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The Adverse Impact of COVID-19 on Men's Health
Joshua Halpern MD, MS will be discussing his recent paper on the adverse impact of COVID-19 on men's health. He shares his study examining the negative impact COVID-19 has on the male genitourinary system, what inspired this research and the relationship between COVID-19 and testicular function.
Featured Speaker:
Learn more about Joshua Halpern, MD, MS
Joshua Halpern, MD, MS
Dr. Halpern is an Assistant Professor of Urology at Northwestern University Feinberg School of Medicine. After graduating summa cum laude from the University of Pennsylvania with a degree in History, he completed medical school at Weill Cornell Medical College, where he was also elected into the Alpha Omega Alpha Medical Honors Society. He remained at Weill Cornell Medical College and New York Presbyterian Hospital for residency training in Urology.Learn more about Joshua Halpern, MD, MS
Transcription:
The Adverse Impact of COVID-19 on Men's Health
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and today we're exploring the adverse impact of COVID-19 on men's health. Joining me is Dr. Joshua Halpern. He's an Assistant Professor of Urology at Northwestern Medicine. Dr. Halpern, it's a pleasure to have you join us again today. It's been a little while, but you and your colleagues at Northwestern Medicine have recently published a study that examined the negative impact COVID has had on the male genitourinary system. Can you tell us a little bit about what inspired this research?
Joshua Halpern, MD, MS (Guest): Of course. Well, first, Melanie, thanks for having me back. It's a pleasure be here today. I think it's no secret that, in these last couple of years, as we're coming up on amazingly two years of this pandemic, that it has impacted all of our lives in so many different ways. And as physicians, I think we've seen a lot of patients who are struggling with various elements of COVID-19, but in our practice, which really focuses on men's health, we're seeing a lot of manifestations with respect to men's physical health and mental health. The other thing is that we're getting a lot of questions from guys, even guys who haven't had COVID about the potential effects of COVID on their men's health, some of the things we think about as far as sexual health and fertility, and so we really want to kind of synthesize all of the evidence and the data that's out there into one place that would really be comprehensive in thinking about how COVID interacts with kind of men's health, when we're thinking specifically about sexual health, mental health, and reproductive health.
Host: So then tell us about your findings. How does COVID affect men's health from a urology perspective?
Dr. Halpern: COVID can affect men's health in all sorts of different ways, but before we even get into how COVID effects these men's health issues, I think we need to talk about how COVID manifests differently in women and in men. You know, there's some good evidence that men tend to do worse with COVID, generally speaking. So men are more likely to be admitted to an ICU when they have COVID. Unfortunately, they're more likely to die when they experience COVID and a lot of that is still being unpacked. But I think that probably has to do with a bunch of different mechanisms. Things like differences in the immune response, higher prevalence of underlying cardiovascular disease in men compared to women and some differences in these ACE2 and TMPRSS2 receptors, which I think we'll talk a little bit more about as it relates to men's health, but the point is that men just are different when it comes to COVID compared to women. Another big part of that is probably testosterone, which we'll get into in a little bit, but men just have a COVID experience compared to women. And that really, I think is part of the next question, which is how does COVID manifest when it comes to men's health generally speaking.
And I think it really can show up in a number of ways that we'll talk about in somewhat greater depth. We know it can affect testosterone levels, which I hope we'll talk about later. We know that COVID can affect fertility and we know that COVID can affect sexual dysfunction as well, different mechanisms for all these things, but really does hit the trifecta of what we consider to be men's health, in our practice. And it's something that we're still understanding more and more about as this pandemic progresses.
Host: Well, then let's talk about that relationship between COVID and testicular function, as you mentioned, testosterone and semen parameters. How can this contribute to erectile dysfunction? Tell us about this causal relation here?
Dr. Halpern: So, we know that COVID can impact the testicle directly. There are probably a number of ways that this can happen. These ACE2 receptors that are so important for COVID infection and for it to cause the various manifestations of that infection are present in the testicle. And so we know that the testicle is susceptible to COVID. That can manifest in a number of ways, but certainly can cause inflammation. We know that men with COVID are more likely to have orchitis or inflammation of the testicle, which can cause issues with both testosterone production and fertility. And in fact, there've been a number of studies at this point that have looked at testosterone levels and fertility in men with COVID. So, when it comes to testosterone levels, a lot of studies showing that men with COVID-19 infection have lower testosterone than healthy controls when you consider kind of age matching and other important considerations.
