Objectives The aim of the study was to investigate the association between sex hormones and SARS-CoV-2 infection severity. Furthermore, the associations between sex hormones and systemic inflammation markers, viral shedding and length of patients’ hospitalization were studied. Design and Methods We conducted a case-control study, including 48 SARS-CoV-2 male patients, admitted to an Italian reference Hospital. The cases were composed by 24 patients with PaO2/FiO2 < 250 mmHg and needed ventilatory support (severe COVID-19). The controls were selected in a 1:1 ratio, matching by ages, among patients who may receive a low-flow oxygen supplementation (mild COVID-19). For each group, sex hormones at hospitalization were evaluated. Results Severe COVID-19 patients had a significantly lower Testosterone levels than mild COVID-19 patients. The median total testosterone (TT) was 1.4 ng/mL in cases and 3.5 ng/mL in controls (p = 0.005); the median bioavailable testosterone was 0.49 and 1.21 (p = 0.008); the median calculated Free Testosterone (cFT) was 0.029 ng/mL and 0.058 ng/mL (p = 0.015), respectively. Either low TT, low cFT and low BioT were correlated to the hyperinflammatory syndrome (p = 0.018, p = 0.048 and p = 0.020) and associated to a longer hospitalization (p = 0.052, p = 0.041 and p = 0.023), respectively. No association was found between hormones and duration of viral shedding nor mortality rate. Conclusions According to our data, lower level of Testosterone is a marker of clinical severity for COVID-19.
The role of testosterone in SARS-CoV-2 infection: a key pathogenic factor and a biomarker for severe pneumonia