Testosterone: COVID19. Sleep, Obesity, Men’s Health

Testosterone is a hormone found in humans, as well as in other animals. In men, the testicles primarily make testosterone. Some people don’t realize that women also produce testosterone.  Women’s ovaries make testosterone, though in much smaller amounts.

Testosterone is most often associated with sex drive and plays a vital role in sperm production. It also affects bone and muscle mass, the way men store fat in the body, and even red blood cell production.

A man’s testosterone levels can also affect his mood.

Low testosterone levels:

Low levels of testosterone, also called low T levels, can produce a variety of symptoms in men, including:

Decreased sex drive

Less energy

Weight gain

Feelings of depression

Moodiness

Low self-esteem

Less body hair

Thinner bones

Injury to the testicles and cancer treatments such as chemotherapy or radiation can negatively affect testosterone production.

Chronic health conditions and stress can also reduce testosterone production. Some of these include:

AIDS

Kidney disease

Alcoholism

Cirrhosis of the liver

Obesity: Obesity, a condition linked to heart disease and diabetes, now appears to be associated with another health problem, but one that affects men only — low testosterone levels.

Results of a study published online ahead of print in the journal Diabetes Care, conducted by University at Buffalo endocrinologists, showed that 40 percent of obese participants involved in the Hypogonadism in Males (HIM) study had lower-than-normal testosterone readings.

 The percentage rose to 50 percent among obese men with diabetes. Results also revealed that as body mass index (BMI) — a relationship of weight-to-height — increased, testosterone levels fell.

“The effect of diabetes on lowering testosterone levels was similar to that of a weight gain of approximately 20 pounds,” says Sandeep Dhindsa, MD, an endocrinology specialist in the UB Department of Medicine and first author on the study.

COVID19: For the first time, data from a study with patients hospitalized due to COVID-19 suggest that the disease might deteriorate men’s testosterone levels.

from the University of Mersin and the Mersin City Education And Research Hospital in Turkey found as men’s testosterone level at baseline decreases, the probability for them to be in the intensive care unit (ICU) significantly increases.

Lead author Selahittin Çayan, Professor of Urology, states that while it has already been reported that low testosterone levels could be a cause for poor prognosis following a positive SARS-CoV-2 test, this is the first study to show that COVID-19 itself depletes testosterone.

It is hoped that the development could help to explain why so many studies have found that male prognosis is worse than those females with COVID-19, and therefore to discover a possible improvement in clinical outcomes using testosterone-based treatments.

“Testosterone is associated with the immune system of respiratory organs, and low levels of testosterone might increase the risk of respiratory infections. Low testosterone is also associated with infection-related hospitalization and all-cause mortality in male patients in ICU, so testosterone treatment may also have benefits beyond improving outcomes for COVID-19,” Professor Çayan explains.

“In our study, the mean total testosterone decreased, as the severity of the COVID-19 increased. The mean total testosterone level was significantly lower in the ICU group than in the asymptomatic group. In addition, the mean total testosterone level was significantly lower in the ICU group than in the Intermediate Care Unit group. The mean serum follicle-stimulating hormone level was significantly higher in the ICU group than in the asymptomatic group.

“We found Hypogonadism — a condition in which the body doesn’t produce enough testosterone -in 113 (51.1%) of the male patients.

“The patients who died had significantly lower mean total testosterone than the patients who were alive.

“However, even 65.2% of the 46 male patients who were asymptomatic had a loss of loss of libido.”

The research team looked at a total of 438 patients. This included 232 males, each with laboratory-confirmed SARS-CoV-2. All data were prospectively collected. A detailed clinical history, complete physical examination, laboratory and radiological imaging studies were performed in every patient. All data of the patients were checked and reviewed by the two physicians.

The cohort study was divided into three groups: asymptomatic patients, symptomatic patients who were hospitalized in the internal medicine unit, and patients who were hospitalized in the intensive care unit.