We know that for a time after COVID, men will continue to have low testosterone levels. And while a lot of these men will recover up to their baseline testosterone level, some of them won't. And so that's really important to keep in mind. From a fertility perspective, we know that COVID can present itself and manifest within the testicle. There has been an autopsy study showing that, men who succumb to COVID-19 actually were found to have viral particles within the testicular tissue. And so that kind of adjacent inflammation due to COVID-19, certainly fevers due to COVID-19 can cause issues with fertility.
We know just having a high fever in and of itself is a risk factor for fertility. So, there are a number of different mechanisms that may be responsible for how COVID can affect the testicle both by way of testosterone and when it comes to male infertility and there have been studies to really demonstrate the latter as well. We see that semen parameters have gone down in men who have COVID-19. And so this is an area where we're still trying to understand the data. We need longer-term data to kind of see how these guys will do over the period of months and years after COVID infection. But there are potentially at least short-term and potentially longterm effects of COVID-19 on the testicle.
Host: Wow. That's really a fascinating study Dr. Halpern. Now we've been talking about COVID-19, what about the vaccine? Is this proven effective in preventing these sequelae from COVID-19? Tell us what we know as of now.
Dr. Halpern: We know that getting COVID-19 is bad. For a lot of the reasons we talked about and many others, of course, but when it comes to men's health, we know that COVID-19 can expose you to low testosterone, to male infertility. We didn't talk too much about erectile dysfunction, but there's some good evidence that COVID-19 can cause erectile dysfunction through a number of mechanisms as well.
And so it stands to reason that any vaccine that can protect against COVID-19. We know that the current vaccines have been shown to be quite effective, that that's going to protect you against these potential negative consequences. So, we've seen that COVID-19 vaccines are effective and, there are some limited studies, we're still try to study this in greater depth, looking at the specific men's health consequences of COVID vaccination.
We have seen, for example, in one large study, that there's a lower risk of orchitis or inflammation of the testicle and epididymitis in men who were vaccinated compared to those who weren't. So, that certainly is some good evidence in favor of vaccines, but we do need some longer evidence to show that it's making a huge difference.
But I do think it's important to remember that COVID-19 vaccination overall has been shown to be very effective and men really should be talking to their doctors about vaccination if it's not something that they've done already. The other question that comes up quite a bit that men have for us specifically is regards to the vaccine and fertility.
This was a question early on when the vaccines came out and fortunately this is a question that has been somewhat put to rest. So, some of our colleagues, down at the University of Miami conducted a study where they looked at 45 men who had semen testing before and after vaccination. And they found that overall there was no decline in semen parameters among these men. And importantly, no men went from having sperm in their ejaculate to not having sperm in their ejaculate. So, certainly not a long-term study, but a very, very reassuring, short term study showing that COVID-19 vaccine is not harmful when it comes to thinking about fertility. And so it's something that we get asked about quite a bit. And I feel very comfortable reassuring our patients, especially our male fertility patients that the COVID-19 vaccine is safe in that regard.
Host: So what do you recommend for other providers as they're counseling their patients, that are dealing with these issues following COVID-19 and as we wrap up, anything else you'd like urologists to know about caring for patients in this COVID time and the adverse impact of COVID-19 on men's health.
Dr. Halpern: Yeah, I think we just really need to be mindful of the fact that COVID-19 has so many different manifestations, both within men's health and beyond. And we really, as providers need to be asking our patients specifically about some of these sequella. We need to ask them about symptoms of low T. Things like low energy, low sex drive, we need to be asking them about sexual dysfunction and we should be asking them about their family planning goals, because all of these things are really important when it comes to COVID-19 and the potential harmful impacts of that virus.
And then by extension, we really should be asking all of our patients about vaccination status at some point during our visits with them. Ask them about whether they've been vaccinated and if they haven't, ask them about their concerns and provide them with some of the data that I've mentioned here today, allaying those concerns to try to encourage men to get vaccinated, because that probably is the best thing they can do for their overall health when it comes to COVID-19.
