Title: Treatment different forms of postCovid hypogonadism.

Biography:

Knigavko Oleksandr Volodimirovich, Since August 2002 till now worked as a doctor urologist-andrologist in the Kharkov Regional Clinical Centre of Urology and Nephrology. It is the biggest Urological center in Europe for 420 beds with highly specialized departments including Andrological department for 30 beds where I've worked for 18 years.

In February 2008 I obtained PhD degree for work “Influence of group agglutinogens secretion on course and treatment of male sexual tract infection".

Abstract

COVID-19 is the most common pandemic in human history. COVID-19 affects ACE receptors, causing autoimmune processes that damage testicular tissue, disrupting the processes of spermatogenesis and testosterone production. Recently, we have seen an increasing number of patients with erectile dysfunction ED appearing 3-6 months after COVID-19.

The aim of our study was to determine effectiveness of hormone stimulating and replacement therapy, possibility of restorative therapy with autologous stem cells (ASC) and Plasma rich Platelets (PRP) - therapy in patients with primary and secondary hypogonadism.

117 patients with ED, which appeared 3-6 months after COVID-19. All patients except ED had clinical signs of decreased testosterone: decreased libido, mental and cognitive functions, decreased performance, fatigue. Testosterone fractions (total and free), LH, Estradiol, FSH before, during and after rehabilitation therapy were studied. Patients were divided into 2 groups: 1^st- 68 patients with primary hypogonadism (Tm = 7.43 + 2.1 below 12 nmol / l), and 2nd - 49 patients with secondary hypogonadism (Tm = 14.1 + 1.8 above 12 nmol / l). l), they were studied the sensitivity of tissue receptors to testosterone.

In the first group, patients were prescribed Tribulus terrestris extract 45% - 750 mg, Fenugreek extract 50% - 25 mg twice a day for 2 months. 37 patients (54.4%), group 1a (mean age 41.6 + 4.3) responded to therapy by normalizing the level of T (more than 12 nmol / l) and improving erectile function, 31 patients (45.6%), group 1b (average age 47.3 + 5.2) without the effect of herbal medicine prescribed testosterone drug Omnadren 250 1 time in 3 weeks. After 2 months of hormone replacement therapy, 28 patients were diagnosed with normal T levels, but only 19 patients (61.2%) in group 1b improved their erectile function.

In the second group, 49 patients were also prescribed Tribulus terrestris extract 45% - 750 mg, Fenugreek extract 50% - 25 mg twice a day for 2 months and PRP therapy (intracavernous injections of 2 ml of autoplasma with a platelet concentration greater than 1 million / ml) 1 time in 10 days 8 times. 23 patients - group 2a responded to therapy with the disappearance of symptoms of hypogonadism and improvement of ED. 26 patients - group 2b - did not have significant improvements, so they received 2 courses of 5 intravenous injections of 5 million autologous stem cells (50 million in total).  17 patients (65.4% of group 2b) improved their mental health, reduction of symptoms of hypogonadism, improvement of erectile function to normal values​​(IIEF -5 increased to 19.4 + 2.2).

Conclusions:

1. Multicenter studies of the effect of COVID-19 on fertile and androgenic function in men and the possibility of their recovery in postpartum pathology are needed.

2. A significant proportion of men with postcovid hypogonadism and ED are men with normal levels of T, but reduced sensitivity of tissue receptors to T (secondary hypogonadism).

3. In the treatment of secondary postcocious hypogonadism, intracavernous PRP therapy and intravenous stem cell therapy have a clinical effect and can be considered as promising treatments for this pathology.