~ 23 ~ ISSN Print: 2664-8733 ISSN Online: 2664-8741 IJRMS 2024; 6(2): 23-29 www.medicalpaper.net Received: 09-06-2024 Accepted: 16-07-2024 Sarojit Das Resident, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Md. Farid Uddin Professor and Founder Chairman, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Shahjada Selim Associate Professor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Md. Kamrul Azad Junior Consultant (Medicine), OSD, (DGHS), Attached in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Choudhury Faisal Md. Manzurur Rahim Junior Consultant (Medicine), OSD, (DGHS), Attached in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Syed Azmal Mahmood Resident, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Corresponding Author: Resident, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Androgen and SARS-Cov-2: Exploring the impact of COVID-19 on testosterone levels in men Sarojit Das, Md. Farid Uddin, Shahjada Selim, Md. Kamrul Azad, Choudhury Faisal Md. Manzurur Rahim and Syed Azmal Mahmood DOI: https://doi.org/10.33545/26648733.2024.v6.i2a.68 Abstract Background: High expression of ACE2 and TMPRSS2 in testes suggests men's vulnerability to SARS- CoV-2 infection, leading to orchitis, oxidative damage, inflammation, and immunological responses that disrupt the hypothalamic-pituitary-gonadal axis and impaired gonadal steroidogenesis, potentially causing hypogonadism, sexual dysfunction, and infertility. Objectives: To determine the frequency of testosterone deficiency in post-COVID patients and its association with the severity of COVID-19 disease. Methods: In this cross-sectional study we enrolled 48 post-COVID male patients aged 18-69 years and equal number of age, BMI, and WC matched participants as healthy control. After using a questionnaire to enlist participants, we measured total testosterone, luteinizing hormone (LH), folicle stimulating hormone (FSH), SHBG, and albumin, then computed free (cFT) and bioavailable testosterone. Testosterone deficiency was defined as TT < 264 ng/ml and/or cFT < 220 pmol/L. Results: Frequency of testosterone deficiency 12 (25%) was significantly (P=0.028) higher in the post- COVID group compared to only 4 (8.3%) in the healthy control group. The recovered COVID-19 patients had significantly lower total (P=0.034), calculated free (p<0.001) and bioavailable testosterone (p<0.001), and higher SHBG (p<0.001) levels in comparison to the healthy individuals. In contrast to post-COVID patients with normal testosterone levels, patients with deficient testosterone had significantly greater rates of central obesity (P=0.040), and sexual dysfunction (P=0.011) as well as hospitalizations requiring oxygen therapy (P=0.007) and COVID-19 disease severity (P=0.004). In regression analysis, COVID-19 was a significant predictor of testosterone deficiency [OR=4.295 (P=0.034, 95% CI= 1.115, 16.548)], and moderate to severe COVID-19 disease increased the odds of testosterone deficiency by approximately 10 times [OR=9.950 (p=0.017, 95% CI= 1.513, 65.454)] in post-COVID group. Conclusion: Post-COVID male patients were found to have a higher prevalence of testosterone deficiency in comparison to matched control participants. COVID-19 severity was the most significant predictor of low testosterone levels in recovered COVID-19 patients. Keywords: COVID-19, testosterone deficiency, severity Introduction A novel Corona virus emerged in December 2019, termed SARS-CoV-2 by the International Virus Taxonomy Committee due to its genetic similarities to the SARS-CoV-1 virus (79.5%) [1] . The infection caused by SARS-CoV-2 has been termed as “COVID-19” (Coronavirus disease-19), as this is a Corona virus-related disease that was discovered originally in 2019 [2] . COVID‐19 has widespread effects throughout the body with lesser known clinical manifestations, and the medium and long‐term health consequences experienced by survivors of COVID‐19, if any, are currently unknown [3] . It is a systemic disease, affecting the respiratory, cardiovascular, digestive, endocrine, and neurologic systems [4] and the knowledge about the impact of this virus on the endocrine system is growing [5] . Although epidemiological data suggests that men may have an increased risk of COVID-19-related morbidity and mortality, the potential impact on male reproduction and any mechanisms remain poorly understood [6] . At the pathophysiological basis, SARS-CoV-2 exploits the ACE-2 receptor and uses it to facilitate viral entry into the target cells [7] and utilizes cell surface protease transmembrane serine protease 2 (TMPRSS2) for viral S protein priming. International Journal of Research in Medical Science 2024; 6(2): 23-29