Why does COVID-19 affect men more than women?

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This story originally appeared in The Conversation

Why does COVID-19 affect men more than women?
Why does COVID-19 affect men more than women?

By Adam Moeser, Matilda R. Wilson Endowed Chair, Associate Professor of Large Clinical Science, Michigan State University

When it comes to surviving critical cases of COVID-19, men seem to get the shorter straw.

First reports from China revealed the first signs of an increase in male mortality related to COVID. According to the Global Health 50/50 research initiative, almost all countries are reporting significantly higher COVID-19 mortality rates for men than for women as of June 4. However, current data show that infection rates are similar for men and women. In other words, while men and women at similar rates are infected with COVID-19, a significantly higher proportion of men in similar age groups succumb to the disease than women. Why do more men die from COVID-19? Or should we ask ourselves why more women survive?

I am an immunologist and I am researching how stress and biological sex can affect a person’s susceptibility to immune diseases. I am examining a specific immune cell called a mast cell. Mast cells play a critical role in our immune system as they are the first to respond to pathogens and coordinate immune responses that help eliminate invading pathogens.

Research has shown that mast cells in women can trigger a more active immune response.

Female mast cells can trigger a more active immune response, research results / Image: BMC

Our research shows that women’s mast cells can trigger a more active immune response, which can help women fight infectious diseases better than men. However, the disadvantage may be that women are at increased risk of allergic and inflammatory diseases. Recent evidence suggests that mast cells are activated by SARS-CoV-2, which causes COVID-19.

Some evidence of why women have higher survival rates can be found in our current understanding of the differences in the immune system between men and women.

Could gender differences play a role in the immune system?

In general, women have a more robust immune response than men, which can help women fight infections better than men. This could be the result of genetic factors or sex hormones like estrogen and testosterone.

Biological women have two copies of the X chromosome, which contains more immune cells. While the genes on an X chromosome are largely inactive, some immunogens can escape this inactivation, which leads to a doubling of the number of immunity-related genes and thus a doubling of the amount of certain immune proteins compared to biological men who only have one X- Have a chromosome.

Sex hormones such as estrogen and testosterone can also affect the immune response. In one study, the researchers showed that activating the estrogen receptor in female mice offers protection against SARS-CoV. And there’s an approved clinical trial that looks at the effects of estrogen patches on the severity of COVID-19 symptoms.

It is interesting, however, that the current data, which shows that women have better survival rates than men, also apply to men and women in the age group of 80 years or older if the hormone levels of both sexes are the same. This suggests that factors other than adult sex hormone levels contribute to gender differences in COVID-19 mortality.

Androgens, a group of hormones – including testosterone – that are known to stimulate the development of male properties and cause hair loss, have also recently received attention as a risk factor for COVID-19 in men. In a study conducted in Italy, diagnosis of prostate cancer increased the risk of COVID-19. However, prostate cancer patients receiving androgen deprivation therapy (ADT), a treatment that suppresses androgen production that promotes the growth of prostate cancer cells, were significantly less at risk of SARS infection. CoV-2. This suggests that androgen blockade in men is protected against SARS-CoV-2 infection.

How ADT lowers infection rates in men is unknown, and whether this has been demonstrated in other countries is not yet clear. Testosterone, an androgen hormone, has immunosuppressive effects. One explanation could be that ADT could boost the immune system to fight SARS-CoV-2 infection.

There is also evidence that men and women have different amounts of certain receptors that recognize pathogens or serve as an invasion point for viruses such as SARS-CoV-2. An example is the number of angiotensin converting enzyme 2 (ACE2) receptors to which SARS-CoV-2 binds to infected cells. While there is currently no conclusive evidence that the role of ACE2 receptors affects gender differences and the severity of COVID-19 disease, this is still a possible factor.

Gender, gender and risk of COVID-19

Various factors can interact with biological gender to increase or decrease susceptibility to COVID-19. Another important factor is gender, which refers to social behavior or cultural norms that society considers appropriate. Men may be at increased risk of serious illness because they generally tend to smoke and drink more, wash their hands less often, and often delay seeking medical help. All of these gender behaviors can put men at higher risk. While current data on the role of gender in COVID-19 is not yet available, this will be a critically important factor to consider when understanding the differences in gender mortality.

Age, psychological stress, and concomitant diseases such as obesity, diabetes and cardiovascular diseases can also interact with biological sex to make the disease worse.

While COVID-19 emphasizes the importance of biological gender for the risk of disease, sexual prejudice for diseases is generally not a new concept. COVID-19 is just another example of a disease that is being added to the growing list of diseases for which men or women are at increased risk.

A history of male biased research

You may be wondering why, when biological sex is so important, why we don’t know what causes the difference in the prevalence of the disease between the sexes, and why there are no gender-specific therapies?

One of the main reasons is that it was mainly men who were involved in scientific research.

This inequality between biological gender differences in research has only recently been resolved. It is only in the past five years that the National Institutes of Health have requested that gender difference data be collected for all newly funded pre-clinical research grants.

While there may be several reasons in research to choose one gender over another, the enormous inequality that currently exists is probably one of the main reasons why we still know relatively little about gender differences in immunity, including the current one. Covid19 pandemic.

This has clearly hindered the improvement of women’s health, but it also has negative consequences for men’s health. For example, given the biological differences between the sexes, drugs and therapies are very likely to have different effects in women than in men.

The biological gender is clearly an important factor for the disease results in COVID-19. It remains to be seen how his biological sex makes him more or less resistant to diseases like COVID-19. Future basic research in animals and clinical studies in humans should consider biological gender and gender interactions as important variables.

This article is republished by The Conversation under a Creative Commons license. Read the original article.

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