Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
Outpatients Clinic of Endocrinology and Metabolic Disease, Conversano Hospital, Bari, Italy.
Andrology. 2021 Jan;9(1):53-64. doi: 10.1111/andr.12836. Epub 2020 Jun 28.
The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease 2019 (COVID-19) seems to have a worse clinical course among infected men compared with women, thus highlighting concerns about gender predisposition to serious prognosis. Therefore, androgens, particularly testosterone (T), could be suspected as playing a critical role in driving this excess of risk. However, gonadal function in critically ill men is actually unknown, mainly because serum T concentration is not routinely measured in clinical practice, even more in this clinical context.
To overview on possible mechanisms by which serum T levels could affect the progression of COVID-19 in men.
Authors searched PubMed/MEDLINE, Web of Science, EMBASE, Cochrane Library, Google, and institutional websites for medical subject headings terms and free text words referred to "SARS-CoV-2," "COVID-19," "testosterone," "male hypogonadism," "gender" "immune system," "obesity," "thrombosis" until May 19th 2020.
T, co-regulating the expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2 in host cells, may facilitate SARS-CoV-2 internalization. Instead, low serum T levels may predispose to endothelial dysfunction, thrombosis and defective immune response, leading to both impaired viral clearance and systemic inflammation. Obesity, one of the leading causes of severe prognosis in infected patients, is strictly associated with functional hypogonadism, and may consistently strengthen the aforementioned alterations, ultimately predisposing to serious respiratory and systemic consequences.
T in comparison to estrogen may predispose men to a widespread COVID-19 infection. Low serum levels of T, which should be supposed to characterize the hormonal milieu in seriously ill individuals, may predispose men, especially elderly men, to poor prognosis or death. Further studies are needed to confirm these pathophysiological assumptions and to promptly identify adequate therapeutic strategies.
新型严重急性呼吸综合征冠状病毒（SARS-CoV-2）疾病 2019（COVID-19）在感染男性中的临床过程似乎比女性更差，因此凸显了对性别易患严重预后的关注。因此，雄激素，特别是睾丸激素（T），可能被怀疑在驱动这种风险增加中发挥关键作用。然而，危重男性的性腺功能实际上是未知的，主要是因为即使在这种临床情况下，血清 T 浓度也未常规在临床实践中测量。
综述血清 T 水平如何影响男性 COVID-19 进展的可能机制。
作者使用医学主题词和自由文本词在 PubMed/MEDLINE、Web of Science、EMBASE、Cochrane Library、Google 和机构网站上搜索了“SARS-CoV-2”、“COVID-19”、“睾丸激素”、“男性性腺功能减退症”、“性别”、“免疫系统”、“肥胖症”、“血栓形成”，直到 2020 年 5 月 19 日。
T 调节宿主细胞中血管紧张素转换酶 2 和跨膜蛋白酶丝氨酸 2 的表达，可能有助于 SARS-CoV-2 的内化。相反，低血清 T 水平可能易患内皮功能障碍、血栓形成和免疫反应缺陷，导致病毒清除和全身炎症受损。肥胖症是感染患者严重预后的主要原因之一，与功能性性腺功能减退症密切相关，并且可能一致增强上述改变，最终易患严重的呼吸和全身后果。
与雌激素相比，T 可能使男性易患广泛的 COVID-19 感染。应假设血清 T 水平低会使男性，尤其是老年男性，预后不良或死亡。需要进一步研究来证实这些病理生理假设，并及时确定适当的治疗策略。
