Long COVID Symptoms May Include Hair Loss and Sexual Dysfunction, Study Shows

Hair loss, ejaculation difficulties, and a lower sex drive have been identified as additional long COVID symptoms, new research shows, further adding to the list of health issues that people can experience following a COVID-19 infection.

The study, published in Nature Medicine and led by researchers from the University of Birmingham, found that patients with a confirmed case of COVID-19 more often reported 62 different symptoms in the 12 weeks after their infection, compared to those who hadn't contracted the virus.

"The main finding of the study is that patients present with a wide range of symptoms in the longer term after COVID-19," lead study author Anuradhaa Subramanian, MSc, a research fellow at the University of Birmingham's Institute of Applied Health Research, told Health in an email. "We found 62 symptoms in total to be associated with COVID-19 in the longer term,"

According to the Centers for Disease Control and Prevention (CDC), nearly 8% of adults in the U.S. experience long COVID symptoms, or symptoms lasting three or more months after their initial sickness. The symptoms—which weren't present before COVID—typically start at least four weeks after infection.

Subramanian said that while an extensive list of long COVID symptoms already exists, the new research supports and validates the broad range of symptoms patients are experiencing and have been telling doctors, family, and friends about since the pandemic began more than two years ago.

"This new information aims to validate patients' voices regarding the breadth of symptoms they experience," Subramanian explained. "Their long-term experiences post COVID-19 are real and not merely an effect of lockdown or [the] pandemic happening in the background."

Commonly-Reported Symptoms of Long COVID

Subramanian and her colleagues analyzed primary care data from more than 2.4 million people in the U.K., collected between January 2020 and April 2021. The data included approximately 486,000 people who had a confirmed case of COVID but were not hospitalized, and about 1.9 million adults with no history of infection. Participants, on average, were 43 years old, and the majority were white and female.

After adjusting for demographic factors, researchers discovered 62 symptoms that were "significantly associated" with a history of confirmed COVID. The large number of symptoms allowed researchers to group patients and their common symptoms into three categories: broad-range symptoms (pain, fatigue, and rash), respiratory symptoms (wheezing and shortness of breath), and mental health conditions (anxiety, depression, and brain fog). Most people fell into the broad-range symptoms category (80%), followed by mental health conditions (14.2%), and respiratory symptoms (5.8%).

Among the 62 different symptoms, some were seen more frequently than others. The most commonly-reported symptoms include:

• Anosmia (loss of sense of smell)
• Hair loss
• Sneezing
• Ejaculation difficulty
• Reduced libido
• Shortness of breath
• Fatigue
• Chest pain
• Hoarse voice
• Fever

Although the study findings aren't necessarily new or groundbreaking, the observed symptoms are consistent and support past observations—meaning, they can validate the wide variety of symptoms long COVID sufferers can and have come across after an initial COVID infection, according to Alba Azola, MD, assistant professor of physical medicine and rehabilitation at Johns Hopkins University School of Medicine and co-director of the Johns Hopkins Post-Acute COVID-19 team.

"The study looks exclusively at people that were not hospitalized, so it solidifies and strengthens the fact that long COVID can happen in people that have a severe infection, but it can also happen to people that have mild infections that were never hospitalized and that the symptoms are significant and there's a lot of variability," Dr. Azola told Health.

Subramanian said more research is needed to understand why some of these common symptoms recognized in the study, including hair loss and low sex drive are associated with long COVID.

"While we have not specifically explored these questions in our study, there are several theories in place that might explain the observations in our study, which need further exploration, such as dysfunction in terms of an autoimmune response, chronic inflammation, persistence of the viral infection in the body, and clotting problems," Subramanian added.

Groups at Highest Risk of Developing Long COVID

Beyond identifying a wider set of symptoms, the research team established key demographic groups and behaviors that put people at an increased risk of developing long COVID.

In looking at a slightly narrower pool of patients—about 384,000 people who contracted COVID-19—researchers identified women, younger adults, people of color, people from low socioeconomic backgrounds, smokers, and people who are overweight or obese as being likelier to develop long COVID.

Patients with some chronic conditions, including chronic obstructive pulmonary disease (COPD), fibromyalgia, multiple sclerosis, and migraine were at a higher risk of developing long COVID, as well.

Although previous research has identified certain modifiable risk factors for long COVID, like smoking and obesity, the new research further validates biological risk factors, like sex and ethnicity, too.

"Women are, for example, more likely to experience autoimmune diseases," Subramanian said in a press release. "Seeing the increased likelihood of women having long COVID in our study increases our interest in investigating whether autoimmunity or other causes may explain the risk in women."

Subramanian added that the same mechanism could be at play with patients of color and the chronic diseases—like diabetes and high blood pressure—they experience at higher rates. "It is likely that we are observing a similar effect of predisposing ethnic minority patients to long COVID," she said.

Seeing long COVID more commonly in younger adults is also a bit of a mystery to investigators. "It is not straightforward why these [younger] patients might be at higher risk for long COVID," Subramanian said. "We focused our study on non-hospitalized patients, [and] since older patients are more likely to be hospitalized post-COVID, the non-hospitalized older adults in our study may represent a healthier group."

What This Means for the Future of Long COVID Treatment and Research

Researchers say they hope the study's findings will help further narrow the focus on factors that may be causing these continuing symptoms after infection and how to best help patients who are experiencing them.

"I hope our research will [...] further validate the voices of patients and involvement groups and provide an approach to support healthcare responses to new and emerging diseases," senior study author Shamil Haroon, PhD, MPH, a clinical senior lecturer at the University of Birmingham's Institute of Applied Health Research, said in a press release.

Furthermore, Subramanian said clinical trials are needed to find potential treatments for the different symptoms of long COVID, which can hopefully improve the quality of life for people experiencing the condition.

"Treatments targeting the specific types of long COVID presentation might be the way forward," Subramanian said. "At this stage, patients living with long COVID are the experts, and validating their diverse experiences helps them feel heard."