Andrologia | 2021
Testosterone levels in COVID‐19: More data, but how do we proceed?
Abstract
Dear Editor, Circulating testosterone represents an important marker, which correlates with sexual function in men (Rastrelli et al., 2018), while testosterone replacement treatment based on serum testosterone concentration has been shown to improve sexual desire and erectile function (Snyder et al., 2016). In addition, recent data suggest that circulating testosterone might have additional implications in daily practice, as it has been shown to exhibit significant prognostic value in preoperative risk assessment in patients with prostate cancer (Ferro et al., 2020). Recently, there has been a vivid and ongoing discussion regarding the role of circulating testosterone in the context of COVID19 pandemic among infected patients. We really appreciated the results of the observational study performed by Okçelik, who demonstrated in a cohort of 44 male patients that those with SARSCoV2 pneumonia had significantly lower testosterone levels compared to COVID19 negative patients (Okçelik, 2021). Recently, Kadihasanoglu et al. demonstrated that among patients with laboratory confirmed SARSCoV2 lower respiratory tract infection, serum testosterone levels were significantly lower compared to controls (patients with nonSARSCoV2 respiratory tract infection and healthy controls), exhibiting a significant correlation with SpO2 levels and hospitalisation duration, unravelling the potential harmful effect of the virus on male reproductive system (Kadihasanoglu et al., 2021). Rastrelli and colleagues have previously documented in a cohort of 31 male patients with SARSCoV2 infection that testosterone levels were significantly lower among those subjects having severe/ critical disease, also highlighting the role of luteinising hormone (LH), similar to Kadihasanoglu et al. (Rastrelli et al., 2021). Çayan et al. also showed that lower testosterone levels correlate significantly with the odds for intensive care unit (ICU) admission and/or death in the course of disease (Çayan et al., 2020). Of note, Salciccia and colleagues demonstrated that higher testosterone levels at baseline were associated with a 57% decrease in the odds for mechanical ventilation in the context of SARSCoV2 infection (Salciccia et al., 2020). Therefore, the question that inevitably arises is whether testosterone should be used as a prognostic risk marker in infected male subjects. It has to be highlighted that testosterone has been shown to correlate with disease severity even among patients with communityacquired pneumonia (Zurfluh et al., 2018). Subsequently, its role in SARSCoV2 pneumonia could be of exceptional value. Collectively, we would greatly appreciate if the author provided additional data regarding testosterone levels according to disease severity. In addition, we think that it would be of exceptional value if additional data concerning the correlation between luteinising hormone (LH): testosterone ratio and disease severity were provided, extending the results formerly presented by Ma and colleagues (Ma et al., 2021). Larger cohorts will shed further light on this promising perspective, regarding severity of disease in male subjects, who are more severely affected than females.