Effects of COVID-19 on testicular function

Background: The impact of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2) on testicular function is unclear. Objective: To clarify the effects of COVID-19 on male gonadal function. Methods: Pubmed search up to February 24, 2021. Search terms included COVID-19, testicles, testosterone, spermatogenesis, hypogonadism. Case reports, retrospective, prospective and autopsy studies are included. Results: Prevalence of patients hospitalized with COVID-19 having scrotal pain varies from 0-19%. Orchitis and/or epididymitis were demonstrated by scrotal ultrasound (US) in approximately 22-42% of men with COVID-19 admitted to the hospital and can be frequently asymptomatic. Circulating testosterone levels are reduced in men admitted with COVID-19 with concomitant elevation of luteinizing hormone (LH) suggesting testicular dysfunction. Men affected with COVID-19 exhibit abnormal semen parameters. Most, but not all, studies failed to detect SARS-CoV-2 in semen. Autopsy studies showed extensive damage of testicular tissues of men who died from severe COVID-19. Conclusion: COVID-19 negatively affects almost all aspects of male gonadal function. Physicians should evaluate testicular function during and after recovery from COVID-19 to preserve normal fertility.