Vitality Unleashed: The Functional Medicine Podcast

Long COVID's Hidden Impact on Men

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 85

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The lingering effects of COVID-19 have puzzled both patients and doctors since the pandemic began. While fatigue, brain fog, and breathing difficulties are commonly discussed aspects of Long COVID, there's a surprising hormonal connection that's only now gaining attention – especially for men.

We dive deep into the emerging research showing that men who've had COVID-19 may be at higher risk for developing hypogonadism (low testosterone). The science suggests this isn't coincidental. SARS-CoV-2 appears capable of disrupting the vital communication pathway between the brain and testes, potentially through direct damage to testicular tissue or through the body-wide inflammatory response that COVID triggers.

Through the lens of a fascinating case study, we explore a 62-year-old man who developed hypogonadism two months after recovering from severe COVID. His experience reveals something crucial – while testosterone replacement therapy successfully addressed his hormone-specific symptoms, it didn't resolve all his Long COVID issues. This highlights the complex, multi-systemic nature of post-COVID conditions and why they require comprehensive treatment approaches.

For men experiencing persistent symptoms after COVID recovery – especially fatigue, changes in body composition, mood disturbances, or sexual dysfunction – this episode provides valuable insights about a connection your doctor might not yet recognize. Understanding the relationship between COVID and testosterone levels could be a crucial step in your recovery journey. If you're in Florida and struggling with these issues, reach out to LifeWellMD at 561-210-9999 to discuss testing and personalized treatment options with providers who are staying current on this emerging research.

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

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Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

Speaker 1:

It seems like everyone's got a COVID story right, Like you hear about people getting sick and then thankfully they recover, the cough goes away, no more fever and they're back to normal End of story. But more and more we're starting to understand that for a lot of folks it's not that simple. Covid can have these lingering effects and sometimes they stick around for a while.

Speaker 2:

Yeah, it's something we're seeing more and more of and it's got a name now long COVID a while. Yeah, it's something we're seeing more and more of and it's got a name now long COVID the World Health Organization. The WHO actually has a definition for it.

Speaker 1:

Oh really, I didn't realize there was an official definition.

Speaker 2:

There is. They say it happens in people who've probably or definitely had a SARS-CoV-2 infection, and the symptoms usually show up about three months after they were first sick. So not right away, but a bit later down the line, exactly, and the symptoms last for at least two months. And here's the key they can't be explained by any other health condition. We're talking about stuff that can really mess with your daily life.

Speaker 1:

Yeah, you hear a lot about the fatigue, like just feeling wiped out all the time. And then there's the shortness of breath and that brain fog making it hard to think straight.

Speaker 2:

Those are definitely big ones, absolutely. But today we're diving into something that might be a bit of a curveball, something that even some doctors aren't totally up to speed on.

Speaker 1:

Oh, okay, lay it on me. I love a good medical mystery.

Speaker 2:

Well, it's the growing evidence linking long COVID in men to hypogonadism.

Speaker 1:

Hypo. What now?

Speaker 2:

Hypogonadism. It basically means low testosterone.

Speaker 1:

Oh, okay, low T Interesting. So that's what we're going deep on today Long COVID and low testosterone in men.

Speaker 2:

Precisely. We want to unpack this connection, look at the research and really understand what it means if you're a guy dealing with long COVID.

Speaker 1:

And for our listeners. You know we like to cut through the noise and give you the need-to-know info. Right, you're here because you're curious, you want the facts and you want them in a way that doesn't require a medical degree to understand.

Speaker 2:

Exactly, We've done the homework, gone through the studies and we're here to be your guides through this potentially surprising link.

Speaker 1:

Okay, so let's get down to brass tacks. What's the research saying about long COVID and low T? What's the connection?

Speaker 2:

Well, a bunch of studies are starting to show that hypogonadism seems to be more common in men who've recovered from COVID compared to the general population.

Speaker 1:

So it's not just a random thing. There's actually a pattern emerging.

