Transient Hypogonadism Induced by SARS-CoV-2 during COVID-19 in Men Aged under 65 Years

Abstract

Background: The presence of the angiotensin-converting enzyme 2 (ACE2) receptor, the main entry receptor for SARS-CoV-2 in lung alveolar tissue, in Sertoli and Leydig cells of the adult testis, may suggest possible testicular involvement during SARS-CoV-2 infection. Our aim was to investigate the impact of COVID-19 on gonadal function in men. Methods: This was a cross-sectional descriptive and analytical study in a population of men aged below 65 years of age with SARS-CoV-2. Not included in the study were any subjects on testosterone replacement therapy or with a known condition that could create hypogonadism. We recruited patients through a questionnaire and then performed total testosterone and SHBG analysis at 8 hours and 2 months post infection by ELISA. We used the Spearman Rho test for statistical analysis of correlations. The significance level was set at 0.05. Results: The sample consisted of 40 male COVID positive patients with a mean age of 46.4 ± 11.8 years. Eight patients were reviewed after infection. The mean total testosterone was 11 ng/ml ± 2.4 and the SHBG was 113 nmol/l ± 66.9 during infection. In the 8 patients reviewed after infection, median total testosterone decreased during infection (11 ng/ml) and increased after infection (12.7 ng/ml), this result was statistically significant (P = 0.028). Median SHBG during infection was increased (115.7 nmol/l) and after infection was decreased (82 nmol/l). There was a statistically significant (P = 0.04) and positive correlation between serum testosterone and SHBG levels in patients with severe infection. Conclusion: There could be a transient relative hypogonadism during SARS-CoV-2 infection, more marked in the severe forms of the disease with a tendency to improve after infection.