The state of reproductive and sexual function in men after COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) has demonstrated high variability and severity of clinical course, as well as the development of complications, both in the early period after recovery and in the long term. Men have a significantly higher risk of severe disease and mortality compared to women, which is associated with a number of factors, including the prevalence of comorbidities. A common cause of complications of COVID-19 is endothelial dysfunction, caused by both direct damage to the vascular endothelium by the virus and the consequences of a «cytokine storm». Therefore, among the complications of coronavirus infection in men, the development of erectile dysfunction, pathospermia and testicular hypofunction in the form of decreased testosterone secretion and the development of pathospermia are distinguished. The aim of the study was to assess changes in the hormonal profile, sperm parameters and erectile function in men after COVID-19. Material and methods. A total of 153 men with confirmed COVID-19 were exam-ined in the acute phase (n=28), 6 months (n=23), 2 years (n=49) and 3 years (n=53) after recovery, as well as 25 control individuals. The
levels of testosterone, luteinizing hormone, follicle-stimulating hormone, interleukin-6 and interleukin-10 were determined by ELISA method. The spermogram was performed according to WHO 2021 standards. Erectile function was assessed by the International Index of Erectile Function-15 scale and Doppler ultrasound. Results. In the acute phase, there was a decrease in testosterone concentration (10.9±0.2 vs. 19.6±2.8 nmol/L; p<0.05), an increase in luteinizing hormone, and follicle-stimulating hormone (p<0.01), and an increase in IL-10 levels (p<0.05). After 6 months, the blood testosterone level remained low, and the gonadotropin level was increased. Hormonal levels returned to normal within 2-3 years after recovery. Ejaculate analysis revealed a decrease in category «a» sperm motility (23.17±2.76% versus 32.80±2.60% in control; p<0.05) and a temporary increase in leukocytes, with subsequent recovery by year 3. Erectile disorders in men who recovered from COVID-19 showed worsening erectile function, decreased orgasmic sensations during sexual intercourse. The International Index of Erectile Function-15 scale remained reduced for up to 2 years with partial recovery after 3 years. Conclusions. In men, COVID-19 causes the development of hypogonadism (decreased testosterone levels against the background of increased luteinizing, and follicle-stimulating hormones), impaired spermatogenesis (asthenozoospermia, increased leukocyte content in the ejaculate), and erectile dysfunction in the acute phase of the disease and within 6 months after recovery. In most of the examined patients, these changes were transient with gradual recovery of these changes occurring over 2–3 years. The use of combination therapy with L-arginine and PDE5 inhibitors in the presence of erectile disorders is an effective method of therapy. Longterm monitoring of men who have had COVID-19 is recommended.