COVID-19, an illness caused by a virus called SARS-CoV-2, has been a major health challenge worldwide. Despite efforts like vaccines, the virus continues to spread, and experts believe it will move from an epidemic to an endemic phase (meaning a long-lasting, regularly occurring disease in society).

With this in mind, medical professionals are motivated to learn about the potential long-term effects of COVID-19, including its impact on male reproductive health. Research on this topic is limited due to the recent nature of the disease. Nevertheless, some studies suggest that the virus may affect the cells in the testicles and the production of hormones like testosterone, which could impact fertility and health.

Recently, researchers performed a comprehensive literature review to gather information on the potential effects of COVID-19 on men’s reproductive health. All studies on the topic in the English language published between November 2019 and September 2022 were included in this review.

The findings could be summarized and grouped into one of the following categories: COVID-19 in tissue specimens, COVID-19 impact on androgens, testosterone replacement and androgen deprivation in COVID-19, COVID-19 impact on semen parameters, and COVID-19 vaccination.

With regard to tissue specimens, researchers found the virus in the testicles of men who died from COVID-19. The testicular tissue showed signs of damage and reduced sperm production. However, these studies only looked at severe cases, so it is unclear how COVID-19 may affect the testicles in milder cases. More research with living patients is needed to understand this better.

Research on COVID-19’s impact on androgens and other hormones has shown mixed results. During the illness, some studies found lower testosterone levels but increased luteinizing hormone (LH), suggesting the body may try to compensate. After recovery, hormone levels often return to normal, but some men still have low testosterone. This may affect men’s sexual health, so doctors should consider patients’ COVID-19 history when treating them for hormone-related issues.

Studies have shown that testosterone replacement therapy (TRT) and androgen deprivation therapy (ADT) do not significantly impact COVID-19 outcomes. TRT does not appear to protect nor harm COVID-19 patients, and ADT does not significantly change COVID-19 risk or severity.

COVID-19 can affect sperm quality and semen parameters. Studies have shown that infected men may have lower sperm concentration, less motility, and less normal sperm shape. Inflammation markers can also increase in semen. These effects are strongest during the acute infection but may improve over a few months.

Lastly, COVID-19 vaccines do not significantly affect sperm quality or fertility in men. Some studies initially suggested a temporary decrease in sperm parameters after vaccination, but this was not consistent across all research. Overall, getting vaccinated is crucial because COVID-19 itself can harm fertility.

References:

• Pellegrino, C. J., Ye, N. Y., Chen, I. K., & Abdelsayed, G. A. (2023). Early and late implications of COVID-19 on male reproductive health: 3 years of data. Sexual Medicine Reviews, 11(3), 224-230. https://doi.org/10.1093/sxmrev/qead017