
Testosterone, a key hormone in the context of Covid-19 pandemic - sebastianconcpt
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185012/
======
kerkeslager
This isn't a study, it's a summary of reasons why testosterone _might_ be
related (positively OR negatively) to Covid19 outcomes in males. The intent
seems to be to solicit funding for actual studies.

I really don't see much reason to be linking papers which are this early in
the scientific process here. It just creates confusion. HN readers often don't
read the links completely or at all, and are prone to overestimate how
conclusive papers are. At the time I'm writing this, literally every single
comment on this thread is misunderstanding what this paper is.

~~~
Cthulhu_
If you think HN commenters are bad, wait until the media gets wind of this,
strips all nuance and goes "ALL MEN ARE GOING TO FUCKING DIE OF THE RONA" or a
variation thereof.

~~~
bilbo0s
HN is the media then, because a lot of these comments really do "strip all
nuance". We seem to have entered an era where we're all a part of the
hysteria.

Kerkeslager is right, we should all take time to actually read what this paper
is saying. But obviously, most people don't, and that causes issues. Which, I
imagine, is why kerkeslager advocated not even informing people until
conclusive data exists. But this strategy, of course, runs into the problem
that Seneca identified long ago, "A lie can make it around the world before
the truth can get its shoes on."

It's just the nature of a social media based world. Not sure there is much we
can do about it other than educate. To keep reminding people that they need to
be skeptical, and read carefully. Even that seems not to work very well, as
most people tend to believe anything that aligns with their world view, and
disbelieve anything that doesn't.

It's just a tough problem. But the most dangerous thing we can do
intellectually is to assume that we don't have the problem, only everyone else
does.

~~~
kerkeslager
> Which, I imagine, is why kerkeslager advocated not even informing people
> until conclusive data exists. But this strategy, of course, runs into the
> problem that Seneca identified long ago, "A lie can make it around the world
> before the truth can get its shoes on."

Well, the problem is that posting this sort of thing for a general audience
_isn 't informing people_. It's actually misleading people. I wouldn't call it
a "lie" because the intent isn't to deceive, but it's certainly spreading
untruth if what you communicate to people is what is being said in this
thread.

------
juskrey
Let me summarize: good health protects from viruses.

~~~
fortran77
And specifically, being at a heathy weight. It seems everyone's dancing around
the elephant in the room, talking about "low testosterone" or "type II
diabetes" as being co-morbidities.

See:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/)
for one of many sources for the link between obesity and low testosterone.
Obesity just cost our nation several trillion dollars.

People on Hacker News don't like to talk about this, either, because the
Computer Programmer community is also affected by obesity.

~~~
lazyjones
The lockdown might prevent some infections, but this sounds like it also
potentially causes more severe outcomes due to less activity at home.

~~~
watwut
You control weight primary by food intake.

~~~
stirbot
If you're already overweight you should combine control of calorie intake with
exercise. The only way fat leaves the body (besides surgery) is by exhaling it
as CO2

~~~
kerkeslager
True, but you're always exhaling CO2, even when you're not exercising.
Exercise simply doesn't create a very large increase the amount of calories
you burn.

Consider: a person at my height/weight burns _approximately_ 2500 calories/day
just by resting metabolic rate. According to this calculator[1], a person of
my weight running a mile at an 8 minute pace burns 136 calories. In other
words, running a 5k every day would only increase my calories burned by 17%.
And running 8 minute miles is one of the more efficient ways to burn calories
--if you're doing some other exercise, your calories burned are likely much
lower.

Compare the effort involved in running a 5k with drinking two less cans of
cola (about equivalent in calories) and you'll quickly see how diet has a much
larger effect on weight loss than exercise. There's a reason they say abs are
made in the kitchen not in the gym.

[1] [https://www.runnersworld.com/training/a20801301/calories-
bur...](https://www.runnersworld.com/training/a20801301/calories-burned-
running-calculator/)

~~~
JoeAltmaier
I ride my bike 20-50 miles for fun. At 50 calories per mile, that definitely
adds up.

Folks who exercise for aerobic reasons, you know, 20 minutes of brisk walking
around the park, are getting benefits. But not weight-loss benefits. There's a
10:1 difference in possible exercise regimines. It all depends where you're at
in that spectrum. Broad generalities are useless.

~~~
kerkeslager
> I ride my bike 20-50 miles for fun. At 50 calories per mile, that definitely
> adds up.

You're literally talking about exercising for 1-5 hours depending on pace.

Perhaps broad generalities are useless, but in the context of talking about
weight loss, I don't think it's unreasonable to assume that the average person
embarking on a weight loss journey is going to jump in and start doing 50 mile
bike rides.

It's much more likely that they'll be doing something like a 10 mile bike
ride, at a much slower pace, in which case the numbers are back into a range
where diet is going to play a much larger role in their success or failure.

~~~
JoeAltmaier
Sure. But my whole family does this; my boys and their spouses; their cousins
and so on. Its not as uncommon as all that. But yes, we are bicycle-obsessed
people.

