The statistics are staggering regardless of where in the world they come from and the message they bring with them is the same – men are more likely to become infected with Covid-19 and die from it than women.
In Europe, it has recently been estimated that 63 percent of all Covid-19 deaths are men. In one large subset of Covid-19 patients in China, more than 70 percent of those who died were men. And in New York City, as of early April, the rate of Covid-19 infection for women was 23 per 100,000, while for men it was nearly double that at 43 per 100,000.
Data cannot lie, and there’s a lot more of it that all points to the same conclusion. Let’s first look at a few reasons why this trend exists then dive into a particular subset of men who are especially vulnerable to the coronavirus.
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Men have More Preexisting Conditions
We’ve heard it dozens of times. Anyone with a certain preexisting medical condition is more likely to be affected negatively by the Covid-19 virus, while those who do not have those conditions are more prone to a better outcome. Here’s the unfortunate part if you’re a man:
Men have higher rates of nine out of the top 10 leading causes of death in the U.S. compared to women.
All of those conditions are going to be problematic when you ask the human body to deal with another threat. But when it comes to Covid-19, conditions like heart disease, high blood pressure, and liver disease are all a concern and all conditions that men have in greater abundance than do women.
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It’s in the Enzyme
A recent study has shown that men have higher concentrations of angiotensin-converting enzyme 2 (ACE2) in their blood than women.
Since ACE2 enables Covid-19 to infect healthy cells, researchers reported that this may contribute to men being more vulnerable to the disease than women.
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Negative Lung Health Behaviors
Research has suggested that smoking may play a role in Covid-19 deaths, as smoking is related to higher expression of those ACE2 receptors we mentioned above.
However, it’s not just smoking that can have negative respiratory effects that may contribute to Covid-19 related problems. Air pollution is also a concern. And unfortunately for men, we’re the ones more likely to be working outside.
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Women have Stronger Immune Systems
It’s no surprise. A stronger immune system can ward off illness and disease more easily than an immune system that’s not working as it should. And thanks to an extra X chromosome, women appear more biologically capable of fighting those battles than men.
According to Veena Taneja, who studies differences in male and female immune systems at the Mayo Clinic, the second X chromosome isn’t usually activated, but it can be activated. "Many of those genes are actually immune-response genes," Taneja said. She added this could provide women with an additional layer of protection against the coronavirus.
That extra X chromosome is also thought to contribute to a higher rate of autoimmune diseases in women.
Low Testosterone in Men Makes Covid-19 Much Worse
There are a number of reasons, as you can see from the above list, why men have a higher death rate when it comes to Covid-19. There are also a number of solutions: Be healthier in general. Don’t smoke. Make sure your immune system is getting the support it needs. But when it comes to Covid-19, there seems to be one factor in particular that separates strong males from susceptible males.
A study published on April 27, 2020 has shown testosterone to be a key hormone in the context of the Covid-19 pandemic. The study points out that testosterone is reduced by age and many preexisting conditions and this, too, comes with higher rates of a poor Covid-19 outcome.
The study found that low testosterone levels can cause a reduction in respiratory muscle activity, while normal testosterone levels have a protective effect on the respiratory system. Most importantly, researchers found a correlation between inflammation, testosterone, and the virus.
The study highlights the role of proinflammatory cytokines in the progression of the Covid-19 infection and how any successful treatment must include reducing that cytokine activity.
The study’s researchers also mention how testosterone may downregulate this inflammation and suggested, “testosterone may have a role in the cascade of events leading to progression of Covid-19 infection due to the cytokine storm.”
According to another study, the majority of male patients with Covid-19 also presented with low testosterone levels on admission to the intensive care unit at University Hospital Hamburg-Eppendorf in Hamburg, Germany.
According to the study, researchers “systematically analyzed sex hormones as well as cytokine and chemokine responses in male and female patients with laboratory-confirmed SARS-CoV-2 infections upon hospital admission.”
Researchers also identified risk factors like hypertension (high blood pressure), cancer, obesity, type 2 diabetes, and chronic heart disease, with cancer being the only factor where the women admitted had a higher prevalence than the men. But it was their testosterone findings that were most surprising.
Most male Covid-19 patients admitted to intensive care had low testosterone levels – 69 percent – and low dihydrotestosterone levels – 49 percent. Perhaps more shocking, most female Covid-19 patients had elevated testosterone levels – 60 percent.
The study’s researchers concluded that “We here show that critically ill male Covid-19 patients suffer from severe testosterone and dihydrotestosterone deficiencies. Both androgens are required to mount antiviral immune responses to combat infection in males.”
There is still much we don’t know about this virus and new information is coming in all the time. However, there are a few things that are becoming clear, like men having a higher prevalence of a bad outcome from Covid-19, but also how important testosterone levels are to every man’s chances of fighting this virus.
TIPS:
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