Letter to the Editor on COVID-19 Infection in Men on Testosterone Replacement Therapy

The letter to the editor challenges the conclusion of a study by Rambhatla et al. that testosterone replacement therapy (TRT) is not associated with worse COVID-19 outcomes. The authors of the letter argue that the data actually suggests TRT could be linked to more severe COVID-19 symptoms, citing a high hospitalization rate (62.5%) and fatality rate (9.4%) among the TRT cohort, which exceeds CDC-reported rates for similar age groups. They request further data analysis comparing men on TRT to the broader population and reference studies indicating benefits of antiandrogen therapy for COVID-19. They highlight the role of androgens in SARS-CoV-2 infection and present evidence from studies on 5-alpha-reductase inhibitors and anti-androgens, which suggest these treatments may reduce COVID-19 severity. The authors conclude that androgen therapy is likely associated with worse COVID-19 outcomes, opposing the original study's findings.