Higher testosterone is associated with increased inflammatory markers in women with SARS-CoV-2 pneumonia: preliminary results from an observational study

Stasi, Vincenza Di; Rastrelli, Giulia; Beccaria, Massimiliano; Garuti, Martina; Costanzo, Domenica Di; Spreafico, Fabio; Cervi, Giulia; Greco, Graziana Francesca; Pecoriello, Antonietta; Todisco, Tommaso; Cipriani, Sarah; Maseroli, Elisa; Scavello, Irene; Glingani, Claudia; Franchini, Massimo; Maggi, Mario; Donno, Giuseppe De; Vignozzi, Linda

doi:10.1007/s40618-021-01682-6

Cited by 10 publications

(9 citation statements)

References 35 publications

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“…A study by stasi et al has assessed the role of testosterone in a cohort of women with sARs-COV-2 pneumonias. The result showed that the higher total testosterone and calculated free testosterone are associated with a greater severity of the disease [149].…”

Section: Covid-19 In Patients With Androgenic Alopeciamentioning

confidence: 93%

Androgens’ Role in Severity and Mortality Rates of COVID-19

et al. 2022

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Background and Aim: by the end of December 2019 new corona virus began to spread from Wuhan, China and caused a worldwide pandemic. COVID-19 deaths and prevalence represented sex discrepant patterns with higher rate of deaths and infection in males than females which could be justified by androgen-mediated mechanisms. this review aimed to assess the role of androgens in COVID-19 severity and mortality Discussion: androgens increase expression of Type II transmembrane Serine Protease (TMPRSS2) and Angiotensin Converting Enzyme 2 (ACE2) which both facilitate new corona virus entry into host cell and their expression is higher in young males than females. According to observational studies, prevalence of COVID-19 infections and deaths was more in androgenic alopecic patients than patients without androgenic alopecia. The COVID-19 mortality rates in aged men (>60 years) was substantially higher than aged females and even young males caused by high inflammatory activities such as cytokine storm due to hypogonadism in this population. Use of anti-androgen and TMPRSS2 inhibitor drugs considerably modified COVID-19 symptoms. androgen deprivation therapy also improved COVID-19 symptoms in prostate cancer: overall the role of androgens in severity of COVID-19 and its associated mortality seemed to be very important . So more studies in variety of populations are required to define the absolute role of androgens.

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Section: Covid-19 In Patients With Androgenic Alopeciamentioning

confidence: 93%

Androgens’ Role in Severity and Mortality Rates of COVID-19

et al. 2022

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“…Contrary to the effect seen in men, one small study reports that higher T levels in women with COVID-19 pneumonia have been reported to be correlated with a more robust inflammatory response. 25 …”

Section: Factors Accounting For Trend Of Male Predominant Severe Covi...mentioning

confidence: 99%

Examining Male Predominance of Severe COVID-19 Outcomes: A Systematic Review

Twitchell

Christensen

Hackett

et al. 2022

Androgens: Clinical Research and Therapeutics

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Although not universal, many epidemiological data sources signal that a higher proportion of males than females with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections have adverse outcomes, such as intensive care unit (ICU) admission and death. Though likely multifactorial, the various hypotheses that have been proposed as underlying factors behind this trend are related to greater smoking prevalence among males, testosterone (T) deficiency causing an inflammatory storm, androgen-driven pathogenesis of SARS-CoV-2, a protective effect of estrogen in females, and inborn errors of cytokine immunity. This review aims at examining the evidence and at assessing the likelihood that the factors being investigated are contributory to the reported trend of male predominance of severe COVID-19 cases. Sources were obtained using the PubMed database and were selected based on their relevance to one of the primary hypotheses attempting to explain the strong male sex bias of severe SARS-CoV-2 infections. Emphasis was placed on meta-analyses and population-based studies. Sources are current through February 22, 2022. A severe COVID-19 case or outcome is defined in this review as a progression of the SARS-CoV-2 virus that results in either admission to an ICU for management of symptoms and clinical stabilization or which leads to death. Although the trend of male predominance of severe COVID-19 cases is likely multifactorial, the hypothesis of T deficiency causing an inflammatory storm has support from many studies with limited conflicting evidence. An inborn error in cytokine immunity is also well supported, but it needs more studies to add support to the hypothesis. The immunologic protective effect of estrogen is supported by multiple studies, but it also has conflicting evidence. It appears less likely that the trend is caused solely by an increased prevalence of smoking among males or an androgen-driven pathogenesis, based on the extent of conflicting evidence.

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“…[24,25]. Other data particularly concerning COVID-19 infection, showed, for instance, as cortisol associates with inflammation markers, so is total testosterone and calculated free testosterone in females with pneumonia due to more intense adrenal cortex activity [26]. Particular aspects related to coronavirus infectionassociated stress include anomalies of coagulation profile in addition to platelets damage as reflected by increased D-dimers, fibrinogen, and coagulation factor VIII, as well as low anticoagulant protein S and activated protein C, reduced coagulation factor XII [27].…”

Section: Cortisol As Stress Hormonementioning

confidence: 98%

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

Popescu

Terzea²,

Cârșote³

et al. 2022

Rom J Morphol Embryol

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Cortisol is a key element in acute stress including a severe infection. However, in coronavirus-associated disease, 20% of subjects experience hypocortisolemia due to direct or immune damage of pituitary and adrenal glands. One extreme form of adrenal insufficiency is found in 2/3 of cases with viral and post-viral adrenal infarction (AI) (with/without adrenal hemorrhage) that is mostly associated with a severe coronavirus disease 2019 (COVID-19) infection; it requires prompt glucocorticoid intervention. Some reports are incidental findings at computed tomography (CT)/magnetic resonance imaging (MRI) scans for non-adrenal complications like pulmonary spreading and others are seen on post-mortem analysis. This is a review of PubMed-accessible, English papers focusing on AI in addition to the infection, between March 1, 2020 and November 1, 2021. Exclusion criteria were acute adrenal insufficiency without the histopathological (HP) and/or imaging report of adrenal enlargement, necrosis, etc., respective adrenal failure due to pituitary causes, or non-COVID-19-related adrenal events. We identified a total of 84 patients (different levels of statistical evidence), as follows: a retrospective study on 51 individuals, two post-mortem studies comprising nine, respectively 12 patients, a case series of five subjects, seven single-case reports. HP aspects include necrosis associated with ischemia, cortical lipid degeneration (+/-focal adrenalitis), and infarcts at the level of adrenal cortex, blood clot into vessels, acute fibrinoid necrosis in arterioles and capsules, as well as subendothelial vacuolization. Collateral potential contributors to adrenal damage are thrombotic events, coagulation anomalies, antiphospholipid syndrome, endothelial dysfunction, severe COVID-19 infection with multiorgan failure, etc. Clinical picture is variable from acute primary adrenal insufficiency to asymptomatic or mild evolution, even a retrospective diagnostic; it may be a part of long COVID-19 syndrome; glucocorticoid therapy for non-adrenal considerations might mask cortisol deficient status due to AI/hemorrhage. Despite its rarity, the COVID-19-associated AI/hemorrhage represents a challenging new chapter, a condition that is essential to be recognized due to its gravity since prompt intervention with glucocorticoid replacement is lifesaving.

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Higher testosterone is associated with increased inflammatory markers in women with SARS-CoV-2 pneumonia: preliminary results from an observational study

Cited by 10 publications

References 35 publications

Androgens’ Role in Severity and Mortality Rates of COVID-19

Androgens’ Role in Severity and Mortality Rates of COVID-19

Examining Male Predominance of Severe COVID-19 Outcomes: A Systematic Review

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

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