Vitality Unleashed: The Functional Medicine Podcast

Unraveling Long COVID’s Hidden Hit To Men’s Hormones And Blood Flow

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 208

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A respiratory virus shouldn’t derail sexual health months later—yet for many men, long COVID does exactly that. We dig into the hidden chain reaction that links SARS-CoV-2 to erectile dysfunction: viral entry through ACE2 and TMPRSS2, a crashed renin-angiotensin system, widespread endothelial injury, and a surprising hit to the testes that drives low testosterone despite elevated LH. The picture that emerges is not simple fatigue or stress; it’s a multi-system disruption that demands careful sequencing and specialized care.

We walk through the science in plain language, connecting endothelial dysfunction to impaired blood flow, and mapping how a smoldering inflammatory state and autonomic neuropathy keep vessels tense and unresponsive. Then we zoom in on hormone data from younger men with mild initial illness who later developed ED, showing clinically meaningful drops in total and free testosterone and lower SHIM scores. These findings point to testicular injury rather than a purely central signaling problem, reframing how we evaluate and treat men who feel “too young” for ED.

Most urgent is our caution on reflexive testosterone therapy. Early research suggests that raising androgens can upregulate the very cellular doorways the virus uses, potentially worsening instability. Instead of chasing numbers, we outline a root-cause plan: restore endothelial health, reduce inflammation and oxidative stress, stabilize blood pressure and autonomic tone, and only then reassess hormones with a full panel before considering carefully monitored TRT. Along the way, we share practical steps for smarter diagnostics and why symptom-only fixes like PDE5 inhibitors rarely deliver lasting results.

If this conversation resonates, subscribe, share with someone who needs it, and leave a review to help more listeners find evidence-based guidance. Your support helps us keep digging deep into the science that turns confusion into a clear path forward.

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

SPEAKER_00:

Welcome back to the deep dive. This is the show where we take your sources and really break them down.

SPEAKER_01:

And today we are tackling something that is well, it's incredibly important, but just doesn't get talked about enough.

SPEAKER_00:

It really doesn't. We're doing a deep dive into a very specific and honestly a very difficult aspect of long COVID recovery. We're talking about the connection between that postviral syndrome and men's intimate and hormonal health, specifically erectile dysfunction.

SPEAKER_01:

Aaron Powell It's a topic that, you know, it just seems to get missed in general practice. When you hear long COVID, what do you think of?

SPEAKER_00:

Fatigue, brain fog, maybe lung issues.

SPEAKER_01:

Right. Chronic fatigue, cognitive problems. But the research we've been looking at, it shows something else. For a lot of men, SORS-CoV-2 leaves behind real measurable damage.

SPEAKER_00:

Damage that lasts.

SPEAKER_01:

Yes, long-term damage to the endocrine system and the vascular network. And this results in real-world symptoms months, even years after the infection is gone.

SPEAKER_00:

And that's exactly our mission for this deep dive. We're going to unpack the hard science. We want to show you how a respiratory virus can cause such specific long-term problems in a man's reproductive and vascular systems.

SPEAKER_01:

We're going to follow the trail.

SPEAKER_00:

We are. We'll trace how the virus attacks, look at the hormonal crash that follows. And this is critical talk about why some of the standard treatments might actually be the wrong move here.

SPEAKER_01:

It's so important to understand this isn't a simple issue. This isn't just one thing going wrong. It's a complex multi-system failure. The virus targets these key cellular systems tied to male sexual function. And it just creates this lingering instability.

SPEAKER_00:

Which is why a standard medical checkup might miss it completely. They just don't connect the dots.

SPEAKER_01:

And that's where specialized care becomes so essential. You have to get a comprehensive diagnosis.

SPEAKER_00:

Exactly. When you're dealing with these kinds of difficult, often unrecognized symptoms after COVID, you need someone who gets this level of complexity. And that's why we're happy to acknowledge that this deep dive really highlights the need for that kind of expert investigation, like the work done at the innovative clinic LifeWellnd.com. They specialize in health, wellness, and longevity.

SPEAKER_01:

They understand that true recovery means you have to dig deeper than the surface symptoms.

SPEAKER_00:

Okay, so let's start digging, let's unpack the core mechanism here. Because on the surface, it feels well, it feels counterintuitive.

