Abstract
Background The severe acute respiratory syndrome coronavirus 2 can affect
the hypothalamic-pituitary-gonadal axis (HPG) due to the expression of the
angiotensin-converting enzyme 2 receptor.
Objectives To assess the prevalence of hypogonadism and Sertoli cell
dysfunction in coronavirus disease 2019 (COVID-19) male survivors.
Method Male subjects recovered from acute COVID-19 infection were
prospectively observed. The primary outcomes included the proportion of
hypogonadism, defined biochemically as serum
testosterone<230 ng/dL or CFT
of<6.4 ng/mL if the total testosterone is between
230–320 ng/m. Sertoli cell dysfunction was defined as
inhibin-B level<54.5 pg/mL. Subjects with hypogonadism
were followed up at 12 months to assess the recovery of the HPG axis.
Results Eighty-three subjects aged≥18 years were evaluated at a
median of 120 (±35) days post-recovery. Their mean age was
49.50±12.73 years, and the mean BMI was
26.84±5.62 kg/m2. Low testosterone was
detected in 21 (24.71%) and low inhibin-B was detected in 14
(19.71%) out of 71 subjects at 3 months. Subjects with low testosterone
were younger, with a mean age of 43.29±12.03 years (P-0.08) and higher
BMI (P-0.012). The severity of COVID-19 infection, duration of hospitalization,
and other factors were not significantly associated with low testosterone. At 12
months, 18 out of 21 subjects came for follow-up, of which 9 (50%)
showed persistently low testosterone, suggestive of hypogonadism.
Conclusion Following COVID-19 infection, testosterone levels recovered
over time; however, a significant proportion of subjects had low levels at
12-month follow-up. These findings have long-term implications for the
management of COVID-19 subjects.
Key words
testosterone - inhibin-B - HPG axis - sertoli cell
