Tassco (EUA)

SARS-CoV-2 affects the testicles, reducing hormones and sperm quality, studies show

Publicado em 03 setembro 2021

By Elton Alisson | Agência FAPESP–While following up on male patients as they recovered from COVID-19 since the start of last year, andrologistJorge Hallak, a professor at the University of São Paulo’s Medical School (FM-USP) in Brazil, noticed that their fertility and hormone tests continued to display alterations for many months after they recovered from the disease.

Several patients’ semen analysis results, for example, showed that sperm motility fell to 8%-12% (compared with more than 50% for healthy men) and remained at this level for almost a year after they were infected by SARS-CoV-2. Hormone tests showed testosterone levels also sharply down after the disease in many patients. Normal testosterone levels are 300-500 nanograms per deciliter of blood (ng/dL). In these patients, they were below 200 ng/dL, and in some cases as low as 70-80 ng/dL.

“We’re increasingly seeing long-lasting alterations in semen and hormone quality in COVID-19 patients, even when they had mild or no symptoms of the disease,” Hallak toldAgência FAPESP.

Studies conducted in recent months by Hallak, in collaboration with colleagues in FM-USP’s Department of Pathology, have helped elucidate these observations made in clinical practice.

The researchers found that SARS-CoV-2 infects the testicles, impairing their production of sperm and testosterone. “It’s a cause of concern that the virus affects the testicles even in asymptomatic patients or patients with mild symptoms of the disease. Of all the agents that harm the testicles I’ve studied to date, SARS-CoV-2 appears to be the most active,” Hallak said. “Every pathology has peculiarities that experience and practice reveal to us. SARS-CoV-2 affects spermatogenesis [sperm production] in ways we’re discovering now, such as persistently low progressive motility without significant alterations to sperm concentration.”

Good sperm motility is critical to fertilization because it assures passage through the female reproductive tract and into the egg. Abnormally motile sperm cannot fertilize.

Ultrasound scans of 26 COVID-19 patients showed half to have severe inflammation of the epididymis, a long, coiled tube that transports sperm from each testicle. Sperm acquires its fertilizing ability and forward motility properties during epididymal transit.

The patients, whose age averaged 33, were admitted to Hospital das Clínicas, a hospital complex run by FM-USP, and tested by Instituto Androscience. The study wassupported by FAPESP. An article reporting the results ispublishedin the journalAndrology.

“In contrast with classic bacterial infections or other viral infections such as mumps, which causes testicular swelling and pain in a third of those infected, the epididymitis caused by SARS-CoV-2 is painless and can’t be diagnosed by visual inspection or palpation,” Hallak said, adding that testicular self-examination should be recommended as a public health policy in response to the pandemic.

“Ideally, adolescents, young adults and men at a reproductive age or who want to have children should consult a urologist or andrologist after being infected by SARS-CoV-2 to have all the relevant tests – measurement of testicular volume, testosterone and other hormones, semen analysis, and a sperm function test – followed by a color Doppler ultrasound scan to see if they have any kind of testicular abnormality that could affect fertility and hormone production,” Hallak said. “They should be followed up for at least one or two years after infection by the virus. We don’t yet know enough about these complications of the disease.”

Invasion of testicular cells

Another studyrecently published by the same group of researchers and alsosupported by FAPESPshowed that SARS-CoV-2 invades all types of testicular cell, causing lesions that can impair hormone function and fertility.

Under the auspices of a project led by Paulo Saldiva and Marisa Dolhnikoff, both also professors at FM-USP, the researchers used a minimally invasive autopsy technique to extract testicular tissue samples from 11 men aged 32-88 who died at Hospital das Clínicas as a result of severe COVID-19. Analysis of the samples showed a number of testicular lesions possibly due to inflammatory alterations that reduce spermatogenesis and hormone production.

“What immediately drew our attention in these patients who died from COVID-19 was the drastic reduction in spermatogenesis. Even the younger ones at a reproductive age had practically no sperm,” saidAmaro Nunes Duarte Neto, principal investigator for the study. Duarte Neto is an infectious disease specialist and pathologist at FM-USP and Adolfo Lutz Institute.

According to Duarte Neto, the probable causes of reduced spermatogenesis in these patients include lesions caused by the virus in the vessels of the testicular parenchyma, with the presence of blood clots leading to hypoxia (low oxygen in the tissue), and fibrosis obstructing the seminiferous tubules, the part of the testicle in which sperm is produced.

A probable reason for reduced hormone production is loss of Leydig cells, interstitial cells that are located next to the seminiferous tubules and produce testosterone.

“The functions performed by the testicles, producing sperm and the main male sex hormone, are independent but connected because fertility declines if hormone production by Leydig cells is impaired,” Duarte Neto said.

