Male pituitary–gonadal axis dysfunction in post‐acute COVID‐19 syndrome—Prevalence and associated factors: A Mediterranean case series

Abstract

Objective Severe acute respiratory syndrome coronavirus 2 through angiotensin‐converting enzyme 2 receptor can harm testes function. The objectives were to analyse the prevalence of low serum testosterone (LT) and impaired fertility potential (Leydig and Sertoli cells dysfunction, respectively) in coronavirus disease 2019 (COVID‐19) male survivors and to evaluate acute infection‐related associated factors. Also, we explore its association with post‐acute COVID‐19 syndrome (PCS) and quality of life (QOL). Materials and Methods Male adults recovered from polymerase chain reaction‐confirmed COVID‐19 were offered a structured evaluation 8–12 weeks after recovery. The main outcome measure(s) were as follows: LT, defined as total testosterone (TT) < 2 ng/ml or if TT levels 2–4 ng/ml as calculated free testosterone < 6.36 ng/dl; Sertoli cell dysfunction was defined as inhibin‐B < 89 pg/ml. Secondary outcome‐associated factors were analysed by multiple logistic regression (odds ratio; 95% confidence interval [CI]). QOL was evaluated by SF‐36 v.2. Results One hundred and forty‐three patients were evaluated at a median (interquartile range) of 77 days (72–83) after disease onset; 72% of them recovered from severe pneumonia. LT was detected in 41 patients (28.7%; 95% CI: 21.8–36.5). Low levels of inhibin‐B were detected in 25 patients (18.1%; 95% CI: 12.5–25.3). After multivariate adjustment, obesity and hypokalaemia were associated with LT, whereas age more than 65 was an independent predictor of Sertoli cell dysfunction. LT or Sertoli cell dysfunction was not associated with PCS. Patients with LT had a lower score in four domains of QOL. Conclusions Prevalence of male LT and impaired fertility potential in COVID‐19 survivors is high in the medium term. Traditional risk factors and severity markers for COVID‐19 could be predictive.

The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers

“…Endocrine disorders are known risk factors for the development and progression of sexual dysfunction in both men and women 162 , 163 , 164 , 165 . Reduced testosterone levels have been reported in long COVID patients, highlighting the risk of persistent hypogonadism following infection 166 . This finding is highly relevant, not only because of the fundamental role of androgens in sexual response 150 , but also because of the worse outcomes being reported in patients with lower testosterone levels 149 , 167 .…”

Higher premorbid serum testosterone predicts COVID-19-related mortality risk in men

“…Thus, serum total testosterone concentration is a biomarker for acute suppression of the HPT axis during the course of COVID-19, the magnitude of which reflects severity of the acute illness. Variable recovery rates of serum total testosterone concentrations have been reported during follow-up ( 30 , 31 , 32 ).…”

Post-COVID-19 menstrual abnormalities and infertility

“…The hypothalamus and pituitary both have ACE 2 receptors and can be sites of SARS-CoV-2 infection if the virus is able to invade the brain. [ 22 ] It is postulated in some studies that SARS-CoV-2 can enter the brain through the olfactory pathway where it enters the brain through cribriform plate which is porous. [ 23 ] The virus may then enter the hypothalamus as the blood–brain barrier is permeable in proximity of this structure.…”