In the patients who had pre-COVID-19 serum gonadal hormones test (n: 24), serum total testosterone level significantly decreased from a pre-COVID-19 level of 458?±?198?ng/dl to 315?±?120?ng/dl at the time of COVID-19 in the patients (p?=?0.003).

Death was observed in 11 of the male adult patients (4.97%) and 7 of the female patients (3.55%), revealing no significance between the two genders (p?>?0.05).

Commenting on the results of the study, Professor Çayan added: “It could be recommended that at the time of COVID-19 diagnosis, testosterone levels are also tested. In men with low levels of sex hormones who test positive for COVID-19, testosterone treatment could improve their prognosis. More research is needed on this.”

The limitations of this study include it not including a control group of patients with conditions other than COVID-19, this was due to the restrictions placed on the hospital that they were monitoring the patients in.

Testosterone levels decline steadily in adult women, however, low T levels can also produce a variety of symptoms, including:

Low libido

Reduced bone strength

Poor concentration

Depression

Low T levels in women can be caused by the removal of the ovaries as well as diseases of the pituitary, hypothalamus, or adrenal glands.

Testosterone therapy may be prescribed for women with low T levels, however, the treatment’s effectiveness on improving sexual function or cognitive function among postmenopausal women is unclear.

For years, it has been suggested that age naturally causes testosterone levels to decrease.

New research indicates that a decline in testosterone levels as men grow older is likely the result — not the cause — of deteriorating general health, say Australian scientists, whose new study finds that age, in itself, has no effect on testosterone level in healthy older men.

The results, presented June 6 2020 at The Endocrine Society’s 93rd Annual Meeting in Boston, are the first findings released from the Healthy Man Study, according to principal investigator David Handelsman, MD, Ph.D., professor, and director of the ANZAC Research Institute at the University of Sydney.

Handelsman and his team, however, found that serum (blood) testosterone levels did not decline with increasing age in older men who reported being in excellent health with no symptoms to complain of.

“We had originally expected age to have an effect on serum testosterone, so the findings were a bit of a surprise,” Handelsman said.

Two study centers in Australia recruited 325 men over the age of 40 (median age, 60) who had self-reported excellent health and no symptom complaints. To test blood testosterone levels, the researchers took blood samples from the men nine times over three months. They excluded men from the study who took medications that affect testosterone.

Obesity caused a mild and clinically unimportant lowering of blood testosterone levels, the investigators reported. Age had no effect on testosterone level.

“The modest decline in blood testosterone among older men, usually coupled with nonspecific symptoms, such as easy fatigue and low sexual desire, maybe due to symptomatic disorders that accumulate during aging, including obesity and heart disease,” he said. “It does not appear to be a hormone deficiency state.”

The message for patients and their doctors, Handelsman said, is “older men with low testosterone levels do not need testosterone therapy unless they have diseases of their pituitary or testes.”

Testing testosterone

A simple blood test can determine testosterone levels. There’s a wide range of normal or healthy levels of testosterone circulating in the bloodstream.

Normal male testosterone levels range between 280 and 1,100 nanograms per deciliter (ng/dL) for adult males, and between 15 and 70 ng/dL for adult females, according to the University of Rochester Medical Center.

Ranges can vary among different labs, so it’s important to speak with your doctor about your results.

If an adult male’s testosterone levels are below 300 ng/dL, a doctor may do a workup to determine the cause of low testosterone, according to the American Urological Association.

Low testosterone levels could be a sign of pituitary gland problems. The pituitary gland sends a signaling hormone to the testicles to produce more testosterone.

Low T-test results in an adult man could mean the pituitary gland isn’t working properly. But a young teen with low testosterone levels might be experiencing delayed puberty.

Moderately elevated testosterone levels in men may produce few noticeable symptoms. Boys with higher levels of testosterone may begin puberty earlier. Women with high testosterone may develop masculine features.

Abnormally high levels of testosterone could be the result of an adrenal gland disorder or even cancer of the testes.