SPEAKER_01:

It does.

SPEAKER_00:

How does a virus that we all think of as a lung and airway problem end up affecting a man's most intimate functions, you know, months down the line?

SPEAKER_01:

It all comes down to a question of cellular real estate. Think of the virus like a master burglar. It has a very specific set of tools to break into your cells. Okay. It needs two things: the angiotensin converting enzyme to receptor, we'll call it ACE2, and another enzyme called TMPRSS2.

SPEAKER_00:

That's its way in, the lock and the key.

SPEAKER_01:

Precisely. And here is where the whole problem starts. Those entry points, ACE2 and TMPRSS2, they aren't just in the lungs. That's the key.

SPEAKER_00:

So they're elsewhere in the body.

SPEAKER_01:

They are highly expressed elsewhere. We're talking about high concentrations in the testis, the prostate, and crucially in the endothelial cells.

SPEAKER_00:

And endothelial cells are What exactly? The delicate single cell lining of every single blood vessel in your body. From the major arteries in your heart all the way down to the tiniest capillaries.

SPEAKER_01:

Wow. So the virus essentially has a built-in superhighway, not just to the lungs, but at the same time to the entire reproductive system and the vascular system.

SPEAKER_00:

It's using the same cellular door to get into all of these critical areas, and the problem gets worse the second it gets in. How so? The moment the virus binds to that ACE2 receptor, it causes what's called downregulation. It essentially shuts it down. And that throws a vital regulatory system into complete chaos.

SPEAKER_01:

Which system is that?

SPEAKER_00:

The Renin angiotensin system or RAS.

SPEAKER_01:

RAS, I've heard of that. That's the body's main system for managing blood pressure, right? Vascular tone.

SPEAKER_00:

It is, but it's a delicate balancing act. Normally, ACE2 does something really beneficial. It takes a chemical called angiotensin the second, which is a powerful vasoconstrictor, meaning it tightens blood vessels.

SPEAKER_01:

Right. It squeezes them. ACE2 converts it into something that's a vasodilator, which relaxes them. It keeps everything in balance.

SPEAKER_00:

So it's like the body's pressure relief valve.

SPEAKER_01:

Exactly. But when the virus hijacks ACE2 and shuts it down, that pressure relief valve gets jammed shut. And what you get is a massive prolonged buildup of that vessel tightening chemical, angiotensin the second.

SPEAKER_00:

It's like the body's throttle pedal is just stuck to the floor.

SPEAKER_01:

That's a perfect analogy.

SPEAKER_00:

When if that throttle is stuck on, I mean, that's going to cause widespread long-term damage, especially to the most delicate blood vessels, the ones you need for healthy blood flow.

SPEAKER_01:

And that's the result. Widespread endothelial dysfunction, damage to the blood vessel linings, persistent inflammation that's fueled by these pro-inflammatory cytokines, just overall systemic instability.

SPEAKER_00:

This sets the stage for all sorts of long-term problems.

SPEAKER_01:

It does. Cardiometabolic issues, neurological complications, and of course, when you disrupt blood flow and damage the vascular lining in the penis, you get the vascular side of erectile dysfunction. This is cellular damage that sticks around long after the fever is gone.

SPEAKER_00:

Aaron Powell Okay. So the pipes, the vascular system, are clearly damaged because of this RAS dysregulation. That makes perfect sense structurally. But the sources we analyzed also point to a problem at the source. Yeah. The factory itself. So let's shift to the hormonal fallout.

SPEAKER_01:

Yes.

SPEAKER_00:

What did the researchers actually find when they looked at long COVID patients with ED and compared them to a healthy control group?

SPEAKER_01:

This was a really critical case-controlled study. They focused on a group that's often overlooked. 39 men, pretty young, aged 31 to 47.

SPEAKER_00:

So not the typical demographic for this issue.

SPEAKER_01:

Not at all. And they had only had mild to moderate COVID, but three months later, they were all dealing with new persistent ED, and they were compared against 20 healthy guys.

SPEAKER_00:

So what did the blood work show? Were the hormonal differences just slight, or was it something you could really see?

