Can Long COVID Lead to Hormonal Dysregulation?

Written by: Denise John, PhD


Published on: March 21, 2024

Photo courtesy of Vijay Sarathy/Stills.com

The results of the CDC’s latest household pulse survey show a recent spike in people who are currently experiencing long COVID—from 5.3 percent in October 2023 to 6.8 percent in January 2024—which marks the first time it’s reached this level since November 2022.

The results could be due to many factors, but it’s clear that this condition is not likely to go away any time soon. We spoke with long COVID researcher David Putrino, PhD, about some key reminders about the condition, his recent research on hormonal and immune differences in long COVID patients, and current treatment protocols.

A Q&A with David Putrino, PhD


Long COVID is the term assigned to a group of conditions that describe individuals who survived an acute SARS-CoV-2 infection. That means they got COVID, they survived, and for whatever reason, they’re not able to fully recover from that infection. And so they continue to experience symptoms over time.

The CDC and the World Health Organization both recommend that the diagnosis of long COVID is made clinically. It’s quite simple to diagnose with these three questions: Did you have a confirmed or suspected COVID infection? Has it been three months since your COVID infection? Are you still symptomatic in some way? If you check yes to all these boxes, you have long COVID.


There are over 300 documented symptoms of long COVID that can affect every organ system, and we believe that there are individual physiological issues that drive specific symptoms.

  • Post-exertional malaise is the most common symptom experienced by people with long COVID. This is a symptom where if you exert yourself in any way—cognitively, physically, emotionally—that is beyond your tolerance, your symptoms will worsen for several days or sometimes even weeks after the time that you overexerted yourself. Around 92 percent of people with long COVID will report having some form of post-exertional malaise.
  • Fatigue is different from post-exertional malaise. We define fatigue as an overall sense of tiredness—a lack of energy and inability to exert oneself. And many people have fatigue as part of their long COVID symptoms, roughly around 90 percent.
  • Cognitive impairment, or what’s more commonly called brain fog, is a really troubling symptom for a lot of people with long COVID. We published a study in 2022 showing that about 70 percent of people with long COVID met the criteria for at least mild cognitive impairment. Thirty percent of the cohort that we studied met the criteria for severe cognitive impairment. It’s really alarming because we used a scale that we typically use to measure cognitive impairment in people who’ve had strokes and traumatic brain injury, which means that this symptom is very prominent in long COVID.

As we go through the list of symptoms, there’s chronic pain, GI disturbances (like diarrhea, constipation, and nausea), and a condition called POTS (postural orthostatic tachycardia syndrome), which causes dizziness and headaches. Other common symptoms are migraines, hair loss (particularly in women), and sexual dysfunction (particularly in men), among others.


We’re beginning to unlock some of the differences that are noticeable between people with long COVID and healthy individuals who managed to recover from the virus completely. Here are a few examples:

  • Vascular: Our research shows that individuals with long COVID have vascular differences from people who do not have long COVID. For example, individuals with long COVID are developing what are known as microclots in their bloodstream. These are not large clots that can block a blood vessel; they’re very, very microscopic clots that can interfere with gas exchange and blood and oxygen getting into tissue. They can cause hypoxic injury to the organs.
  • Immune: A study we published with an amazing immunologist, Akiko Iwasaki, showed that many people with long COVID are more likely to have latent viruses, like Epstein-Barr and herpes simplex 1, reactivate and cause health issues, indicating that the immune system is severely imbalanced.
  • Hormonal: Many people with long COVID have low morning cortisol—a hormone that helps us wake up in the morning. What we saw from our research is that people with long COVID don’t have that morning spike in their cortisol. In fact, their cortisol is much lower than that of folks who do not have long COVID, indicating hormonal dysregulation.

Our recent research that is pending publication shows significant sex differences in people with long COVID—women with long COVID have extremely low testosterone levels, and men with long COVID have extremely low estradiol levels. This leads to different symptoms being expressed in women than in men—for example, hair loss in women and sexual dysfunction in men.

We’re starting to uncover more very clear immune, hormonal, neurological, and vascular differences in people with long COVID. And we’re just scratching the surface, because this virus seems to travel everywhere in the body—it affects every organ system—so the symptoms are very diverse. But the one thing that’s for sure is that these are biological changes that are occurring, not psychosomatic symptoms.


We have seen people from all walks of life experience long COVID. Generally, it appears that anyone can experience it. The patient population at our center ranges from 5 to 96 years of age. We see elite athletes and high-performance individuals who were in peak physical condition before they had a mild COVID infection that led to long COVID, and we see people who were already managing multiple chronic health conditions before they went on to develop long COVID. You may have a slightly elevated chance of developing long COVID if you have an existing autoimmune condition or an existing condition that involves immune dysfunction.

Every COVID infection you get increases your risk of developing long COVID, even if the first few infections didn’t seem to affect you.


We prescribe different medications and treatment protocols based on what an individual’s medical assessment shows. For example, sometimes we have people with long COVID who will have vascular abnormalities, so we treat them with different interventions based on what their blood tests are telling us. We’ll prescribe different medications to address those particular issues, which often relate to things like inflammation of the blood vessels or the formation of microclots in the bloodstream, for instance.

There are other individuals who develop a condition called dysautonomia, which is when your autonomic nervous system—the part of your nervous system that controls sweat, blood pressure, temperature control, digestion, etc.—becomes out of balance. For people with dysautonomia, we provide treatment in the form of rehabilitation, breathwork, and medications that can help them regulate their blood pressure and heart rate, along with different forms of noninvasive neurostimulation (such as vagus nerve stimulation) or surgical procedures, in severe cases.

Many of our patients with long COVID have significant gastrointestinal issues. If they have gut dysbiosis, we pair them with a registered dietitian to work with them on improving their gut health. If they have small intestinal bacterial overgrowth (SIBO), which is common in many people with long COVID, we refer them to a gastroenterologist to be treated with antibiotics.

A sizable portion of people with long COVID have what we call viral persistence. That means that many of their symptoms are occurring because their body has not cleared the SARS-CoV-2 virus. We’re currently in the process of conducting a number of clinical trials using different antiviral medicines to treat long COVID, and we’re hoping that a subset of the population will respond favorably to those treatments.

We have learned a lot since the beginning of the COVID-19 pandemic. When I think about where we were in late April 2020—not understanding what was going on at all—to the progress of therapies and treatments that we can offer now, we’ve come a long way. But we have a long way to go—there are many people who still need our help. The more we know about how COVID-19 is affecting their bodies, by conducting the necessary research as quickly as possible, the more we can help the millions of people who are endlessly suffering.



David Putrino, PhD, studied computational neuroscience at Harvard Medical School, MIT, and NYU. He is currently the director of rehabilitation innovation for the Mount Sinai Health System, the Nash Family Director of the Cohen Center for Recovery from Complex Chronic Illness, and a professor in the Department of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai. He works to develop innovative technology solutions for individuals in need of better health care accessibility.


This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.