Low testosterone in men tied to severe COVID-19
New data presented at the European Association of Urology congress this week show that men with low testosterone who were hospitalized for severe COVID-19 during the first wave of infections in Milan, Italy, were more likely to need intensive care and mechanical ventilation, and they had a sixfold increased risk of death.
The findings come from San Raffaele University Hospital in Milan, where researchers compared 286 male COVID-19 patients who presented for emergency care, with 305 healthy controls who donated blood at the hospital from February to May 2020. Both groups had hormone testing, and low testosterone was defined as 9.2 nanomoles per liter (nmol/L).
Ninety percent of the males with severe COVID had low testosterone, compared with 17% of controls. And men with severe COVID-19 had very low levels of the male sex hormone: Those admitted to intensive care or who died had just 0.7 to 1.0 nmol/L, and those with more mild disease also had low levels (3 to 4 nmol/L).
“We never expected to see such a high proportion of Covid patients with these extremely low levels of testosterone, in comparison to a similar group of healthy men. The relationship is very clear: the lower the testosterone, the higher the severity of the condition and likelihood of death,” said Andrea Salonia, MD, PhD, a specialist in urology and endocrinology at San Raffaele Hospital.
In a press release, Salonia said it was not clear if COVID-19 infections caused a drop in testosterone or was a pre-exiting condition in the patients.
Jul 6 European Association of Urology press release
Swiss study: Almost 40% of patients had long COVID after 7 to 9 months
Seven to 9 months postacute COVID-19 infection, 39.0% of 410 adults still had symptoms of long COVID-19, according to a study yesterday in the Annals of Internal Medicine.
The researchers included symptomatic outpatients in Geneva enrolled from Mar 18 to May 15, 2020. Of those who responded to follow-up at 7 to 9 months post-infection, 39.0% still had symptoms, of which half experienced one or two symptoms (27.6% and 26.4%, respectively).
Of 311 participants who checked in at all three follow-up points (enrollment, 30 to 45 days, 7 to 9 months), 37% had symptom resolution at the 30- to 45-day mark, and 19% more had resolution at 7 to 9 months, for a total of 56%.
At 7 to 9 months, the most common symptom was fatigue (20.7%), and of the 85 patients who experienced it, 27.0% said it was bad enough to restrict strenuous physical activity. A little over 10% of patients who still experienced symptoms reported shortness of breath (11.7% of 48), with 60.4% saying that it occurred even when walking up a slight hill or hurrying on ground level. Other frequent symptoms included loss of taste or smell (16.8%) and headache (10.0%).
Almost three quarters of the 7- to 9-month cohort (72.4%) had no prior COVID risks (eg, hypertension), the researchers note, and 67.1% were females. The average age of the original 629 participants enrolled at baseline was 42.1 years.
“Recognition of postacute sequelae of SARS-CoV-2 and potential predictors is important in reaching a more thorough understanding of the disease and its long-term effects,” the researchers write. “With a high prevalence of symptoms at 7 to 9 months, physicians should continue to monitor patients with COVID-19 over the long term.”
Jul 6 Ann Intern Med study
Less than 5% of COVID-19 studies have plan to factor in sex, analysis finds
Although sex is associated with different COVID-19 mortality rates and can affect pharmacological side effects, only 4% of COVID-19 studies on ClinicalTrials.gov explicitly plan to include them as a variable, according to a Nature Communications study yesterday.
The researchers looked at 4,420 registered COVID-19 studies from Jan 1, 2020, to Jan 26, 2021 and found that 21.2% addressed sex and gender solely in the context of recruitment, 5.4% planned sex-matched or representative samples or emphasized sex reporting, and 4.0% explicitly stated there was a plan to include sex as a variable.
While some study summaries may not mention their complete plans, the researchers note that only 17.8% of 45 COVID randomized clinical trials (RCTs) published by Dec 15, 2020, report sex-disaggregated analyses.
Most studies that mention sex as an analytical variable are observational and patient registry studies (132 [74.2%]) or have matching/reporting (153 [64.6%]), data showed. Also, only 1.3% of 1,161 pharmacological intervention RCTs and 2.4% of 1,314 other interventional studies have registered a plan to consider sex as an analytical variable.
This issue has had low priority throughout the pandemic, the researchers write, adding, “Ignoring sex and gender aspects of COVID-19 is not scientifically or ethically justifiable, and interventional trials should be designed to account for these variables.”
Jul 6 Nat Commun study