SPEAKER_01:

Oh, it was striking. The differences were statistically significant. The long COVID patients with ED had much, much lower serum levels of total testosterone compared to the healthy controls.

SPEAKER_00:

Aaron Powell How much lower are we talking?

SPEAKER_01:

It wasn't a small drop. The controls were averaging around 22.95 nanomoles per liter. The long COVID patients were down at 18.52.

SPEAKER_00:

Wow. That's a big enough drop to really impact function and you know quality of life.

SPEAKER_01:

Absolutely. It's clinically relevant. And they saw a similar significant drop in free testosterone and the free androgenic index as well.

SPEAKER_00:

So it confirms what some of the earlier research was hinting at.

SPEAKER_01:

Exactly. That the SARS-CoV-2 infection is linked not just with lower testosterone system-wide, but often with impaired sperm production. It suggests a direct hit on the reproductive factory itself, the testes.

SPEAKER_00:

Aaron Powell Okay. So if testosterone is low, the body's command center, the pituitary gland, the hypothalamus should notice that, right? It should be sending out signals to ramp up production.

SPEAKER_01:

It should, yes.

SPEAKER_00:

So what did those pituitary hormones show? What was going on with the hypothalamic pituitary genetal axis, the HPG axis?

SPEAKER_01:

Aaron Powell And this is where the story gets really interesting. This is how we can start to see the nature of the damage. In these long COVID patients, they found that the levels of luteinizing hormone or LH were actually elevated.

SPEAKER_00:

Aaron Powell And LH is the signal. That's the message from the pituitary gland to the testes saying, hey, make more testosterone.

SPEAKER_01:

It's essentially screaming, boost production, we have a shortfall.

SPEAKER_00:

So the signal from the command center is loud and clear, the pituitary shouting, but the final product, the testosterone, is still low. That sounds less like a communication problem and more like a failure at the factory.

SPEAKER_01:

You've nailed it. When you see high LH combined with low total testosterone, it points directly toward dysfunction deep inside that HPG axis.

SPEAKER_00:

And specifically injury to the testes.

SPEAKER_01:

The suspicion is testicular injury. It seems the virus is damaging the LATION cells, the actual workers on the factory floor that make testosterone, or the cells that regulate sperm.

SPEAKER_00:

So the body is trying desperately to compensate. It's sending the maximum signal possible, but the factory is just too damaged to respond. And that leads to what doctors call central hypogonadism.

SPEAKER_01:

Precisely. And this biochemical reality, it translated directly into clinical symptoms. They measured the men's function using what's called the shim score, the sexual health inventory for men. It's the standard tool.

SPEAKER_00:

And what was the actual quantifiable difference in their function?

SPEAKER_01:

The healthy controls had an almost perfect average score, about 23.98. The long COVID patients, though, had a significantly lower average score of 18.56.

SPEAKER_00:

And that drop is big enough to be considered clinical ED.

SPEAKER_01:

It places them squarely in that category. And crucially, the study found a direct statistical link. The lower shim scores correlated directly with the low total and free testosterone levels. The low T wasn't just some random finding, it was directly associated with the functional problem.

SPEAKER_00:

So if we just step back for a second, the picture we've built is pretty clear. We have damaged plumbing from the endothelial dysfunction and a damaged factory, the testicular failure, which leads to low T, even with a high LH signal. It's obvious that ED in these long COVID patients is not just a simple low T problem you might see in an older man.

SPEAKER_01:

It is so much more complicated. It's a cascading systemic failure. And the source discussion really highlighted the other interwoven factors that keep this dysfunction going.

SPEAKER_00:

What else is at play?

SPEAKER_01:

Well, you have the persistent endothelial dysfunction from that lingering RAS disruption that keeps the whole vascular system impaired. Then you have a constant elevated hyperinflammatory status.

SPEAKER_00:

The aftermath of that cytokine storm.

SPEAKER_01:

Yes, that low-level fire that just keeps burning and impacts all tissues. And we know inflammation and vascular health are just, they're completely tied together. They are. And there was one more thing. The researchers noted that the long COVID patients had consistently higher blood pressure profiles than the healthy controls, even though they were young and healthy before they got sick.

SPEAKER_00:

What does that suggest?

