Title:Covid-19 in Man: A Very Dangerous Affair
Volume: 21
Issue: 9
Author(s): Giuseppe Lisco, Vito A. Giagulli, Giovanni De Pergola, Anna De Tullio, Edoardo Guastamacchia and Vincenzo Triggiani*
Affiliation:
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Bari, Apulia,Italy
Keywords:
Covid 19, SARS-CoV-2 , male gender, testosterone, erectile dysfunction, immune system.
Abstract: The novel pandemic of Coronavirus disease 2019 (COVID-19) has become a public
health issue since March 2020, with more than 30 million people found to be infected worldwide.
Men may be considered to be at a higher risk of poor prognosis or death once the infection occurred.
Concerns surfaced regarding the risk of a possible testicular injury due to SARS-CoV-2 infection.
Several data support the existence of a bivalent role of testosterone (T) in driving poor
prognosis in patients with COVID-19. On the one hand, this is attributable to the fact that T may facilitate
SARS-CoV-2 entry in human cells by means of an enhanced expression of transmembrane
serine-protease 2 (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2). At the same time, a
younger man with normal testicular function compared to a woman of similar age is prone to develop
a blunted immune response against SARS-CoV-2, being exposed to less viral clearance and
more viral shedding and systemic spread of the disease. Conversely, low levels of serum T observed
in hypogonadal men predispose them to a greater background systemic inflammation, cardiovascular
and metabolic diseases, and immune system dysfunction, hence driving harmful consequences
once SARS-CoV-2 infection occurred. Finally, SARS-CoV-2, as a systemic disease, may
also affect testicles with possible concerns for current and future testicular efficiency. Preliminary
data suggested that the SARS-CoV-2 genome is not normally found in gonads and gametes. Therefore,
transmission through sex could be excluded as a possible way to spread the COVID-19. Most
data support a role of T as a bivalent risk factor for poor prognosis (high/normal in younger; lower
in elderly) in COVID-19. However, the impact of medical treatment aimed to modify T homeostasis
for improving the prognosis of affected patients is unknown in this clinical setting. In addition,
testicular damage may be a harmful consequence of the infection, even if it occurred asymptomatically.
Still, no long-term evidence is currently available to confirm and quantify this phenomenon.
Different authors excluded the presence of SARS-CoV-2 in sperm and oocytes, thus limiting worries
about both a potential sexual and gamete-to-embryos transmission of COVID-19. Despite these
evidence, long-term and well-designed studies are needed to clarify these issues.
