SARS-CoV-2.
A good guess as to what’s really going on here is that low testosterone in men is a marker for poor health in general, as the modern male lifestyle, with its insufficiency of exercise and quality nutrition, and its intake of chemical estrogens, pesticides, and other xenobiotics, tends to negatively affect both testosterone and natural immunity.
As the various clinical trials unfold, and we learn more about how the virus operates, we may get a clearer story on testosterone and COVID, but for now, it’s safe to say that a healthy lifestyle is more critical than it’s ever been, not just when it comes to maintaining immune function, but also for staying calm and emotionally balanced during such an incredibly stressful time.
As the saying goes: in the post-COVID era, self-care is no longer a luxury. It’s a necessity.
Matt Dorsey, BSc, MAcOM, LAc
CHOQ Chief Scientific Officer
Matt Dorsey is a licensed acupunturist, medical herbalist, clinical nutritionist, and doctoral candidate. He describes himself as ‘medically bilingual’, blending the best of both classical Eastern medicine and Western scientific approaches in his holistic medical practice.
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