Dare we say that we are emerging from the worst of the pandemic. At least in our little slice of the universe, infection rates have declined again, and vaccines are finally becoming more available. With sunshine and warm weather upon us, “normal” life looks like it is soon to return. Hopefulness and optimism notwithstanding, lest we forget this pandemic claimed nearly 4 million lives worldwide and took an immeasurable toll in so many other ways.  

Furthermore, it is clear that there are long-term health consequences for some COVID-19 survivors. Post-acute COVID-19 syndrome is the emerging diagnosis recognizing the multi-system, chronic effects we are seeing in “long-haulers.” 

In honor of Men’s Health Week (which is the week leading up to Father’s Day, and not to be confused with Movember), let’s discuss the one very specific concern with COVID-19: can it affect male reproductive health?  

We know that many infections, due to the fevers that they cause, can at least temporarily result in a decline in sperm count. Mumps is perhaps the most well-known example of a viral infection that can cause acute testicular damage (aka, orchitis), rendering some men sterile.  

It turns out that COVID-19 also has a special affinity for the testicles: the portal of entry into the lung tissue, the ACE2 receptor, is also highly expressed in the testicles, specifically on the Leydig cells which are critical for hormone production, and the Sertoli cells which are required for spermatogenesis.  

Men recovering from COVID-19 infection demonstrated lower semen volume, sperm concentration, motility, morphology as well as elevated markers of inflammation and oxidative damage.  Post-mortem studies have demonstrated the COVID-19 infection has caused destruction of the testicular tissue. A study from Italy showed that some men infected with COVID-19 will develop hypogonadism (aka, testicular failure), with the associated lower testosterone levels predictive of a poorer prognosis and greater mortality from the infection. 

To add insult to injury, COVID-19 infection in men may also be associated with erectile dysfunction. The “cytokine storm” caused by the infection is responsible for the life-threatening damage in the respiratory and cardiovascular systems, but also damages the endothelial cells that line blood vessels throughout the body, including the penile tissue. In turn, the presence of erectile dysfunction is also associated with other health consequences such as heart disease, a classic vicious cycle.  

But is it safe to get the vaccine? The experts certainly believe so, demonstrated by a joint statement from the Society for Male Reproduction and Urology and the Society for the Study of Male Reproduction. While it is true that about 16% of patients will develop a brief fever after vaccination, it is not necessarily severe enough to cause a decrease in sperm count. Even so, such an effect would be temporary, in contrast to the potentially more severe and long-lasting destructive effects of the virus itself. A soon to be concluded study will reveal more objective data on the effects of the COVID-19 vaccine on semen parameters.  

So if you are a person with testicles and a penis, protect them from COVID-19. Get vaccinated, which by the way, might also save your life.