Researchers are still learning more about patients who experience long-term COVID symptoms, and some of what they've found so far may surprise you. Beyond the better known coronavirus symptoms like cough, fever, fatigue, and sensory losses, some patients are experiencing much more intimate, less talked about symptoms. As it turns out, both men and women have reported effects on their sexual and reproductive systems following a COVID infection: specifically, some women with long COVID have experienced menstrual changes, and men have reported erectile dysfunction (ED) long after other symptoms have subsided. And for more on extended COVID cases, check out The 5 Warning Signs You're Likely to Suffer From "Long COVID".
A literature review published in the Journal of Endocrinological Investigation in July was one of the earliest to confirm onset ED as a symptom of coronavirus. Those researchers found trends in the literature that suggested that male COVID patients were more likely to experience hypogonadism—a condition in which a person's sex organs release little or no sex hormone—than those who have not had COVID. "Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered," the researchers explained.
They also noted lower counts of Leydig cells, which are found in the testicles. These maintain the male reproductive tract, assist in the production of testosterone, and are responsible for spermatogenesis, the generation of sperm. The researchers hypothesized that the suppression of testosterone "might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men."
However, women also experience sexual and reproductive symptoms that doctors believe are linked to hormones. Louise Newson, MD, a general practitioner and menopause specialist, recently shared with Vox that she is currently conducting a pilot survey on these symptoms in COVID-19 patients. With 842 patient responses recorded so far, she says the results "confirm [her] thoughts that long COVID is likely to be related to low hormone levels (estrogen and testosterone), which so far have been neglected with research."
In support of her theory, Newson added that many women notice worsening COVID symptoms just before their period begins—when estrogen levels are at an all time low. She suspects it's not entirely coincidence that certain long COVID symptoms like brain fog, fatigue, dizziness and joint pain are also symptoms of menopause.
Though more research is needed to flesh out the role of hormones in COVID cases, there's some good news in the meantime. According to Vox, "Newson says that anecdotally, patients with long COVID from her menopause clinic have improved with the right dose and type of hormone replacement therapy." Read on for more doctors' insights on how coronavirus appears to be linked to our hormones, and for more shocking COVID developments, check out The One Thing About the COVID Vaccine That's Surprising Even Doctors.
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Low testosterone may increase the risk of respiratory infections.
According to a Turkish study published in the journal The Aging Male, "Testosterone is associated with the immune system of respiratory organs, and low levels of testosterone might increase the risk of respiratory infections," writes Selahittin Cayan, MD, a professor of urology and the lead author of the study. "In our study, the mean total testosterone decreased, as the severity of the COVID-19 increased," Cayan adds. And for more on COVID symptoms, check out If You Have These 2 COVID Symptoms, You Could End Up in the Hospital.
Women with low estrogen are more likely to have severe COVID.
A study in Wuhan, China found that non-menopausal women with severe COVID experienced shorter hospital stays than women of the same age who had begun menopause. "Non-menopause and female sex hormones, especially E2 and AMH, are potential protective factors for female COVID-19 patients," write the researchers, referring to Estradiol and Anti-Mullerian Hormones. "E2 supplements could be potentially used for COVID-19 patients," they add.
The testes express the ACE2 enzyme in men.
We now know that for COVID to enter cells, the virus's spike protein needs to bind to the ACE2 receptor like a key entering a lock. And according to a position paper penned by the British Society of Sexual Medicine (BSSM), "The testes are one of the highest sites of ACE2 expression," suggesting a link between the reproductive system and COVID-19.
The BSSM also notes that COVID-19 damages the endothelial cells, which line the inner surface of our blood vessels. This condition is "frequently present in men with erectile dysfunction and testosterone deficiency," they explain. And for more on how COVID infects the body, check out This Is How Coronavirus Will Most Likely Enter Your Body, Study Finds.
COVID may affect your sperm count.
According to a study published by The Lancet, there's reason to believe that COVID could impair men's long-term production of sperm. Vox reported on this particular study, explaining, "in some patients, they also found auto-immune orchitis, or inflammation of the testis with specific anti-sperm antibodies," a condition which could cause future infertility. Experts say there is not currently enough evidence to determine whether these effects are permanent.