Men are hit harder by COVID. They are more likely than women to become seriously ill and more likely to die from it. Now, a growing body of research shows that COVID is also affecting them in ways they may not want to talk about; COVID can cause erectile dysfunction and infertility.

Recent studies have shown that the virus can reduce testosterone levels and sperm count. The good news is that these effects, for the most part, are temporary. Treatments are available.

And urology and reproductive health specialists point out that COVID vaccines have no such side effects. They strongly recommend that all men get vaccinated to avoid these complications.

“I’ve seen patients who never had erection, orgasm, or libido problems, and then they got COVID,” said Dr. Danielle Velez, a specialist in male infertility and sexual dysfunction at Robert Wood Johnson Medical School in New Brunswick.

The link between COVID and erectile dysfunction is real

“When you have acute COVID, for a variety of reasons, you may have a much higher risk of erectile dysfunction,” said Dr. Hossein Sadeghi-Nejad, a physician at New Jersey Urology, director of the Center for Male Reproductive Medicine at the Hackensack University. Medical Center and Professor at Rutgers New Jersey Medical School.

“Part of it is the anxiety and the stress of being confined at home, he said, referring to the early days of the pandemic shutdowns and the periods of isolation after a positive test result.

But there are also physiological reasons. “There are a lot of things that have to go into a good erection,” Velez said. “It’s not just about being in the right frame of mind – it’s a delicate interplay of hormones kicking in at the right time, proper blood flow and functioning nerves sending signals to the penis.”

Dr. Hossein Sadeghi-Nejad, director of the Center for Male Reproductive Medicine at Hackensack University Medical Center, professor of urology at Rutgers New Jersey Medical School, and physician at New Jersey Urology, part of Summit Health

A study called “Mask up to keep it up” interviewed 100 sexually active men in Italy during the first months of the pandemic. He found “a significant effect of COVID-19 on the development of erectile dysfunction“, even after correcting for men’s psychological status, obesity and age.

  • COVID infection can reduce testosterone levels. Testosterone, a hormone produced in the testicles, is important because it affects libido and muscle strength, among other functions. When the virus attacks, “it kind of shuts down the factory,” Sadeghi-Nejad said. That’s because testicular cells, like those in the lungs, heart, and blood vessels that have been vulnerable to COVID, have a protein on their surface where the virus likes to bind. The virus’ spike protein fits into this surface protein like a key in a lock, allowing it to invade the cell. Evidence suggests that the more severe the COVID infection, the greater the reduction in testosterone, Sadeghi-Nejad said.
  • The virus can affect the blood vessels in the penis. The SARS-CoV-2 virus also binds to epithelial cells that line the blood vessels of the penis. This can affect the blood flow essential for a good erection. Epithelial cells line blood vessels elsewhere in the body and the lungs, where the effects of COVID on coagulation and inflammation have been well documented. The effect is similar.
  • The virus can also cause swelling of the testicles and the epididymis, the sperm-producing organ next to the testicle. Several small studies have found that 10% to 22% of men with active and severe COVID disease experience these effects.
A positive COVID test can cause anxiety, but there are also physiological reasons why men's health is affected.

Those with pre-existing erectile dysfunction were also more likely to contract severe illness with COVID, he found. Conditions that predispose men to erectile dysfunction — high blood pressure, diabetes, obesity and a history of heart disease — also increase COVID risks.

COVID’s impact on libido may have long-term consequences

Their experiences “run the gamut,” she said, “from ‘It’s really creeped up on me; I have less and less interest in sex and worse erections,” to some who said it was like a switch. Suddenly they couldn’t have an erection and had no interest in sex.

For a 40-year-old former sailor and police officer who chose not to get vaccinated, a COVID infection in March 2021 had life-changing consequences.

James, who asked that only his middle name be used, to protect his privacy, was ill for three weeks and developed bronchitis and pneumonia, but did not seek treatment in hospital. “When I started to regain some energy,” he said, “it was very difficult to be intimate with my wife.”

Over time, his persistent symptoms, which also included a cough, chest tightness and fatigue, led him to seek treatment for lengthy COVID symptoms at Robert Wood Johnson University Hospital. After being referred to Velez, he began treatment with testosterone and another drug intended to help preserve fertility.

But by then his wife had left him.

There were other reasons their 18-year marriage ended, James said, but the impact of COVID on their sex life was one of them.

“I feel like a fat old man,” he said. “I’m tired of walking up the stairs with the laundry.” He is focused on increasing his testosterone levels to reduce his fatigue and has requested early retirement from the police department.

Does COVID affect pregnancy?

Sperm are affected in three ways by COVID: their concentration, their speed of movement (motility) and their shape (morphology).

Additionally, COVID is causing temporary infertility in some men.

“We know that COVID infections can disable or downregulate sperm production,” said Dr. Eric Seaman, urologist and male fertility expert at New Jersey Urology, part of Summit Health. But “unless they are so ill that they are hospitalized, in three months the men are pretty much back where they started.”

Fever and inflammation can influence sperm production. Experts say sperm are affected in three ways by COVID: their concentration, their speed of movement (motility), and their shape (morphology). Said Sadeghi-Nejad: “All of these can affect fertility rates.”

COVID infection “was associated with a slightly longer time to pregnancy in couples where the male partner had recently tested positive for COVID19,” researchers from the Boston University School of Public Health found, in a study published in January. “The association disappeared after 60 days.”

Couples were 18% less likely to conceive within 60 days of the man’s positive COVID test, but there was no difference if the infection had occurred more than two months previously, the study found. funded by the National Institutes of Health. It analyzed data from over 2,000 couples who were trying to get pregnant from December 2020 to September 2021 and participated in the PREgnancy STudy Online (PRESTO) study.

Any delay can be difficult for couples wanting to have a baby. “The hardest part of fertility, once a couple decides they want to have a baby, they want to be pregnant yesterday,” Velez said. “It may take some time to see a positive pregnancy test.”

Men concerned about the long-term effects of COVID on their sexual or reproductive health should see a specialist, Sadeghi-Nejad said. “There are solutions.

For James, the ex-Marine being treated for low testosterone, fertility hasn’t been an issue. He signed up as a sperm donor with an online application, he said, and was approached by a lesbian couple who wanted to have a baby.

“I’ve helped a few couples conceive,” he said.

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Current research suggests that the risk of sexual transmission of COVID from fully recovered men is negligible, a study published in February reported.

Does the COVID vaccine affect pregnancy?

The Moderna COVID-19 vaccine.

COVID vaccines, unlike COVID disease, do not affect men’s fertility or sexual function, according to several studies.

The study of more than 2,000 couples, funded by the National Institutes of Health, “found no difference in the chances of conception if either male or female partner had been vaccinated, compared to unvaccinated couples”.

The results were similar regardless of the type of vaccine, whether one or two doses were received by the man or the woman, how long they had been vaccinated, whether they were healthcare workers or they have a history of infertility, the NIH says.

The American Society for Reproductive Medicine, which includes male and female reproductive health experts and others, strongly urges people trying to get pregnant to get vaccinated. “There is currently no credible evidence to support that COVID-19 vaccines can impact fertility,” its research summary said in March 2021. “However, there may be a negative impact of COVID-19 disease on male fertility.”

And the Centers for Disease Control and Prevention say there is currently no evidence that COVID vaccines cause fertility problems in women or men.

Experts in the field get questions about it all the time, they said.

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“It’s a very important message to take home,” Sadeghi-Nejad said. “As a community of reproductive endocrinologists and male fertility specialists, we strongly encourage our patients to get vaccinated.”