Why Do Men Fare Worse With COVID-19? Cleveland Doctor Studies Hormones

Emerging research about COVID-19 shows men seem to have more severe cases and higher death rates than women. Local endocrinology experts think these gender differences could be linked to hormones.

“In particular, sex hormones like androgens, that we study fairly routinely,” said Dr. Nima Sharifi, endocrinology researcher and director of Cleveland Clinic’s Center for Genitourinary Malignancies.

Sharifi led a study that looked into whether men and women have differences in levels of TMPRRS2, one of the proteins through which the coronavirus enters the lungs. 

TMPRRS2 is stimulated by androgens, male sex hormones, in the prostate. Sharifi wondered if that was also the case in the lungs, which would help explain gender discrepancies in COVID-19 outcomes.

Researchers assessed both human and mouse lungs. In both cases, they found no gender-specific differences in the levels of TMPRRS2 in male and female lungs. 

“Unfortunately, we didn’t get the answer that we were hoping to get,” Sharifi said.

But, he said other hormonal factors could be the cause. 

“Androgens suppress the immune system,” he said. “The immune system may still be in play, that may still be an explanation, although we didn’t test that here.”

Sharifi will continue to research gender differences in COVID-19 outcomes. He says studies on genetic and biologic factors should also be conducted.

If androgens are the reason for higher infection and death rates in men, he said, doctors might be able to use existing drugs to treat COVID-19 patients.

“That’s something that could be manipulated by drugs that we use for other purposes, and it would have a real value, not just a theoretical thing,” he said.