The Battle of the Sexes in the Fight Against Coronavirus

As coronavirus continues to ravage communities across the globe, new findings are emerging every day. Doctors are discovering new symptoms and early warning signs, vaccines and drug trials are proceeding at an unprecedented speed, and … women may be more likely to recover than men? In an article from the New York Times, Roni Caryn Rabin explores the connection between sex and the novel coronavirus.

Whenever a pattern emerges that shows one group is disproportionately advantaged in a certain situation, it is important to figure out why, especially in the life or death race against coronavirus. Hospitals have noted that there are significantly more men in intensive care units around the world and that they take longer to recover than do the women. 75% of the intensive care coronavirus patients on ventilators in Cedars-Sinai Los Angeles are men. In the early stages of this pandemic, China noted that men were dying at a higher rate, but attributed it to higher smoking rates. Doctors in America tentatively linked women’s resistance to and recovery from coronavirus to hormones in late March.

Not only are women more resistant to and more likely to recover from coronavirus than men, but pregnant women are also suffering more mildly with coronavirus. This is especially notable, because women are more immunocompromised during pregnancy. However, doctors note that women have higher levels of estrogen and progesterone during pregnancy.

Clinical trials started in mid-April to test this hormone hypothesis. In a New York clinic, male coronavirus patients with mild to moderate symptoms started estrogen treatments in the form of an Estradiol patch for one week. In a Los Angeles lab, similar male coronavirus patients were treated with progesterone using progesterone shots twice daily for five days. Estrogen and progesterone are female sex hormones. Progesterone, specifically, is anti-inflammatory and could potentially prevent overreactions of the immune system. Estrogen reduces the angiotensin-converting enzyme 2 (ACE2) protein expression. Coronavirus uses the ACE2 receptors on cell surfaces as entry routes. Because women have more estrogen, they will have less ACE2 expression, a benefit against coronavirus. Interestingly, doctors had already advised against taking Ibuprofen early in March, because it increases the ACE 2 receptor expression.

Fig. 1: The female sex hormones estrogen and progesterone

Some researchers have voiced their concerns with this hormone theory. They note that elderly women are also outliving their male peers during this pandemic. Elderly women have already gone through menopause, and therefore have a much lower level of these female sex hormones, so these hormones cannot be the primary cause of the sex disparity. Other scientists also point out that behavioral differences may play a large role. Men everywhere smoke more, wash their hands less, and have less robust immune systems than women. However, results of these hormone trials are due to come out in the summer, so the best practice for now is to follow official guidelines on cleanliness, distancing, and masks, and maybe also avoid the ACE2-enhancing Advil.