SPEAKER_01:

It strongly suggests that the RAS dysregulation and the damage to the nerves that control blood vessels, what we call autonomic neuropathy, that this damage is long-term. And that neuropathy is absolutely critical for function. It's a whole body failure that starts with how the virus gets in.

SPEAKER_00:

This brings us to the most critical clinical question. If you have such clear evidence of low T, the conventional medical wisdom, especially for a men's health specialist, would be pretty simple.

SPEAKER_01:

Right. Prescribed testosterone.

SPEAKER_00:

Exactly. TRT. But what does the study say about jumping straight to treating this hypogenadism? Are we missing a huge risk here?

SPEAKER_01:

This is the critical caution. And it is, I think, the single most important reason why you need a specialized holistic diagnosis for these specific patients. The source explicitly warns against immediately jumping to testosterone therapy.

SPEAKER_00:

Why? What's the risk?

SPEAKER_01:

Aaron Powell Well, here's why. Existing research suggests that having high testosterone levels, what's called a hyperandrogenic status, may actually increase the expression of the very doors the virus uses to get in.

SPEAKER_00:

You mean ACE2 and TMPRSS2? The very same ones. Wait a minute. So by artificially raising testosterone, you might be unintentionally, what, putting out more welcome mats for any lingering virus or making the inflammatory environment worse?

SPEAKER_01:

That is the hypothesis that the sources present. It's possible that the body's reduction in testosterone was actually a protective move, a counterbalancing mechanism the body used to fight severe viral propagation during the acute infection.

SPEAKER_00:

Aaron Powell So the low T might have been a defense mechanism.

SPEAKER_01:

It's possible. Because a hyperandrogenic status has been linked to more severe COVID-19 outcomes, injecting high doses of testosterone might inadvertently make the systemic instability or the inflammation worse. You could even increase the risk of a subsequent vascular event.

SPEAKER_00:

That is a staggering finding. So the standard go-to fix for low T could actually create a much riskier biological situation if you haven't dealt with the underlying vascular and inflammatory damage first.

SPEAKER_01:

That's it exactly. The research is clear on this point. It warns that testosterone therapy for hypogonadism and ED in long COVID patients should be approached with extreme caution and maybe even avoided until that whole complex web of endothelial damage, inflammation, and HPG axis failure is fully understood and managed.

SPEAKER_00:

You need a specialized scheme to untangle that.

SPEAKER_01:

You absolutely do.

SPEAKER_00:

And that really is the core takeaway for you, our listener. Long COVID can cause persistent multisystem damage. It can lead to ED through this incredibly complex, interconnected pathway.

SPEAKER_01:

A damaged factory, the HPG axis dysfunction, systemic inflammation, and the damaged pipes, the lingering blood pressure and vascular problems.

SPEAKER_00:

And this can all happen even after a relatively mild initial illness that you might have barely even noticed at the time.

SPEAKER_01:

Aaron Powell And if we just connect this to the bigger picture for a moment, given how intricately long COVID hits the cardiovascular, endocrine, and neurological systems all at once, you just you need a comprehensive approach.

SPEAKER_00:

Standard treatments won't cut it.

SPEAKER_01:

Standard ED treatments, you know, like PD5 inhibitors, they might help with the symptom for a little while, but they do nothing to address the root cause, the endothelial damage, the testicular failure, or that chronic inflammatory state. To get lasting recovery, you have to treat the whole system.

SPEAKER_00:

So if you're out there and you are experiencing these difficult, often unrecognized post-COVID symptoms, please know that you are not alone. And you need attention from professionals who specialize in unraveling these specific viral mechanisms. You need a team that understands this complex viral pathway, the RES dysregulation, and especially the critical hormonal cautions that we just talked about.

SPEAKER_01:

Don't let these symptoms be dismissed by a general practitioner who might not recognize this unique specialized link between a viral injury and your intimate health. Specialized care is available right now.

SPEAKER_00:

If you are ready to start your wellness journey with experts who understand these postviral complexities, who can give you a truly tailored solution that looks beyond just standard symptom relief, we encourage you to contact LifeWellmd.com.

SPEAKER_01:

It's about finding the root cause.

SPEAKER_00:

It is. Call 561 210 9999 today to start your deep dive into lasting recovery. Thanks for diving deep with us.