Low testosterone levels as an independent risk factor for mortality in male patients with COVID-19: Report of a Single-Center Cohort Study in Mexico

Introduction and objectives

Throughout the coronavirus disease 2019 (COVID-19) pandemic, a greater severity and lethality of the disease has been highlighted in male patients, so we set out to evaluate the prognostic role of serum testosterone levels in the clinical results of this population.

Methods

In this single-center and cross-sectional design, we included male patients admitted to our hospital with COVID-19 confirmed diagnosis. The biochemical analysis included lymphocytes, lactate dehydrogenase (LDH), total testosterone (TT), dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone. Receiver operating characteristic curves, univariate and bivariate analysis, and binary logistic regression for multivariate analysis were performed. A p value < 0.05 was consider significant.

Results

From 86 men included, 48.8% died. TT levels were lower in non-survivor patients than in survivor patients (4.01 nmol/L [0.29–14.93] vs 5.41 (0.55–25.08) nmol/L, p = 0.021). The independent risk factors that increased the relative risk (RR) of dying from COVID-19 were: age > 59 years (RR 3.5 [95% IC 1.0–11.6], p = 0.045), TT levels < 4.89 nmol/L (RR 4.0 [95% IC 1.2–13.5], p = 0.027) and LDH levels > 597 IU/L (RR 3.9 [95% IC 1.2–13.1], p = 0.024). Patients who required mechanical ventilation (p = 0.025), had lymphopenia (p = 0.013) and LDH levels > 597 IU/L (p = 0.034), had significantly lower TT levels compared to those who did not present these conditions. There were no differences in TT levels between patients who had or did not have comorbidities.

Conclusions

A TT level < 4.89 nmol/L increase four times the RR of death from COVID-19 in men, regardless of age or presence of comorbidities.