According to a recent retrospective cohort study, low testosterone levels in men may increase their risk of hospitalization for COVID-19. Conversely, normal testosterone levels in men, (whether due to the body’s natural production of testosterone or testosterone therapy,) may be protective against severe cases of COVID-19.

Male hypogonadism is a medical condition in which the gonads (i.e., the testes in men) do not produce enough testosterone, which leads to low levels of testosterone and symptoms such as fatigue, erectile dysfunction (ED), decreased sex drive, and changes in mood.

Eugonadism, on the other hand, is the term used to refer to those with healthily functioning gonads. For this study, hypogonadism was defined as a total testosterone concentration below 175 to 300 ng/dL.   

The study involved 723 men: 116 men with hypogonadism, 427 men with eugonadism, and 180 men who were receiving testosterone therapy. All of the men included in the analysis were diagnosed with COVID-19, and the average age of the men was 55 years old.

Of the hypogonadal men, 45% were hospitalized with COVID-19. This percentage was much higher than that of the eugonadal men, of whom just 12% were hospitalized with COVID-19. For the sake of comparison, the median testosterone level for the men with hypogonadism was 131 ng/dL, while the median testosterone level for the men with eugonadism was 381 ng/dL.

Interestingly, the risk of hospitalization for COVID-19 went down for the men who were receiving testosterone therapy that brought their testosterone up to normal levels. These men faced a similar risk of hospitalization for COVID-19 as the eugonadal men. Nevertheless, the men who were receiving an inadequate dose of testosterone and were still below normal levels did not see this protective benefit. They still had a higher risk of hospitalization for COVID-19 than the eugonadal men.

Although the researchers made adjustments for potentially cofounding variables such as age, race, ethnicity, body mass index (BMI), immunosuppression, and comorbid conditions, there were still some key differences between the groups of men. In general, the hypogonadal men were older, more likely to have diabetes or another comorbid condition, more likely to have a higher BMI, and more immunosuppressed than the eugonadal men.

These findings suggest that low testosterone may be a risk factor for hospitalization due to COVID-19, perhaps contributing to a decreased ability to recover from such an illness. However, it is too soon to say whether testosterone therapy should be used as a preventative treatment option to guard against severe COVID-19. Therefore, future studies should explore using testosterone therapy as a prevention strategy for hospitalization from this illness.