Host: Very, very interesting, Dr. Halpern. Thank you so much for joining us today and telling us about this important study in these COVID times and the impact of COVID on men's health. So, thank you so much again. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. For updates on the latest medical advancements and breakthroughs and research, please follow us on your social channels. I'm Melanie Cole.
The Adverse Impact of COVID-19 on Men's Health
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and today we're exploring the adverse impact of COVID-19 on men's health. Joining me is Dr. Joshua Halpern. He's an Assistant Professor of Urology at Northwestern Medicine. Dr. Halpern, it's a pleasure to have you join us again today. It's been a little while, but you and your colleagues at Northwestern Medicine have recently published a study that examined the negative impact COVID has had on the male genitourinary system. Can you tell us a little bit about what inspired this research?
Joshua Halpern, MD, MS (Guest): Of course. Well, first, Melanie, thanks for having me back. It's a pleasure be here today. I think it's no secret that, in these last couple of years, as we're coming up on amazingly two years of this pandemic, that it has impacted all of our lives in so many different ways. And as physicians, I think we've seen a lot of patients who are struggling with various elements of COVID-19, but in our practice, which really focuses on men's health, we're seeing a lot of manifestations with respect to men's physical health and mental health. The other thing is that we're getting a lot of questions from guys, even guys who haven't had COVID about the potential effects of COVID on their men's health, some of the things we think about as far as sexual health and fertility, and so we really want to kind of synthesize all of the evidence and the data that's out there into one place that would really be comprehensive in thinking about how COVID interacts with kind of men's health, when we're thinking specifically about sexual health, mental health, and reproductive health.
Host: So then tell us about your findings. How does COVID affect men's health from a urology perspective?
Dr. Halpern: COVID can affect men's health in all sorts of different ways, but before we even get into how COVID effects these men's health issues, I think we need to talk about how COVID manifests differently in women and in men. You know, there's some good evidence that men tend to do worse with COVID, generally speaking. So men are more likely to be admitted to an ICU when they have COVID. Unfortunately, they're more likely to die when they experience COVID and a lot of that is still being unpacked. But I think that probably has to do with a bunch of different mechanisms. Things like differences in the immune response, higher prevalence of underlying cardiovascular disease in men compared to women and some differences in these ACE2 and TMPRSS2 receptors, which I think we'll talk a little bit more about as it relates to men's health, but the point is that men just are different when it comes to COVID compared to women. Another big part of that is probably testosterone, which we'll get into in a little bit, but men just have a COVID experience compared to women. And that really, I think is part of the next question, which is how does COVID manifest when it comes to men's health generally speaking.
And I think it really can show up in a number of ways that we'll talk about in somewhat greater depth. We know it can affect testosterone levels, which I hope we'll talk about later. We know that COVID can affect fertility and we know that COVID can affect sexual dysfunction as well, different mechanisms for all these things, but really does hit the trifecta of what we consider to be men's health, in our practice. And it's something that we're still understanding more and more about as this pandemic progresses.
Host: Well, then let's talk about that relationship between COVID and testicular function, as you mentioned, testosterone and semen parameters. How can this contribute to erectile dysfunction? Tell us about this causal relation here?
Dr. Halpern: So, we know that COVID can impact the testicle directly. There are probably a number of ways that this can happen. These ACE2 receptors that are so important for COVID infection and for it to cause the various manifestations of that infection are present in the testicle. And so we know that the testicle is susceptible to COVID. That can manifest in a number of ways, but certainly can cause inflammation. We know that men with COVID are more likely to have orchitis or inflammation of the testicle, which can cause issues with both testosterone production and fertility. And in fact, there've been a number of studies at this point that have looked at testosterone levels and fertility in men with COVID. So, when it comes to testosterone levels, a lot of studies showing that men with COVID-19 infection have lower testosterone than healthy controls when you consider kind of age matching and other important considerations.