~~~
kerkeslager
And how many of these people are concerned about losing weight?

~~~
JoeAltmaier
Ha! None of them. All lean and strong.

------
acqq
The real summary of it is just:

"Is _low_ testosterone a promoter of COVID-19 infection?

Is _high_ testosterone a promoter of COVID-19 infection?

The elucidation of the role of testosterone in the battle towards COVID-19
infection turns out to be an urgent need.

"

But the answer can still be _neither-nor_ in spite of the fact that
"difference in the number of cases reported by gender increases progressively
in favor of male subjects."

------
Infinitesimus
Attempt at a simple summary:

From what I see, low testosterone is a risk because there is a strong link
between lower respiratory muscle activity and lower testosterone levels and
high testosterone is a risk because high test -> more androgen receptor
expressions -> more binding opportunities for TMPRSS2 and that gene seems to
be an active factor in transcription of covid-19.

Its not a magic bullet but the TMPRSS2 angle is quite interesting since we
could target drugs that temporarily minimize androgen receptor affectiveness
to control the spread ( which might complicate other things in the meantime..)

Tangent, what's the state of drug discovery when it comes to simulating
interactions of hormonal treatments with cells?

~~~
sandworm101
>> we could target drugs that temporarily minimize androgen receptor
affectiveness to control the spread

Modifying key hormone functionality across the population, what could possibly
go wrong? The impact on other diseases, not to mention behavior, is huge open
question.

~~~
strofcon
Presumably this would only be done for those found to be at risk based on
tested testosterone levels.

Fortunately the linked paper doesn't recommend it, only notes the stats and
details and concludes that "The elucidation of the role of testosterone in the
battle towards COVID-19 infection turns out to be an urgent need."

Seems pretty even-handed to me.

~~~
sandworm101
That's the difference between treating patients and reducing spread. Appling a
preventative to a small population of at-risk individuals will help them
individually but won't decrease spread with the population, won't decrease
their exposure. That requires preventing the infection from spreading amongst
all people, including those who are at no real risk.

This is one of those special situations where one contemplates a applying
treatment to patients A B and C not to protect them from harm but to protect
them from spreading something to patients D and E. The ethical difficulty is
how one balances the potential increased in risks to ABC against the benifits
to DE. What if hormone therapy to ABC reduces their lifespan? What it if
causes long term behavioral or repoductive changes? How should that be
balanced against D and E's chances of infection/death?

Remember that any widespread COVID therapy will likely be with us as long as
the disease. Altering hormone levels across a population, potentially for many
years or even decades, is a radical approach. And to think of altering
testosterone amongst the reproductive-aged population, potentially modifying
sexual development of exposed children too, to safeguard those beyond
reproductive age from COVID? That's a very dangrous area.

------
gingerbread-man
Speaking only for myself, I found this article to be particularly difficult to
comprehend. If there are any physicians or molecular biologists who could more
plainly summarize the authors' conclusions, I would greatly appreciate it.

From what I can gather: _—_ SARS-CoV-2 uses ACE2 in the alveolar epithelium as
an entry receptor. ACE2 may also be involved in regulating cytokine activity
and in viral replication. _—_ "Pro-inflammatory cytokines have a central role
in the progression of COVID-19 infection." _—_ Anti-cytokine therapy may help
reduce pulmonary inflammation in C19 patients. _—_ ACE2 is also present in the
leydig (testosterone producing) cells of male rats. _—_ Long-term smokers
express higher levels of ACE2 in their lungs. COPD patients are more likely to
have low testosterone levels. And low testosterone has been linked to
increased Pro-inflammatory cytokine activity. ——> Maybe testosterone reduces
inflammation and, by extension, mortality, in COVID-19 patients? (I still do
not really understand how the production of ACE2 in the leydig cells is
related to this.)

Or, on the high-testostetone side: _—_ Androgen receptors activate the
transcription of TMPRSS2, a transmembrane serine protease found primarily in
prostate epithelium. _—_ "TMPRSS2 activity is regarded as essential for viral
spread and pathogenesis in the infected hosts." ——> Elevated testosterone in
some young men may increase TMPRSS2 activation, and be a common cause in the
relatively small number of severe cases in that age group.

------
purple_ferret
The question is: should men after a certain age supplement with testosterone
injections?

------
mister_hn
If it's a key hormone, why Covid19 seems to attack especially men?

~~~
joemazerino
Because men in 2020 have statistically lower testosterone than men decades
before them.

~~~
rodiger
Source on that? Or just a quip about a lack of perceived "toughness"?

Edit: Wow looks like it's true, TIL!

~~~
erfgh
[https://www.forbes.com/sites/neilhowe/2017/10/02/youre-
not-t...](https://www.forbes.com/sites/neilhowe/2017/10/02/youre-not-the-man-
your-father-was/) or [https://archive.is/cVyND](https://archive.is/cVyND)

~~~
gowld
That article starts off with interesting science (T dropping 50% in a century,
T possibly boosted for a generation by cigarettes, etc) and then takes a weird
turn at Tyler Cowen and meanders into speculative woods.

~~~
excursionist
Do you have a source for 'cigarettes boost T'? Is it the nicotine or some
other chemical in cigarettes?

------
TheSockStealer
I can see this information playing into some troubling right-wing tropes about
masculinity. Basically, if you are an Alpha (High T) you won't get sick, but
if you are a weak Beta (Low T) you will. Therefore, if you get sick from Covid
and you are a man, you are weak and somehow deserve it.

I hope this does not play out like this and everyone is rational and
compassionate, but I doubt it.

~~~
lobotryas
Alpha vs Beta (as far as that concept is useful) is a question of behavior,
attitude, and being able to love yourself; not T levels. Your comment betrays
that you have a very shallow understanding of these topics. I encourage you to
do some reading on this from first sources to get an understanding of the
topic.

~~~
mattbk1
In the spirit of good faith, I think the comment was explaining the
(incorrect) tropes, not supporting these ideas as fact.

~~~
TheSockStealer
Exactly

