Low Testosterone on Hospital Admission with COVID-19 infection is associated with increased mortality

ABSTRACT

Objective: Men appear at greater risk of poor clinical outcomes and death from Covid-19. This suggests that serum testosterone could be a mediator. The aim of this retrospective study was to evaluate the association between serum total testosterone (TT), other prognostic indicators, and mortality in men with COVID-19. Methods: 110 men consecutively admitted to a district general hospital (with COVID-19 related symptoms) tested for SARS-CoV-2, 85 were positive and 27 of these men died. Serum TT was compared (rank-sum test) between men negative and positive for SARS-CoV-2. Factors associated with mortality in the latter group were analysed. Results: No significant difference was found (p=0.12, rank-sum test) in serum TT between men positive and negative for SARS-CoV-2. Serum TT was lower (p=0.0011, rank-sum test) in men with COVID-19 who died (median TT 2.0nmol/L) compared with survivors (median TT 5.0nmol/L). Mortality (logistic regression) was associated with age and serum TT (odds ratio 0.77, 95% confidence intervals (CI) 0.64, 0.91). Survival (Cox regression) was inversely associated with serum TT (continuous variable, hazard ratio (HR) 0.85 (95% CI 0.74, 0.98), stratified by median, TT ≥ 3.9nmol/L (reference, TT < 3.9nmol/L), HR0.24, (95% CI 0.089, 0.63). Conclusions: Serum TT was inversely associated with mortality in men with COVID-19 and requires measurement at admission and whilst managing long COVID. Future research should establish whether low serum TT, possibly associated with negative acute phase response, contributes to a poorer prognosis and a role for testosterone therapy.