We know that for a time after COVID, men will continue to have low testosterone levels. And while a lot of these men will recover up to their baseline testosterone level, some of them won't. And so that's really important to keep in mind. From a fertility perspective, we know that COVID can present itself and manifest within the testicle. There has been an autopsy study showing that, men who succumb to COVID-19 actually were found to have viral particles within the testicular tissue. And so that kind of adjacent inflammation due to COVID-19, certainly fevers due to COVID-19 can cause issues with fertility.
We know just having a high fever in and of itself is a risk factor for fertility. So, there are a number of different mechanisms that may be responsible for how COVID can affect the testicle both by way of testosterone and when it comes to male infertility and there have been studies to really demonstrate the latter as well. We see that semen parameters have gone down in men who have COVID-19. And so this is an area where we're still trying to understand the data. We need longer-term data to kind of see how these guys will do over the period of months and years after COVID infection. But there are potentially at least short-term and potentially longterm effects of COVID-19 on the testicle.
Host: Wow. That's really a fascinating study Dr. Halpern. Now we've been talking about COVID-19, what about the vaccine? Is this proven effective in preventing these sequelae from COVID-19? Tell us what we know as of now.
Dr. Halpern: We know that getting COVID-19 is bad. For a lot of the reasons we talked about and many others, of course, but when it comes to men's health, we know that COVID-19 can expose you to low testosterone, to male infertility. We didn't talk too much about erectile dysfunction, but there's some good evidence that COVID-19 can cause erectile dysfunction through a number of mechanisms as well.
And so it stands to reason that any vaccine that can protect against COVID-19. We know that the current vaccines have been shown to be quite effective, that that's going to protect you against these potential negative consequences. So, we've seen that COVID-19 vaccines are effective and, there are some limited studies, we're still try to study this in greater depth, looking at the specific men's health consequences of COVID vaccination.
We have seen, for example, in one large study, that there's a lower risk of orchitis or inflammation of the testicle and epididymitis in men who were vaccinated compared to those who weren't. So, that certainly is some good evidence in favor of vaccines, but we do need some longer evidence to show that it's making a huge difference.
But I do think it's important to remember that COVID-19 vaccination overall has been shown to be very effective and men really should be talking to their doctors about vaccination if it's not something that they've done already. The other question that comes up quite a bit that men have for us specifically is regards to the vaccine and fertility.
This was a question early on when the vaccines came out and fortunately this is a question that has been somewhat put to rest. So, some of our colleagues, down at the University of Miami conducted a study where they looked at 45 men who had semen testing before and after vaccination. And they found that overall there was no decline in semen parameters among these men. And importantly, no men went from having sperm in their ejaculate to not having sperm in their ejaculate. So, certainly not a long-term study, but a very, very reassuring, short term study showing that COVID-19 vaccine is not harmful when it comes to thinking about fertility. And so it's something that we get asked about quite a bit. And I feel very comfortable reassuring our patients, especially our male fertility patients that the COVID-19 vaccine is safe in that regard.
Host: So what do you recommend for other providers as they're counseling their patients, that are dealing with these issues following COVID-19 and as we wrap up, anything else you'd like urologists to know about caring for patients in this COVID time and the adverse impact of COVID-19 on men's health.
Dr. Halpern: Yeah, I think we just really need to be mindful of the fact that COVID-19 has so many different manifestations, both within men's health and beyond. And we really, as providers need to be asking our patients specifically about some of these sequella. We need to ask them about symptoms of low T. Things like low energy, low sex drive, we need to be asking them about sexual dysfunction and we should be asking them about their family planning goals, because all of these things are really important when it comes to COVID-19 and the potential harmful impacts of that virus.
And then by extension, we really should be asking all of our patients about vaccination status at some point during our visits with them. Ask them about whether they've been vaccinated and if they haven't, ask them about their concerns and provide them with some of the data that I've mentioned here today, allaying those concerns to try to encourage men to get vaccinated, because that probably is the best thing they can do for their overall health when it comes to COVID-19.
Host: Very, very interesting, Dr. Halpern. Thank you so much for joining us today and telling us about this important study in these COVID times and the impact of COVID on men's health. So, thank you so much again. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. For updates on the latest medical advancements and breakthroughs and research, please follow us on your social channels. I'm Melanie Cole.