Speaker 2:

Right, and there's this one study that really piqued our interest. It pointed out that SARS-CoV-2, the virus that causes COVID, seems to have this ability to mess with something called the pituitary-gonadal axis. Okay, hold up Pituitary-gonadal axis. That sounds pretty intense. Break that down for me. Think of it like the communication highway between your brain and your testes. It's the system that controls how much testosterone your body produces.

Speaker 1:

So the virus is like a roadblock on that highway, screwing up the signals.

Speaker 2:

That's one way to put it. It's like the virus is interfering with your body's ability to make this vital hormone.

Speaker 1:

That's a pretty direct. Hit.

Speaker 2:

It is, and it's not just a long COVID thing either. Research suggests that having low testosterone during the initial COVID infection, like when you're acutely ill, can actually be linked to worse outcomes for men.

Speaker 1:

Oh wow. So low testosterone might not just be a result of long COVID. It could actually play a role in how your body handles the initial infection.

Speaker 2:

That's what the research seems to suggest.

Speaker 1:

Now we've also heard that some guys with long COVID are reporting issues like erectile dysfunction or ED. Could low testosterone be a factor there?

Speaker 2:

It's definitely possible. You see hypogonadism, along with other things that can happen after a COVID infection, like problems with your blood vessels, which is called endothelial dysfunction, or even times when your body's not getting enough oxygen what we call hypoxia, not to mention the mental and emotional stress like PTSD. All these things together could be contributing to ED in some long COVID patients.

Speaker 1:

Right. So it's probably not just one thing, but a whole bunch of factors at play.

Speaker 2:

It's a complex interplay and, speaking of research, the research specifically looking at using testosterone replacement therapy, or TRT, for hypogonadism that develops after long COVID is pretty fresh.

Speaker 1:

Oh, so this is really cutting edge stuff.

Speaker 2:

It is, and our deep dive today is actually based on a specific case study that sheds some light on this.

Speaker 1:

OK, let's hear about it. Give us the details.

Speaker 2:

This case study focuses on a 62-year-old man who developed something called hypogonadotropic hypogonadism, which essentially means the signal from his brain telling his testes to produce testosterone wasn't strong enough.

Speaker 1:

So his brain wasn't properly telling his body to make testosterone.

Speaker 2:

Right, and this happened about two months after he recovered from a pretty rough bout with COVID.

Speaker 1:

OK, let's rewind a bit. What was his initial COVID experience like?

Speaker 2:

He got really sick back in March 2021, ended up hospitalized for about a month with SARS-CoV-2 interstitial pneumonia.

Speaker 1:

That's a mouthful. What does that even mean?

Speaker 2:

Basically, it's inflammation deep in the lung tissue making it hard to breathe. That's serious it was. He needed a whole range of treatments Remdesivir, glucocorticoids, heparin to prevent blood clots, oxygen therapy and even CPAP to help him breathe.

Speaker 1:

So not a walk in the park. And then, two months after recovering from all that, that's when these new symptoms started popping up.

Speaker 2:

Exactly he developed gynecomastia.

Speaker 1:

Gyneco-what.

Speaker 2:

Gynecomastia. It means he started developing breast tissue.

Speaker 1:

Oh wow, Didn't see that coming.

Speaker 2:

Yeah, it's a common symptom of low testosterone. He also reported feeling super fatigued, having achy joints, and he gradually gained about 11 kilograms, roughly 24 pounds.

Speaker 1:

Okay, that's a lot to deal with on top of recovering from a serious COVID case.

Speaker 2:

It is. And when they did a physical exam they noted his weight, height, bmi, all that and found he was in the overweight category. They also measured his waist and checked for any abnormalities. His tests were normal in size, but they felt a bit firmer than usual and there was some tenderness and swelling in the epididymis.

Speaker 1:

What's the epididymis again?

Speaker 2:

It's a coiled tube that sits on top of each testicle and stores sperm.

Speaker 1:

Right, okay.

