The Tribune

By Dr Greggory Pinto

A fourth COVID-19 surge in reported cases, hospitalisations and deaths has our small nation’s healthcare system on the brink of disaster. The more contagious Delta variant and vaccination hesitancy among young adults, in particular, has led to an increase in younger COVID-19 patients being admitted to hospital with severe cases of the virus, when compared to the three previous pandemic surges.

The Bahamas is running out of available hospital beds and the intensive care units are at full capacity. Frontline workers are overwhelmed, understaffed and physically and emotionally fatigued. Hospital resources are stretched thin. Emergency rooms now have a constant daily barrage of very ill COVID-19 patients and sadly the healthcare system is struggling to contend with non-COVID related emergency patients.

This current surge of cases is more deadly than the previous waves. Variants of the virus such as the Delta variant are far more contagious and transmissible. Outlandish. unsubstantiated conspiracy theories related to COVID-19 have an astonishingly high number of Bahamians and residents refusing to take the vaccine.

COVID-19 associated with low testosterone in Men

Men have been dying at higher rates from COVID-19 than women and it has been speculated that the hormone differences between the sexes may play a role.

At the July 2021 European Association of Urology congress (EAU21), investigators reported a case control study that determined that low testosterone in men was strongly linked to more severe COVID-19 symptoms and even higher incidences of death. The case control study was led by Professor Andrea Salonia of the San Raffaele University Hospital in Milan, Italy. The scientific study determined that nearly 90 percent of men hospitalised for severe symptoms had low testosterone levels, or hypogonadism. The study compared the testosterone levels of 286 men hospitalised for COVID-19 with 281 healthy male blood donors. 89.2 percent (257) of the men admitted to hospital for COVID-19 had low testosterone levels, whereas only 14.9 percent (42) of the healthy male control group had low testosterone.

Low testosterone was strongly linked to a worse prognosis for men infected by the COVID-19 virus, with a greater likelihood of more severe symptoms, higher hospitalisation rate, greater risk for needing intubation and mechanical ventilation and a 33 percent increased risk of death from COVID-19.

Investigators in this study did not have access to testosterone levels in the men prior to contracting COVID-19, so it is not clear whether low testosterone was a pre-existing condition in these men or whether the COVID-19 virus led to the low testosterone levels.

A previous scientific study examined 90 men who were admitted to the Barnes Jewish Hospital in St Louis, Missouri between March and May 2020, with 31 of these men presenting with severe COVID-19 disease, a further 35 of these men developed severe disease within three days of hospital admission and 24 of the men in the study had mild COVID-19 disease. The study found that the median testosterone levels at the time of admission was significantly lower for the men with severe COVID-19 disease (48 ng/dl) and for the men who developed severe COVID-19 disease one to three days into their hospital admission when compared to the COVID-19 positive men who had mild disease (testosterone median level of 151 ng/dl).

The median testosterone level at day three of hospitalisation of the men with ICU admission was 17 ng/ml, compared to a testosterone of 104 ng/ml of men who did not require ICU admission; 12 ng/ml for men who required a ventilator and 60 ng/ml for men who did not require a ventilator. The median testosterone level for men who died from COVID-19 in this study was 15 ng/ml versus 60 ng/ml for men who survived.

The Missouri study found that men with severe COVID-19 disease had 65 to 85 percent lower testosterone levels compared to the men with a mild case. The severity of the disease did not correlate with testosterone levels for 62 women who presented with COVID-19 at the same hospital.

Testosterone is known as the male hormone, but women do have low levels of testosterone, just as men have low levels of oestrogen.

Testosterone is a known natural suppressor in the body for inflammation. The novel coronavirus causes a widespread nonspecific inflammatory response within the body, as the body’s defences have not been exposed to the COVID-19 virus before. Low testosterone levels can lead to a more severe inflammatory response to the virus. There is a well-established inverse relationship between testosterone levels and inflammatory markers in men with COVID. The lower the testosterone levels, the higher the levels of inflammatory factors such as interleukin 6, C-reactive protein, hepatocyte growth factors, amongst others. The primary cause of death from COVID is often due a ‘cytokine storm’, an overactive immune response to the virus. Testosterone has a potential role in modulating the sex-specific immune response. Testosterone can suppress the activity of inflammatory factors and complexes and thus reduce the immune response in men to the virus.

Multiple comorbidities such as diabetes, obesity and coronary artery disease have been shown to result in more severe COVID-19 symptoms and poorer outcomes. Low testosterone in men is strongly linked to type 2 diabetes, obesity, coronary artery disease, heart failure, chronic renal failure, chronic obstructive pulmonary disease and HIV. Multiple studies for example have shown that low testosterone increases the risk for type 2 diabetes mellitus by three- to four-fold in men. The association between type 2 diabetes mellitus and low testosterone is bidirectional and a vicious cycle.

Worldwide, and locally, men have more severe COVID-19 cases than women, with a higher rate of hospitalisations, a higher incidence of ICU admissions and a higher likelihood of death compared to women.

Men are also more likely to not take the COVID-19 vaccine.

As this fourth COVID wave surges on and creates devastation in every corner and aspect of our society, the only hope of suppressing it is to achieve vaccination in more than 70 percent of our population and continuing to adhere to social distancing, wearing a protective mask and proper hand hygiene.

• Dr Greggory Pinto is a board-certified Bahamian urologist and laparoscopic surgeon. He has trained in Germany, South Africa and France, and is a member of the European Association of Urology. He can be contacted at OakTree Medical Center, #2 Fifth Terrace & Mount Royal Avenue. Telephone: (242) 322-1145 (6) (7); e-mail: welcome@urologycarebahamas.com, or visit the website:www.urologycarebahamas.com.