Division of Endocrinology, Diabetes and Metabolism, St Louis University School of Medicine, St Louis, Missouri.
Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Netw Open. 2022 Sep 1;5(9):e2229747. doi: 10.1001/jamanetworkopen.2022.29747.
Male sex is associated with severe COVID-19. It is not known whether the risk of hospitalization differs between men with hypogonadism, men with eugonadism, and those receiving testosterone therapy (TTh).
To compare COVID-19 hospitalization rates for men with hypogonadism who were not receiving TTh, men with eugonadism, and men receiving TTh.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in 2 large academic health systems in St Louis, Missouri, among 723 men with a history of COVID-19 who had testosterone concentrations measured between January 1, 2017, and December 31, 2021.
The primary exposure was gonadal status (hypogonadism, eugonadism, and TTh). Hypogonadism was defined as a total testosterone concentration below the limit of normal provided by the laboratory (which varied from 175 to 300 ng/dL [to convert to nanomoles per liter, multiply by 0.0347]).
The primary outcome was rate of hospitalization for COVID-19. Statistical adjustments were made for group differences in age, body mass index, race and ethnicity, immunosuppression, and comorbid conditions.
Of the 723 study participants (mean [SD] age, 55 [14] years; mean [SD] body mass index, 33.5 [7.3]), 116 men had hypogonadism, 427 had eugonadism, and 180 were receiving TTh. Men with hypogonadism were more likely than men with eugonadism to be hospitalized with COVID-19 (52 of 116 [45%] vs 53 of 427 [12%]; P < .001). After multivariable adjustment, men with hypogonadism had higher odds than men with eugonadism of being hospitalized (odds ratio, 2.4; 95% CI, 1.4-4.4; P < .003). Men receiving TTh had a similar risk of hospitalization as men with eugonadism (odds ratio, 1.3; 95% CI, 0.7-2.3; P = .35). Men receiving inadequate TTh (defined as subnormal testosterone concentrations while receiving TTh) had higher odds of hospitalization compared with men who had normal testosterone concentrations while receiving TTh (multivariable adjusted odds ratio, 3.5; 95% CI, 1.5-8.6; P = .003).
This study suggests that men with hypogonadism were more likely to be hospitalized after COVID-19 infection compared with those with eugonadism, independent of other known risk factors. This increased risk was not observed among men receiving adequate TTh. Screening and appropriate therapy for hypogonadism need to be evaluated as a strategy to prevent severe COVID-19 outcomes among men.
男性性别与严重的 COVID-19 相关。目前尚不清楚患有性腺功能减退症的男性、具有正常性腺功能的男性和接受睾酮治疗（TTh）的男性之间住院风险是否存在差异。
比较患有性腺功能减退症但未接受 TTh 治疗的男性、具有正常性腺功能的男性和接受 TTh 的男性的 COVID-19 住院率。
设计、地点和参与者：这项队列研究在密苏里州圣路易斯的 2 家大型学术医疗系统中进行，共纳入 723 名有 COVID-19 病史的男性，他们的睾酮浓度在 2017 年 1 月 1 日至 2021 年 12 月 31 日之间进行了测量。
主要暴露因素是性腺状态（性腺功能减退症、正常性腺功能和 TTh）。性腺功能减退症定义为总睾酮浓度低于实验室提供的正常范围下限（范围从 175 到 300ng/dL[要转换为纳摩尔/升，请乘以 0.0347]）。
主要结果是 COVID-19 住院率。对组间年龄、体重指数、种族和民族、免疫抑制和合并症等差异进行了统计学调整。
在 723 名研究参与者中（平均[标准差]年龄，55[14]岁；平均[标准差]体重指数，33.5[7.3]），116 名男性患有性腺功能减退症，427 名男性具有正常性腺功能，180 名男性接受 TTh。患有性腺功能减退症的男性比具有正常性腺功能的男性更有可能因 COVID-19 住院（52/116[45%]与 53/427[12%]；P<0.001）。在多变量调整后，患有性腺功能减退症的男性住院的可能性高于具有正常性腺功能的男性（优势比，2.4；95%CI，1.4-4.4；P<0.003）。接受 TTh 的男性与具有正常性腺功能的男性住院风险相似（优势比，1.3；95%CI，0.7-2.3；P=0.35）。接受 TTh 但治疗效果不足的男性（定义为接受 TTh 时睾酮浓度低于正常值）与接受 TTh 时睾酮浓度正常的男性相比，住院的可能性更高（多变量调整后的优势比，3.5；95%CI，1.5-8.6；P=0.003）。
这项研究表明，与具有正常性腺功能的男性相比，患有性腺功能减退症的男性在感染 COVID-19 后更有可能住院，这与其他已知的风险因素无关。在接受足够 TTh 的男性中未观察到这种增加的风险。需要评估对性腺功能减退症的筛查和适当治疗，作为预防男性 COVID-19 严重后果的一种策略。
