If you find yourself with these symptoms (and even if you don't - see below for why), whatever your gender, get your testosterone level checked. We've known for decades that low testosterone causes fatigue and brain fog and the treatment for it has been approved for medical use for over 80 years, but you can go to doctor for "long COVID" and they'll do a blood test for a huge list of things and ignore testosterone, as does this article. If you want it checked you'll probably need to push for it and/or pay extra. There's a stigma around it and it's a controlled substance, but some people simply need it and will not feel normal without it.
There's a persistent myth that testosterone production in men falls as a natural part of aging. The truth of what happens to "normal" levels with age is more complex [1] but what is known is that in some people testosterone production falls dramatically and permanently at some point at some point in their life, sometimes after an injury or infection, sometimes for no discernible reason, and it can cause exactly the symptoms described here. When that happens it's not a "male menopause". It's not normal aging. It's pathological and it's treatable. The reason to get your level checked even if you don't have symptoms is so you know your personal baseline and can tell if a sudden change happens later.
The situation in women is more complex, and testosterone treatment carries different risks, but androgens are very much part of healthy female hormone production.
It's early days but there's been some interesting research about a possible mechanism for permanent changes in androgen production after COVID [2].
I'm not saying this is the only cause of long COVID. There's certainly more than one mechanism, and what helps one person can harm another (as with the graded exercise program mentioned in the article, which was entirely counterproductive for me). But it is one of the possibilities and if it were routinely checked for in people reporting these symptoms it would have spared me a few years of hell.
1. https://europepmc.org/article/pmc/pmc4190174
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10507138/
There's a persistent myth that testosterone production in men falls as a natural part of aging. The truth of what happens to "normal" levels with age is more complex [1] but what is known is that in some people testosterone production falls dramatically and permanently at some point at some point in their life, sometimes after an injury or infection, sometimes for no discernible reason, and it can cause exactly the symptoms described here. When that happens it's not a "male menopause". It's not normal aging. It's pathological and it's treatable. The reason to get your level checked even if you don't have symptoms is so you know your personal baseline and can tell if a sudden change happens later.
The situation in women is more complex, and testosterone treatment carries different risks, but androgens are very much part of healthy female hormone production.
It's early days but there's been some interesting research about a possible mechanism for permanent changes in androgen production after COVID [2].
I'm not saying this is the only cause of long COVID. There's certainly more than one mechanism, and what helps one person can harm another (as with the graded exercise program mentioned in the article, which was entirely counterproductive for me). But it is one of the possibilities and if it were routinely checked for in people reporting these symptoms it would have spared me a few years of hell.
1. https://europepmc.org/article/pmc/pmc4190174
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10507138/