Speaker 2:

The doctors also noted the gynecomastia, which was tender to the touch, and it's important to mention he had a history of some other health conditions too, like Hashimoto's, thyroiditis, high blood pressure, an enlarged prostate, mild asthma, some nodules in his lungs and a history of skin cancer.

Speaker 1:

So a few things going on already, even before COVID. What did the blood work show?

Speaker 2:

His blood work revealed that his total testosterone level was quite low, below the normal range. His sex hormone binding globulin, or SHBG, was normal, but his calculated free testosterone, which is the testosterone that's actually available for the body to use, was also low. His LH and FSH levels, which are hormones from the brain that stimulate the testes, were within normal limits.

Speaker 1:

So it sounds like it wasn't a problem with his tests themselves, but more with the signals from his brain telling them to produce testosterone.

Speaker 2:

You got it. That's why it's called hypogonadotropic hypogonadism or secondary hypogonadism. They also did tests for antibodies that can sometimes cause these problems but those came back negative Interesting. What about imaging? Did they do any scans? Yes, they did a scrotal ultrasound and found a moderate hydra cell, which is basically a fluid collection around the testicle, and a mild varicose cell on the left side.

Speaker 1:

Varicose cell. That's like a varicose vein, but in the scrotum right.

Speaker 2:

Exactly, and they also did a breast ultrasound which confirmed the gynecomastia.

Speaker 1:

So, based on all this, what was the initial plan? Did they start him on treatment right away?

Speaker 2:

Well, because he had been so sick with COVID, they thought it might be a temporary thing that his hormone levels might bounce back on their own. So they decided to monitor him closely and see how things developed.

Speaker 1:

Okay, makes sense. Yeah, give his body a chance to recover. But the case study mentions his symptoms got worse. What happened?

Speaker 2:

Unfortunately, after about a year, his symptoms had actually intensified. He had severe asthenia, which is extreme fatigue and weakness. His mood also took a nosedive.

Speaker 1:

Oh man, that's rough.

Speaker 2:

It was.

Speaker 1:

And when they checked his hormones again, his total testosterone had dropped even lower, confirming that he had overt hypogammatism.

Speaker 2:

So that's when they decided to go ahead with testosterone replacement therapy Right. They started him on a testosterone gel 2% concentration applied daily.

Speaker 1:

Man what kind of results did they see?

Speaker 2:

After a couple of months his total testosterone levels were back in the normal range. They also saw his gynecomastia improve. The breast tissue shrunk.

Speaker 1:

That's great news, but what about the other long COVID symptoms like the fatigue and low mood? Did the TRT help with those?

Speaker 2:

That's where things get interesting. While the TRT helped with his testosterone levels and the gynecomastia, it didn't seem to make much difference in his fatigue, mood, joint pain or overall quality of life. His weight didn't change much either.

Speaker 1:

So the TRT helped with the low T symptoms but not so much with the other long COVID issues.

Speaker 2:

Exactly. They used a bunch of questionnaires to track his progress, things like WOMAC and AIMS for joint pain and function, iief5 for erectile function, an ERT test for hypogonadism symptoms, and the SF36 to assess his overall quality of life. The questionnaire specific to hypogonadism showed improvement, but the others not so much.

Speaker 1:

So this case really highlights that while low T can definitely happen after COVID and TRT can help with those specific hormonal issues, it's not a cure-all for everything. Long COVID is complex.

Speaker 2:

It is. This study tells us a couple important things. First, hypogonadism seems to be more common in folks who've had COVID and it might be part of the bigger long COVID picture. Second, trt can help with the symptoms directly linked to low T, but it may not fix the other stuff that's going on.

Speaker 1:

So let's talk about the why here. Why might COVID lead to low testosterone? What's the biological connection?

Speaker 2:

Researchers have a few theories. One is that the A32 receptors, which is how the virus gets into our cells, are actually present in the testes, specifically on cells involved in testosterone and sperm production.

Speaker 1:

So the virus could be attacking the testes directly.

