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. 2022 Sep 1;5(9):e2229747.
doi: 10.1001/jamanetworkopen.2022.29747.

Association of Male Hypogonadism With Risk of Hospitalization for COVID-19

Sandeep Dhindsa  1 , Cosette Champion  2 , Ekamjit Deol  3 , Matthew Lui  2 , Robert Campbell  1 , Jennifer Newman  1 , Aparna Yeggalam  1 , Srikanth Nadella  1 , Vaishaliben Ahir  1 , Ekta Shrestha  1 , Thomas Kannampallil  4 , Abhinav Diwan  5   2   6   7   8
Affiliations

Association of Male Hypogonadism With Risk of Hospitalization for COVID-19

Sandeep Dhindsa et al. JAMA Netw Open. .

Abstract

Importance: Male sex is associated with severe COVID-19. It is not known whether the risk of hospitalization differs between men with hypogonadism, men with eugonadism, and those receiving testosterone therapy (TTh).

Objective: To compare COVID-19 hospitalization rates for men with hypogonadism who were not receiving TTh, men with eugonadism, and men receiving TTh.

Design, setting, and participants: This cohort study was conducted in 2 large academic health systems in St Louis, Missouri, among 723 men with a history of COVID-19 who had testosterone concentrations measured between January 1, 2017, and December 31, 2021.

Exposures: The primary exposure was gonadal status (hypogonadism, eugonadism, and TTh). Hypogonadism was defined as a total testosterone concentration below the limit of normal provided by the laboratory (which varied from 175 to 300 ng/dL [to convert to nanomoles per liter, multiply by 0.0347]).

Main outcomes and measures: The primary outcome was rate of hospitalization for COVID-19. Statistical adjustments were made for group differences in age, body mass index, race and ethnicity, immunosuppression, and comorbid conditions.

Results: Of the 723 study participants (mean [SD] age, 55 [14] years; mean [SD] body mass index, 33.5 [7.3]), 116 men had hypogonadism, 427 had eugonadism, and 180 were receiving TTh. Men with hypogonadism were more likely than men with eugonadism to be hospitalized with COVID-19 (52 of 116 [45%] vs 53 of 427 [12%]; P < .001). After multivariable adjustment, men with hypogonadism had higher odds than men with eugonadism of being hospitalized (odds ratio, 2.4; 95% CI, 1.4-4.4; P < .003). Men receiving TTh had a similar risk of hospitalization as men with eugonadism (odds ratio, 1.3; 95% CI, 0.7-2.3; P = .35). Men receiving inadequate TTh (defined as subnormal testosterone concentrations while receiving TTh) had higher odds of hospitalization compared with men who had normal testosterone concentrations while receiving TTh (multivariable adjusted odds ratio, 3.5; 95% CI, 1.5-8.6; P = .003).

Conclusions and relevance: This study suggests that men with hypogonadism were more likely to be hospitalized after COVID-19 infection compared with those with eugonadism, independent of other known risk factors. This increased risk was not observed among men receiving adequate TTh. Screening and appropriate therapy for hypogonadism need to be evaluated as a strategy to prevent severe COVID-19 outcomes among men.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dhindsa reported receiving personal fees from Bayer and Acerus Pharmaceuticals and grants from Clarus Therapeutics outside the submitted work. Dr Kannampallil reported receiving personal fees from Pfizer Inc and Elsevier Inc and grants from the National Institutes of Health and the Agency for Healthcare Research and Quality outside the submitted work. Dr Diwan reported serving as a consultant for interpretation of echocardiograms for clinical trials for Clario (previously ERT Systems); and receiving nonfinancial support from Dewpoint Therapeutics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Sample and Group Allotment According to Study Inclusion and Exclusion Criteria
RT-PCR indicates reverse transcription–polymerase chain reaction.
Figure 2.
Figure 2.. Probability of Hospitalization Based on Testosterone Concentrations in Men With Hypogonadism and Men With Eugonadism, After Multivariable Adjustment for Age, Body Mass Index, Charlson Comorbidity Index, Race and Ethnicity, and Immunosuppression Status
SI conversion factor: To convert testosterone to nanomoles per liter, multiply by 0.0347.
See this image and copyright information in PMC

Comment in

References

    1. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. doi: 10.1001/jamainternmed.2020.0994 - DOI - PMC - PubMed
    1. Peckham H, de Gruijter NM, Raine C, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317. doi: 10.1038/s41467-020-19741-6 - DOI - PMC - PubMed
    1. Wadman M. Sex hormones signal why virus hits men harder. Science. 2020;368(6495):1038-1039. doi: 10.1126/science.368.6495.1038 - DOI - PubMed
    1. Dhindsa S, Ghanim H, Batra M, Dandona P. Hypogonadotropic hypogonadism in men with diabesity. Diabetes Care. 2018;41(7):1516-1525. doi: 10.2337/dc17-2510 - DOI - PMC - PubMed
    1. Tajar A, Forti G, O’Neill TW, et al. ; EMAS Group . Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010;95(4):1810-1818. doi: 10.1210/jc.2009-1796 - DOI - PubMed