Post-COVID-19 transient hypogonadism and erectile dysfunction

Abstract

Introduction. The SARS-CoV-2 virus pandemic is one of the biggest public health challenges in the modern era. Currently, along with the continuing high incidence rate, the immediate and long-term consequences of COVID-19 are predictably becoming increasingly important. The impact of the COVID-19 on andrological health and erectile function has been studied insufficiently. The aim of this study was to assess the impact of COVID-19 infection on erectile function. Material and methods. From May 2020 to April 2021 44 men after COVID-19 pneumonia were consulted for decrease in libido, erectile function and the quality of sexual intercourse in three Astrakhan medical centers. The examination of patients included standard general clinical methods, hormonal profile studying (testosterone, luteinizing homone, prolactin) and number of standardized questionnaires. Results. No changes in the levels of luteinizing hormone and prolactin were observed. Total testosterone levels ranged from 8.0 to 14.8 nmol / L. According the testosterone level patients were divided into two groups. In group 1 patients testosterone level was 12.0 nmol/L and more, in group 2 patients – less than 12 nmol/L. In patients of the group 1 erectile dysfunction was regarded as one of the manifestations of asthenic syndrome and was relatively easily corrected by the administration of PDE-5 inhibitors and antiasthenic therapy. Patients of the group 2 had more severe complaints, «worse» scores on questionnaire scales and more significant asthenic syndrome. Discussion. The possible mechanisms of androgen deficiency and hormonal profile changes in those patients may be a direct damaging of gonadal cells by virus and nonspecific suppression of the hypothalamic-pituitary system caused by a severe illness. In some cases, testosterone preparations were prescribed to those patients to achieve a therapeutic effect. Conclusions. COVID infection may have a negative impact on erectile function. The main causes of this are decrease of testosterone level, endothelial dysfunction, and long-term asthenization. Those changes may be reversible by rehabilitation and drug correction. One should not rush to begin hormone replacement therapy. It makes sense to start treatment with antiasthenic drugs, and add testosterone preparations in the absence of an effect only. This study addresses only some aspects of the COVID-19 influence on the men's health. In the context of the ongoing pandemic and the inevitable increase in the number of ill patients, further comprehensive studies are needed to clarify all the details and organize adequate andrological care for these patients.