Speaker 2:

It's a possibility. There's also the inflammation that the virus causes. If the virus is present in the testes, it could trigger an immune response and potentially damage the testicular tissue.

Speaker 1:

Makes sense, so direct damage and inflammation could be playing a role.

Speaker 2:

Right, and remember how we talked about secondary hypogonadism, where the problem is with the signals from the brain. Well, severe COVID can lead to high levels of inflammatory molecules called cytokines, and these cytokines have been shown to impair the function of the hypothalamus, which is the part of the brain that controls hormone production.

Speaker 1:

Oh, so the inflammation could be messing with the brain's ability to tell the testes what to do.

Speaker 2:

Inflammation could be messing with the brain's ability to tell the testes what to do Exactly. It's a bit like what happens in metabolic syndrome, where chronic inflammation affects hormone regulation.

Speaker 1:

So it could be a combination of direct effects on the testes and this whole body inflammation affecting the brain's signaling.

Speaker 2:

That's the current thinking.

Speaker 1:

Is it clear whether this post-COVID hypogonadism is a temporary blip or a long-term thing?

Speaker 2:

That's the million-dollar question. We need more research, longer studies to know for sure. This case study suggests it might be reversible in some cases, but we can't say for sure.

Speaker 1:

So the takeaway is that hypogonadism seems to be a part of the long COVID syndrome and while TRT can address the low T symptoms, it may not be a fix for all the other aspects of long COVID.

Speaker 2:

Right Long. Covid has so many effects on the body, and hypogonadism is just one piece of the puzzle.

Speaker 1:

So what should our listeners do if they think they might be dealing with long COVID and low T?

Speaker 2:

If you're experiencing persistent symptoms after a COVID infection, especially things like fatigue, breast tissue development or changes in sexual function, talk to your doctor. Ask about getting your testosterone levels checked. Many doctors might not be aware of this connection yet.

Speaker 1:

So being your own advocate is important. And if someone is diagnosed with low T, in this context, what's the role of TRT?

Speaker 2:

TRT can definitely improve the specific symptoms of low T, even if it doesn't solve all the long COVID issues. It's about managing that hormonal imbalance. But remember, more research is needed to understand the long term effects of post-COVID hypogonadism and the best ways to treat it.

Speaker 1:

It's an evolving area, that's for sure. Now, for our listeners in Florida, if you're experiencing long COVID symptoms or have concerns about low T, where can you turn for help?

Speaker 2:

Here at LifeWellMDcom. We're a clinic in Florida that specializes in health, wellness and longevity. We're staying up to date on the latest research on long COVID and its connection to low testosterone. Dr Kumar and our team are dedicated to providing comprehensive evaluations and personalized treatment plans. We understand that many people, and even some doctors, aren't familiar with this link, and we're here to help.

Speaker 1:

So if you're in Florida and this resonates with you, how can you connect with LifeWellMD?

Speaker 2:

Give us a call at 561-210-9999. Taking proactive steps is crucial, especially with something as complex as long. Covid, we're here to listen, evaluate your situation and work with you to create a plan that gets you back on track.

Speaker 1:

So to recap, Long COVID in men can be linked to low testosterone, and TRT can be a useful tool in managing those specific symptoms. But Long COVID is multifaceted and might need a multi-pronged approach. More research is definitely needed.

Speaker 2:

Agreed. It highlights how important it is to be proactive about your health and find healthcare providers who are knowledgeable about the latest research, particularly when dealing with new and evolving conditions like long COVID.

Speaker 1:

And if you're in Florida and want to take that proactive step, especially if you're dealing with lingering post-COVID symptoms or concerned about your testosterone levels, the team at LifeWellMDcom is here to help. Give them a call today at 561-210-9999 to start your wellness journey.

Speaker 2:

We're here for you. Don't wait, reach out and take charge of your health.

Speaker 1:

And on that note we'll wrap up this deep dive. Until next time, stay curious, stay informed and stay well.