Testosterone in COVID-19: An Adversary Bane or Comrade Boon.

Hayder M Al-Kuraishy,Gaber El-Saber Batiha,Athanasios Alexiou,Hani Faidah,Ali I Al-Gareeb

doi:10.3389/fcimb.2021.666987

Abstract

COVID-19 is a pandemic disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), which leads to pulmonary manifestations like acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In addition, COVID-19 may cause extra-pulmonary manifestation such as testicular injury. Both high and low levels of testosterone could affect the severity of COVID-19. Herein, there is substantial controversy regarding the potential role of testosterone in SARS-CoV-2 infection and COVID-19 severity. Therefore, the present study aimed to review and elucidate the assorted view of preponderance regarding the beneficial and harmful effects of testosterone in COVID-19. A related literature search in PubMed, Scopus, Web of Science, Google Scholar, and Science Direct was done. All published articles related to the role of testosterone and COVID-19 were included in this mini-review. The beneficial effects of testosterone in COVID-19 are through inhibition of pro-inflammatory cytokines, augmentation of anti-inflammatory cytokines, modulation of the immune response, attenuation of oxidative stress, and endothelial dysfunction. However, its harmful effects in COVID-19 are due to augmentation of transmembrane protease serine 2 (TMPRSS2), which is essential for cleaving and activating SARS-CoV-2 spike protein during acute SARS-CoV-2 infection. Most published studies illustrated that low testosterone levels are linked to COVID-19 severity. A low testosterone level in COVID-19 is mainly due to testicular injury, the primary source of testosterone.

Highlights

The novel coronavirus disease 19, commonly known as COVID-19, is an infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), leading to acute systemic disturbances, pro-inflammatory activation, hypercytokinemia, cytokine storm, and multi-organ damage (Al-Kuraishy et al, 2020)
Binding of SARS-CoV-2 to ACE2 leads to downregulation of these protective receptors with subsequent increment in the level of vasoconstrictors angiotensin II (Ang II) and reduction of vasodilator angiotensin (Ang 1-7) (Ang 1-9) with induction release of pro-inflammatory cytokines (Bank et al, 2021)
In the COVID-19 era, different reports, retrospective, and small sample size prospective studies revealed that testosterone serum might correlate with COVID-19 severity and poor clinical outcomes

Summary

Introduction

The novel coronavirus disease 19 (nCoV19), commonly known as COVID-19, is an infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), leading to acute systemic disturbances, pro-inflammatory activation, hypercytokinemia, cytokine storm, and multi-organ damage (Al-Kuraishy et al, 2020). Lugnier et al, 2021) This systemic effect of COVID-19 is due to the wide distribution of angiotensin-converting enzyme 2 (AEC2), a receptor and entry point for SARS-CoV-2 (AlKuraishy et al, 2020b). Binding of SARS-CoV-2 to ACE2 leads to downregulation of these protective receptors with subsequent increment in the level of vasoconstrictors angiotensin II (Ang II) and reduction of vasodilator angiotensin (Ang 1-7) (Ang 1-9) with induction release of pro-inflammatory cytokines (Bank et al, 2021). The mortality rate ranges from 0.9% to 10.5% in COVID-19 patients without comorbidities than COVID-19 patients with comorbidities, respectively (Anjorin et al, 2021)

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