Why COVID-19 Is Worse for Men

Medically Reviewed By William C. Lloyd III, MD, FACS
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As experts continue to study and evaluate the data for patients diagnosed with COVID-19 (SARS-CoV-2), a recent study from China published in the journal Frontiers in Public Health found that men were at a higher risk for more severe complications and even death than women. In fact, the study found that the COVID-19 death rate number of men is 2.4 times that of women.

While research continues to determine exactly why COVID-19 complications are more prevalent in men versus women, there is some evidence this is a result of underlying conditions, testosterone, a lower appreciation for the risk of exposure, and a failure to follow basic prevention guidelines. A recent study sheds more light on why some men may be at greater risk for severe COVID-19.

Age does not lead to higher severity in older men versus older women.

Although an older age is associated with COVID-19 patients experiencing more severe cases and even death, the Chinese study found that age was comparable between the men and women in the study and, therefore, had no impact on why men have a higher COVID-19 severity or death rate than women.

Women have stronger immune systems than men.

One explanation for why men experience higher COVID-19 severity and mortality could be found in the X-chromosome. While men have just one X-chromosome (in addition to a Y-chromosome), women have two X-chromosomes, which researchers say strengthens the immune system. This is due to ‘microRNAs’ encoded on the X-chromosome that serve an important role in immunity.

Furthermore, several studies, including one in the journal PLOS Pathogens reveal that males with severe COVID-19 show a greater reduction than female patients in the number of lymphocytes—a type of immune cell that helps fight off infections and other diseases.

Testosterone can negatively affect men’s immune system response.

Not surprisingly, men have a higher level of testosterone, the male sex hormone, than women. According to a study published in the Western Journal of Emergency Medicine, this increased testosterone results in “a less robust immunologic response” to viral respiratory illnesses. In addition, it also leads to an increased morbidity and mortality rate in men.

What's more, testosterone (an androgen) appears to help the virus infect cells and plays a role in developing severe COVID-19. Researchers found that men on androgen-deprivation therapy (ADT) for prostate cancer had lower infection rates and less severe illness than men not on ADT. Men with male pattern baldness also make up a higher proportion of hospitalized patients. Many scientists are investigating the use of androgen-blocking drugs as a potential therapy for COVID-19.

Underlying conditions in men lead to more severity and even death.

While many coronavirus studies already show that underlying conditions can increase COVID-19 severity, men with underlying illnesses were more vulnerable to severe illness than those without an underlying medical condition. In the PLOS Pathogens paper, 36% of male patients had a chronic condition, particularly diabetes, cardiovascular disease and cerebrovascular disease. Females, on the other hand, did not display this same level of vulnerability.

Interferon-blocking antibodies may underlie severe COVID-19 in some men.

Type I interferons (IFNs) are part of the immune system, playing a crucial role in the body’s ability to fight off viral infections. Self-antibodies—autoantibodies—that inhibit IFNs are linked to viral diseases and viral pneumonia. In a study of critically ill COVID-19 patients, 10% had autoantibodies that block IFNs, and 94% of them were male. Screening for IFN autoantibodies as well as therapies that can offset them may be useful in treating at-risk COVID-19 patients.

Men take higher health-related risks than women.

Although the U.S. Centers for Disease Control and Prevention have continually shared guidelines and precautions for lowering the risk of exposure to the coronavirus, men continue to take higher risks than women with their health. In fact, according to a study published by the Society for Judgment and Decision Making, men were found to take more risks related to their health because their perceived likelihood of negative outcomes were lower than that of women. Males also seem to take more enjoyment from taking risks than women.

Men wash their hands less often than women.

One of the key recommendations for helping curb the spread of COVID-19 is regular hand washing. However, according to a 2019 study in the journal, BMC Public Health, women generally have a better knowledge and implementation of hand washing than men. In addition, a significantly higher number of men than women ignore hand washing if they are in a hurry, are alone in the bathroom, or if they only urinated. The upside of the study, more than 70% of respondents perform hand washing during infectious disease outbreaks.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 8
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