Some symptoms of testosterone deficiency (hypogonadism), including loss of muscle mass, fatigue, irritability, memory loss and weight gain, can be confused with the long-term effects of COVID-19.

“An important part of this clinical condition is undoubtedly due to low testicular function, but the connection had never been made before because these patients don’t complain of pain and it isn’t routine practice to measure hormone production or analyze sperm after recovery from COVID-19,” Hallak said.

The researchers plan to conduct a follow-up study of male patients who have had the disease in order to find out if testicular lesions can heal naturally or be cured with medication. “We don’t know whether the lesions can be reversed or how long it would take,” he said.

His main concerns relate to men of reproductive age, adolescents and prepubertal children, given the lack of data on the testicular lesions caused by COVID-19. Nothing is known about the effects of the disease on puberty in terms of fertile capacity, whether hormone production is affected temporarily, for a long time or definitively, and the degree of irreversible residual damage.

Because there is no data on the condition of these male COVID-19 patients before they were infected, prospective studies should include a control group for comparison, Hallak suggested. “These subjects may have infertility problems and hormone alterations in future, and be unaware that this was caused by COVID-19 because they had mild symptoms or none at all,” he said.

Increase in male infertility

Hallak believes COVID-19 can cause an increase in male infertility. Between 15% and 18% of couples have difficulty conceiving, caused by male problems in 52% of cases. This trend may lead to an increase in demand for assisted reproduction, which in his view is sometimes rushed in Brazil, and provided without a properly standardized initial assessment to diagnose the cause. There has to be enough time to work out and propose the approach with the best cost-benefit ratio, including specific treatment to address the cause or restore natural fertile capacity.

“We’ll need to take great care with assisted reproduction in the wake of the pandemic. We don’t know much about the consequences of COVID-19 in the months following infection,” Hallak said.

Because SARS-CoV-2 has been detected in all types of testicular cells, which participate in all stages of spermatogenesis, scientists do not know whether the virus is also present in the sperm of COVID-19 patients months after they recover from the disease. Their sperm may have been affected by the virus, and in Hallak’s view medical teams should wait around 90 days, the time taken by a spermatogenesis cycle, to perform a fresh andrological examination.

“We’ve seen DNA lesions caused by the virus at very high levels of around 80%, whereas up to 25% is considered normal and up to 30% acceptable,” he said.

Another concern is unnecessary testosterone replacement. “If a patient has had COVID-19 and a decline in hormone production is detected, testosterone replacement will further inhibit testicular function,” Hallak stressed. “The testicles have repair mechanisms that restore hormone production, and there are medications that increase natural production of steroid hormones, gradually reestablishing intrinsic testicular function, although we don’t yet know to what extent will it depend on whether Leydig cells have been damaged and how badly.”

“At FMUSP, we are bringing together specialists from various medical specialties to study a group of 749 male patients who had COVID-19 who will undergo a first evaluation over the next four years to obtain more knowledge about the post-COVID-19 syndrome,” says Hallak.

The article “Radiological patterns of incidental epididymitis in mild-to-moderate COVID-19 patients revealed by color Doppler ultrasound” (doi: 10.1111/and.13973) by Felipe Carneiro, Thiago A. Teixeira, Felipe S. Bernardes, Marcelo S. Pereira, Giovanna Milani, Amaro N. Duarte-Neto, Esper G. Kallas, Paulo H. N. Saldiva, Maria C. Chammas and Jorge Hallak is

The article “Testicular pathology in fatal COVID-19: a descriptive autopsy study” (doi: 10.1111/andr.13073) by Amaro N. Duarte-Neto, Thiago A. Teixeira, Elia G. Caldini, Cristina T. Kanamura, Michele S. Gomes-Gouvêa, Angela B. G. dos Santos, Renata A. A. Monteiro, João R. R. Pinho, Thais Mauad, Luiz F. F. da Silva, Paulo H. N. Saldiva, Marisa Dolhnikoff, Katia R. M. Leite and Jorge Hallak is

The article “SARS-CoV-2 and its relationship with the genitourinary tract: Implications for male reproductive health in the context of the COVID-19 pandemic” (doi: 10.1111/andr.12896) by Jorge Hallak, Thiago A. Teixeira, Felipe S. Bernardes, Felipe Carneiro, Sergio A. S. Duarte, Juliana R. Pariz, Sandro C. Esteves, Esper Kallas and Paulo H. N. Saldiva is

The article “Viral infections and implications for male reproductive health” (doi: 10.4103/aja.aja_82_20) by Thiago A. Teixeira, Yasmin C. Oliveira, Felipe S. Bernardes, Esper G. Kallas, Amaro N. Duarte-Neto, Sandro C. Esteves, Joël R. Drevet and Jorge Hallak is

