Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study

  1. Ling Ma
  2. Wen Xie
  3. Danyang Li
  4. Lei Shi
  5. Yanhong Mao
  6. Yao Xiong
  7. Yuanzhen Zhang
  8. Ming Zhang

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Abstract

Since SARS-CoV-2 infection was first identified in December 2019, it spread rapidly and a global pandemic of COVID-19 has occurred. ACE2, the receptor for entry into the target cells by SARS-CoV-2, was found to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. However, there is no clinical evidence about whether SARS-CoV-2 infection can affect male gonadal function so far. In this study, we compared the sex-related hormones between 81 reproductive-aged men with SARS-CoV-2 infection and 100 age-matched healthy men, and found that serum luteinizing hormone (LH) was significantly increased, but the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19. Besides, multivariable regression analysis indicated that c-reactive protein (CRP) level was significantly associated with serum T:LH ratio in COVID-19 patients. This study provides the first direct evidence about the influence of medical condition of COVID-19 on male sex hormones, alerting more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.

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    SciScore for 10.1101/2020.03.21.20037267: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was reviewed and approved by the Medical Ethical Committee of Zhongnan Hospital of Wuhan University (approval number 2020033).
    Consent: Therefore, written informed consent was waived.
    Randomization100 age-matched healthy men were randomly selected and the data of their sex-related hormones were collected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableStudy design and patients: We performed a retrospective study involving 81 male patients with COVID-19 as the study group, who were hospitalized in Wuhan Leishenshan Hospital from Mar 5 to Mar 18, 2020.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: All statistical analysis was performed using Graphpad Prism 6.04 (San Diego, USA) and SPSS 16.0 (Chicago, IL, USA).
    Graphpad
    suggested: (GraphPad, RRID:SCR_000306)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are also some limitations in this study. First, neither semen parameters nor existence of SARS-CoV-2 in semen was detected, which are more straightforward evidence for testes injury caused by SARS-CoV-2. Second, due to the small size of samples, only 2 mild cases, 7 severe cases and 2 very severe cased are included in, which may affect the power of statistical analysis, such as the association between severity and T:LH ratio. Third, in the condition of COVID-19, some other factors such as stress and corticosteroid therapy may also influence hypothalamic-pituitary-gonadal axis. However, it should be mentioned that corticosteroids are usually believed to impair LH release instead of promoting it as seen in this study [21,22]. In the end, repeated detection with appropriate time interval (such as 3 months or 6 months later) is necessary.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.03.21.20037267v2 on medRxiv
  3. Version published to 10.1101/2020.03.21.20037267v1 on medRxiv