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Sex Hormones Impact COVID-19
Both estrogen and progesterone play a role in fighting COVID-19, according to an article in the January 2021 science journal Trends in Endocrinology & Metabolism.
As early as the 1940s researchers identified a sex bias in our immune systems, with women showing a more aggressive and more effective immune response, especially with viral infections. That sex bias became strikingly more evident during the recent COVID pandemic, with men’s risk of fatality at three times that of women.
Female sex hormones encourage increased levels of viral antibodies, boost immune cell ability – including the “repair response” – and strengthen anti-inflammatory actions. More specifically, estrogen helps with the initial detection and resulting signals to our immune system to kick it into gear. Estrogen also helps monitor the immune response, keeping it proportionate to the level of infection. Progesterone has a similarly strong role in regulating the anti-inflammatory response to infection.
These powerful inflammation-regulating functions are critical in fighting COVID-19, in which “cytokine storms” often lead to the complications that prove fatal to COVID patients. Cytokines are specialized white blood cells that enter the blood stream, circulating throughout our bodies to fight infection and disease. If unchecked, this immune response causes too much cell inflammation, damaging organs. Some cytokines specifically affect blood vessels and an overproduction of these cytokines can cause drastic drops in blood pressure, decreasing blood flow and starving crucial tissues and organs of oxygen.
The author of the study published in Trends in Immunology & Metabolism theorizes that women fair better than men in the fight against COVID-19 because premenopausal women have higher levels of progesterone and estrogen than men.
Small observational studies also recognized the age-related increase in infection risk and disease severity begins earlier in in women than men – at 50-55 years, which coincides with menopause and its resulting decrease in sex hormone production. Men’s age-related risk increase starts rising closer to 60.
Another small pilot study found that low testosterone levels were linked to worse outcomes, also supporting the theory that sex hormones may impact COVID-19.
Although there are vast quantities of data that point to the sex-biased severity and mortality in COVID-19, there is no consensus on treating it based on gender. Although some smaller studies have begun, large-scale trials are needed to gather the necessary information to develop an actionable plan for abating these discrepancies.