Objective: Males, despite equal sex-related susceptibility to COVID-19, appear at a greater risk of poor clinical outcomes and death. This suggests that serum testosterone could be a mediator. The aim of this retrospective study was to evaluate the association between serum total testosterone (TT), other prognostic indicators, and mortality in men with COVID-19. Methods: Of the 110 men consecutively admitted to Walsall Manor Hospital (with COVID-19 related symptoms) tested for SARS-CoV-2, 85 were positive and 27 of these men died. Serum TT was compared (rank-sum test) between men negative and positive for SARS-CoV-2, and this was followed by establishing factors associated with mortality in the latter group (rank-sum, logistic, Cox regression analyses). No patient was on testosterone therapy (TTh). Results: No significant difference (p = 0.12, rank-sum test) in serum TT between men positive [median TT (IQR) = 3.9 (1.9–7.22) nmol/L, 0 days (median) postadmission] and negative [median TT (IQR) = 5.9 (2.69–10.1) nmol/L, 2 days (median) postadmission] for SARS-CoV-2 was observed. Serum TT was lower (p = 0.0011, rank-sum test) in men with COVID-19 who died [median TT (IQR) = 2.0 (1.5–3.6) nmol/L] compared with survivors [median TT (IQR) = 5.0 (2.6–9.4) nmol/L]. Comorbidities obtained via medication history were not associated with mortality. Mortality (logistic regression) was associated with only age and serum TT (odds ratio: 0.77, 95% confidence intervals [CI]: 0.64–0.91). Survival (Cox regression) was inversely associated with serum TT (continuous variable, hazard ratio [HR]: 0.85) (95% CI: 0.74–0.98), stratified by median, TT ≥3.9 nmol/L (reference, TT <3.9 nmol/L), HR: 0.24 (95% CI: 0.089–0.63). Conclusions: Serum TT was inversely associated with mortality in men with COVID-19 and requires measurement at admission and while managing long COVID. Future research should establish whether low serum TT, possibly associated with negative acute phase response, contributes to poorer prognosis and a role for TTh.
In recent decades, although prostate cancer (PCa) mortality has dramatically decreased, addressing the quality of life for PCa survivors has become an area of great interest. This is especially important among men who are enrolled in active surveillance (AS) to manage their PCa. Since men with PCa are likely to experience erectile dysfunction, decreased libido, and loss of lean muscle mass secondary to testosterone deficiency (TD) as a consequence of antitumor therapies or advanced age, testosterone therapy (TTh) is typically the indicated treatment to alleviate the symptoms of TD. However, due to the theoretical causal relationship of increased testosterone levels leading to PCa development, the usage of TTh in men who have been diagnosed with PCa has long been the subject of debate. As there is an increased number of men with PCa who are enrolling in AS for the management of PCa, there needs to be an evaluation of the safety and efficacy of TTh in this cohort. Recently, the previous relationship between TTh and PCa has been challenged, and emerging evidence suggests that TTh may not be directly associated with PCa development or progression. Instead, TTh usage may safely improve the quality of life for those men on AS. This review summarizes and analyzes the latest findings on the use of TTh in men on AS for PCa.
Introduction: Anabolic–androgenic steroids (AASs) are commonly used by both professional and amateur athletes to improve strength, muscle mass, and physical appearance. Aims: Scientific data on the adverse effects of AASs are scarce and there is little place for the subject in medical curricula. This may lead to a lack of knowledge and distrusting attitudes of physicians toward AAS users. The aim of this case series is to illustrate how these issues may lead to diagnostic delay and to make a plea for better education on the topic. Case Description: We describe three patients who attended our outpatient AAS clinic with azoospermia, gynecomastia, and hypogonadism, respectively. After referral to the appropriate specialist, symptoms were wrongly appreciated, sometimes despite our medical recommendations, and patients did not receive the necessary additional investigations or treatment in a timely manner. Discussion: Diagnostic delay in the presented cases was the result of inexperience with the subject and unfamiliarity with health effects of AASs. Prejudice and stigmatization may lead to a tendency to wait, and a reluctance to help, (former) AAS users. Conclusion: All patients and substance abusers, including AAS users, should be treated equally, despite the cause of their illness. Diagnostic delay can be prevented with an unbiased attitude and improved education.
Testosterone therapy (TTh) is a well-established and safe treatment for men with testosterone deficiency. Historically, great caution has been used in the use of testosterone in men with prostate cancer (PCa) given the pioneering work by Huggins and Hodges showing castration decreased serum acid phosphatase in men with metastatic PCa. For the past several decades new theories including the saturation model have gained traction and as a result the treatment of testosterone deficiency in men with PCa has been transformed. In men treated for localized PCa with prostatectomy a growing body of evidence exists supporting its safety and efficacy in these men. In addition, it has been suggested that TTh may decrease biochemical recurrence. The data are more limited in men treated with radiation and there are no studies currently with a control group. Overall, the body of literature continues to grow suggesting the safety of TTh in well-selected men treated for localized PCa.
Purpose: Oral and injectable testosterone replacement therapies have been reported to increase blood pressure (BP) in hypogonadal men. Less is known about the effects of topical testosterone formulations on BP. Materials and Methods: We studied the effects of a new oral testosterone undecanoate (TU) (Kyzatrex™) and a topical testosterone gel (Androgel™) on BP and heart rate, in a 2:1 randomized trial of men with hypogonadism. Digital BPs and clinical assessments were obtained at baseline and at 90, 180 and 365 days. Results: There were 314 men randomized (mean age 49.7 years, 82% white, and 35% with treated hypertension). The mean changes from baseline in systolic BP were 2.2 mmHg (95% confidence interval [CI] 0.6–3.7) on the oral TU and 3.1 mmHg (95% CI 1.0–5.1) on the topical testosterone at 90 days. Similar findings were seen after 180 and 365 days. Heart rate increased by 4.3 and 2.7 beats/min at 90 days on oral and topical testosterone, respectively. For those men with treated hypertension, changes in systolic BP in the oral TU group were higher compared with those without hypertension, whereas those on topical testosterone had similar increases in systolic BP regardless of hypertension status. Outlier analyses for systolic BP at 90 days demonstrated a higher proportions of subjects with increases of 5 and 10 mmHg postbaseline on topical testosterone gel versus this oral TU. Conclusions: These data demonstrate that the overall effects of the oral TU on BP were comparable with a topical testosterone. In men without hypertension, the oral TU induced smaller changes in BP compared with topical testosterone. Clinical Trial Registration (https://www.clinicaltrials.gov/): NCT04467697.
