key: cord-0763133-10ofy1tx
authors: Rambhatla, Amarnath; Bronkema, Chandler J.; Corsi, Nicholas; Keeley, Jacob; Sood, Akshay; Affas, Ziad; Dabaja, Ali A.; Rogers, Craig G.; Liroff, Stephen A.; Abdollah, Firas
title: COVID-19 Infection in Men on Testosterone Replacement Therapy
date: 2020-10-09
journal: J Sex Med
DOI: 10.1016/j.jsxm.2020.09.013
sha: 24e6136f51b841ee49842c1ff521afeed81700bf
doc_id: 763133
cord_uid: 10ofy1tx

Men who contract Coronavirus Disease 2019 (COVID-19) appear to have worse clinical outcomes compared to women which raises the possibility of androgen dependent effects. We sought to determine if testosterone replacement therapy (TRT) is associated with worse clinical outcomes. Through a retrospective chart review, we identified 32 men diagnosed with COVID-19 and on TRT. They were propensity score matched to 63 men diagnosed with COVID-19 and not on TRT. Data regarding comorbidities and endpoints such as hospital admission, intensive care unit (ICU) admission, ventilator utilization, thromboembolic events, and death were extracted. Chi-square and Kruskal-Wallis tests examined differences in categorical and continuous variables, respectively. Logistic regression analysis tested the relationship between TRT status and the study endpoints. There were no statistically significant differences between the two groups and TRT was not a predictor of any of the endpoints on multivariate analysis. These results suggest that TRT is not associated with a worse clinical outcome in men diagnosed with COVID-19.

There were no statistically significant differences between the two groups and TRT was 38 not a predictor of any of the endpoints on multivariate analysis. These results suggest that 39 TRT is not associated with a worse clinical outcome in men diagnosed with COVID-19. Descriptive characteristics are reported in Table 1 19.0%, p=0.2) than patients not on TRT but none were statistically significant. TRT was 100 not an independent predictor of any of the examined endpoints on multivariable analysis 101 (Table 2) . 102

Discussion 104

To our knowledge, this is the first study looking at outcomes of men on TRT who 105 developed COVID-19. In our cohort, the thromboembolic and death rates were similar in 106 both groups. Despite having a higher rate of baseline comorbidities, there were lower 107 rates of ICU admission and mechanical ventilator utilization that were observed in the 108 TRT group, although not statistically significant. Androgens appear to play an important role in COVID-19 but the overall clinical 130 picture is a much more complex interplay between exposure risks, age, comorbidities, 131 genetic predisposition, and socioeconomic status. A combination of these factors may be 132 responsible for the differences in disease severity between men and women. Limitations 133 of this study include small sample size, which limits the statistical power of the study. 134

Other limitations are unknown testosterone levels in men of the control cohort, and the 135 retrospective nature of this study with the potential for residual bias caused by 136 unobserved confounders, even after propensity score matching. In conclusion, our study 137 Legend: all multivariable analyses were adjusted to age, race, body mass index, smoking status, comorbidity (as a cumulative number), and ZIP code. The control group was set as the reference category.

Case-Fatality Rate and Characteristics of Patients 162

Dying in Relation to COVID-19 in Italy

Commentary: Testosterone, a key hormone in the context of

COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS

CoV-2) infection is likely to be androgen mediated

Incidence of venous 174 thromboembolism in hospitalized patients with COVID-19

Risk 179 of Venous Thromboembolism and Hypovitaminosis D

Androgen sensitivity gateway to

COVID-19 disease severity

Androgen-deprivation therapies for prostate 187 cancer and risk of infection by SARS-CoV-2: a population-based study (n=4532) 188

Low testosterone levels predict clinical adverse 192 outcomes in SARS-CoV-2 pneumonia patients

Both hyper-and 196 hypogonadotropic hypogonadism occur transiently in acute illness: bio-and 197 immunoactive gonadotropins

The relationship between 201 circulating testosterone and inflammatory cytokines in men