Essa notícia também repercutiu nos veículos:
Yahoo! SBT CNN (Brasil) Portal R7 Folha de Pernambuco online Portal Exame Diário do Poder O Povo Jovem Pan SBT Interior UOL Veja online Estadã O Estado de S. Paulo Folha de S. Paulo Folha de Itapetininga Folha de Itapetininga Folha de Itapetininga Radio Sudamericana 100.5 (Argentina) Sudoeste Bahia Cidade Morena Notícias La Brújula 24 FM 93.1 (Argentina) The World News (Paraguai) Remo News (Índia) Play Crazy Game Tech 4 Health Ecuador Chequea (Equador) Jornal Cidade (Barreiras, BA) online Urgence TV MSN (Brasil) Plantão Caicó RemoNews (Brasil) Portal Mariliense 24 Ecuador (Equador) El Telégrafo (Equador) online Garanhuns Notícias Pauta Brasil CV Agora N5 Notícias TV Caparaó Jornal Tabloide online (Cotia, SP) ID Brasil Notícias Brasil BSB Digital DF Agora Blog da Luciana Pombo DMB Tecnologia Tech Break Blog do Montoril Pfarma Notícias da Sua Cidade WebMais TV Caruaru Portal Cidade Araraquara TV Jornal TV Jornal The World News (Ucrânia/Brasil) VNExplorer (Brasil) UTEC - Associação das empresas e profissionais autônomos do segmento de software e hardware de Uberaba SP Notícia Portal Tech4Health RemoNews (Brasil) Gazeta de Rio Preto online Rádio Cultura FM 93,7 (Pará) TV Minas Potiguara Online Ipiaú Urgente Blog Diário Tancredense Colider News Saúde Brasília News Founded (África do Sul) Guia Viver Bem Mídia Bahia Portal Abrantes Beto News Portal Gongogi Sudoeste Bahia Boa Saúde Andaiá FM En Agenda (Argentina) ArgenData Noticias (Argentina) Periodico Vespertino de Chiapas (México) Diario 26 (Argentina) Rede Ilha FM Noticiero Universal (Espanha) El Tribuno (Argentina) online Diario Salto Al Día (Uruguai) MinutoUno (Argentina) La Crítica (Argentina) San Juan 8 (Argentina) Informate Salta (Argentina) Chaco Hoy (Argentina) Centro de Informes (Argentina) Revolución Popular Revista Códigos (Argentina) online (Argentina) Radio Dos FM 99.3 (Argentina) Grupo La Provincia (Argentina) Diario de Cuyo (Argentina) El Litoral (Argentina) online Portal Ciudadano (Argentina) El Día (Argentina) online LT7 Noticias - Radio LT7 95.3 y AM900 (Argentina) Diario Con Vos (Argentina) El Cronista Comercial (Argentina) online Red 92 (Argentina) Ituzaingó HOY (Argentina) RPerezNetOnLine (Argentina) GENTE Online (Argentina) Noticias de (Argentina) Sextacontenidos Agencia El Vigía (Argentina) La Brújula San Juan (Argentina) Imagen Poblana (México) Diario UNO (Argentina) online Revista La Columna (Argentina) online Brasil Amazônia Agora El Universo (Equador) online Folha de Itapetininga O Vale Tony Show Cada Minuto Hora PR RP10 SCC 10 Oficial News O Mariliense Minuto Cidade Jornal Cidade COOPECIR-PB - Cooperativa dos Cirurgiões da Paraíba BataNews Portal Santa Teresinha Machadinho Online Fundação Astrojildo Pereira El Heraldo de México (México) online NewsBeezer (Brasil em inglês) Gazeta Brasil Baidú Brasil Bomba Bomba eplay Blog do Valente Blog do Mak Juárez Hoy (México) online Portal Jornal do Norte Albert Sabin News Easy Branches (Portugal) Palco Noticias (México) NoticiasPV – Noticias de Puerto Vallarta (México) El Diario Nuevo Día (Argentina) Accesscanal Marco Antonio na Notícia Planeta online MSN (Portugal) People's Daily (China) (China) Liga Democrática Saense Tabocas Notícias Rádio Jaraguar FM 94.5 Notícia da Bahia NORDESTeuSOU Panorama de Notícias Portal Paraíba Todo Dia NE10 Blog Waldiney Passos BonitoNet Porto Murtinho Notícias Rádio Caçula FM 96,9 Bahia Econômica Verdinho Notícias Jornal Ação Popular Brumado Urgente Rádio Costa Sul FM 99.3 Rádio Vale FM 102,3 (Bahia) TV Futuro Yahoo! Finanças Play Crazy Game MSN (Brasil) IEA - Instituto de Estudos Avançados da Universidade de São Paulo Expresso 