High testosterone levels may also occur in less serious conditions. For example, congenital adrenal hyperplasia, which can affect males and females, is a rare but natural cause for elevated testosterone production.

If your testosterone levels are extremely high, your doctor may order other tests to find out the cause.

Testosterone replacement therapy

Reduced testosterone production, a condition known as hypogonadism, doesn’t always require treatment.

You may be a candidate for testosterone replacement therapy if low T is interfering with your health and quality of life. Artificial testosterone can be administered orally, through injections, or with gels or skin patches.

Replacement therapy may produce desired results, such as greater muscle mass and a stronger sex drive. But the treatment does carry some side effects. These include:

Oily skin

Fluid retention

Testicles shrinking

Decrease in sperm production

Some studies Trusted Source have found no greater risk of prostate cancer with testosterone replacement therapy, but it continues to be a topic of ongoing research.

One study suggests that there’s a lower risk of aggressive prostate cancers for those on testosterone replacement therapy, but more research is needed.

Testosterone is most commonly associated with sex drive in men. It also affects mental health, bone and muscle mass, fat storage, and red blood cell production.

Abnormally low or high levels can affect a man’s mental and physical health.

Your doctor can check your testosterone levels with a simple blood test. Testosterone therapy is available to treat men with low levels of testosterone.

If you have low T, ask your doctor if this type of therapy might benefit you.

High Testosterone Levels: Is it Good or Unhealthy?

Higher levels of testosterone can have significant health benefits for some middle-aged men, according to a Penn State study.

Men with higher testosterone are less vulnerable to high blood pressure, heart attacks, frequent colds, and obesity,” says Dr. Alan Booth, professor of sociology and human development. “In addition, they are more likely to rate their health as excellent or good rather than fair or poor. Studies show self-ratings of health correlate highly with physicians’ assessments.

“The benefits of higher testosterone levels have a downside, however,” Booth notes. “Some, but not all, men with higher levels of testosterone are more likely to engage in behavior that cancels out the beneficial effects of testosterone.”

Those with higher levels of testosterone are more inclined to smoke, drink alcohol excessively and indulge in risky behavior that leads to injury. The biggest detriment to health by far is the tendency for high testosterone men to smoke.

The researchers studied testosterone and health in a sample of 4,393 men between the ages of 32 and 44 who had served in the military between 1965 and 1971. The men were interviewed and medically examined. Testosterone was measured in plasma from blood drawn at 8 a.m. Concentrations ranged from 53 nanograms per deciliter (ng/dl) to 1,500 with an average of 679.

“Comparison of men with slightly average levels of testosterone (400/ng/dl) with men with slightly above average levels (800 ng/dl) revealed significant differences in the indicators of health,” Booth says.

Men at the higher level were 45 percent less likely to have high blood pressure, 72 percent less likely to have experienced a heart attack, 8 percent less likely to have 3 or more colds in a year, and 45 percent less likely to rate their health as fair or poor.

On the negative side, men at the higher level were 25 percent more likely to report one or more injuries, 32 percent more likely to imbibe 5 or more drinks in a single day and 151 percent more likely to smoke.

“Monitoring testosterone through saliva samples is now possible and offers distinct advantages over the traditional means of assaying blood,” Granger notes. “Saliva sampling is non-invasive, samples can be self-collected, repeated samples can be obtained with minimal effort and the accuracy of saliva assays has substantially improved in recent years.”

Cutting back on sleep drastically reduces a healthy young man’s testosterone levels, according to a study published in the June 1 issue of the Journal of the American Medical Association (JAMA).

“Low testosterone levels are associated with reduced well-being and vigor, which may also occur as a consequence of sleep loss,” said Van Cauter.

At least 15% of the adult working population in the US gets less than 5 hours of sleep a night and suffers many adverse health effects because of it. This study found that skipping sleep reduces a young man’s testosterone levels by the same amount as aging 10 to 15 years.

“As research progresses, low sleep duration and poor sleep quality are increasingly recognized as endocrine disruptors,” Van Cauter said.

 

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