222 Índices Bovespa Revista La Columna (Argentina) online MidiaMax Rádio Jornal Portal Terra Santa Notícias Cotia 24 horas Mundo e Negócios Folha da Minha Sampa Sistema Costa Norte de Comunicação Giro Goiás Guarulhos Online Jornal Democrata online Blog O Correspondente Notícias do Dia Na Hora Online Veja Saúde online Blog Edenevaldo Alves Giro Notícias Goiás Blog do Elias Hacker Jornal Primeira Página online Por Dentro de Tudo Diário da Saúde InfoHealth Altair Tavares Acontece Botucatu Guarulhos Hoje online Alagoas Agora online Agência de Notícias – Defesa Porto Alegre 24 Horas Portal do Curimataú Play Crazy Game Impacto Notícias Portal Grande Prudente Agora ES online Jornal da Orla online Diário em Foco Informativo Astral Portal Prudentino Conexão Na Cidade Grupo News Paraná CVN Notícias Campo Belo em Foco FEDAP - Fundação de Estudos para o Desenvolvimento da Administração Pública Notícia de Limeira Alvo Notícias GPS da Notícia Play Crazy Game Roraima na Rede Coluna Supinando Inova PB Imaculada Online Blog do João Moura Portal Varada Folha de Londrina online O Jiló Portal da Cidade (Registro, SP) Jornal de Itatiba online RC 8:32 Região Noroeste Orla Notícias Casa de Notícias De Fato Rondônia Blog Borg FM Ao Vivo Grande Ponto Novoeste A Cidade On (São Carlos, SP) Jornal de Piracicaba online Blog de Assis Veja São Paulo online Meio Norte online (Piauí) Agora RN online Play Crazy Game SBT News Gazeta do Povo online (PR) Portal Correio Free Game Guide Jornal da Franca Folhamax Blog Do Gesso Folha do Araçá A Crítica (AM) online Antenados Notícias Botucatu Jornal Estação online BSB Notícias Tribuna Paulista Panorâmica News Penha News Portal do Governo do Estado de São Paulo Portal de Notícias Virou Manchete Mix Vale Mirante da Bocaina Novo Cantu Notícias Oeste Ao Vivo Relato News O Repórter Regional online Oeste 360 Jornal A Voz do Povo online (Uberlândia, MG) Mustach TV Interbam Portal RBN Ata News Zatum Rádio ABC AM 1570 Saber Atualizado GMundo News Piauí Hoje RIC Mais Galileu online Portal Tarauacá Blog Tarauacá Agora Poder360 Poliarquia Press From Brasil (EUA) Aracaju Agora Notícias Luciano Vale São Miguel para Todos Blog do BG Jornal da Ciência online Santa Portal Diario de Yucatán (México) online Coluna Italo Cofemac Revista Cariri Saiba de Tudo Beto Ribeiro Repórter Diário da Amazônia online Blog Jornal da Mulher Revista Pará+ online Noticias de Contagem online El Patagónico (Argentina) Xinhua Español (China) Crescer online Terra O Antagonista Play Crazy Game Política Livre MSN (Brasil) Polêmica Paraíba ClickPB Portal 1001 Notícias Sem Censura PB Tony Show Play Crazy Game Play Crazy Game Olhar Digital Jornal A Semana Gazeta Brasil MSN (Portugal) Diário de Votuporanga online Blog A vida da criança Porto Alegre 24 Horas GP1 MSN (Brasil) Head Topics (Brasil) Tribuna da Bahia online Cabresto Paraíba Master Pleno.News El Territorio (Argentina) online Estúdio Livre News Tudo é Espanto Head Topics (Brasil) Folha de Alagoas online Plantão News (MT) Play Crazy Game Tribuna do Paraná online Pensar Piauí Blog do Banana O Observador online Brasil 247 Play Crazy Game Folha de Itapetininga TV & VC? TV & VC? Neo Net Music (Argentina) Télam - Agencia Nacional de Noticias (Argentina) (Argentina) Diario Jornada Online Mendoza (Argentina) Folha de Itapetininga Polo Sur TDF (Argentina) Radio Activa (Argentina) La Voz del Neuquén (Argentina) Folha de Itapetininga Folha de Itapetininga 1822 Jornal Blog do Márcio Rangel Dom Total GK Notícias Folha de Itapetininga Folha de Itapetininga Cronica del Noa (Argentina) Canaltech Agora TS São Miguel Agora O Melhor da Cidade Olhar Digital Blog do Elias Hacker Encart Notícias CNRN YouYes ABJ Notícias