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Chasing clues to COVID-19’s particular severity in men

June 25, 2020

People wearing masks during COVID-19 pandemic

COVID-19 appears to be hitting men harder than women, and four months into the pandemic, the reason is still a mystery. Scientists are looking at a range of potential factors, including immune response, a protein called ACE 2, hormones, smoking and the well-documented male reticence of going to the doctor.

“Doing research, it’s like you’re trying to throw an anchor into the vast ocean of possibilities,” Christina Jamieson of the University of California (UC), San Diego, told Science.

The theories

Sixty-three percent of NY City COVID-19 deaths, for example, have been males.

Among the theories for male over-representation in COVID-19 severity and deaths:

  • Women are benefitting from an immune response known to be more aggressive than men’s.
  • The ACE2 protein, more prevalent in men, is structured in a way that makes it especially vulnerable to the coronavirus’ signature spikes, enabling the virus to embed itself in cells.
  • Female hormones offer women greater protection.
  • The same male hormones associated with prostate cancer and baldness also foster COVID-19 infection.
  • Men smoke in far higher numbers than women.
  • Going to the doctor later rather than sooner may put men at a disadvantage from the start.

None of the theories have been confirmed and simple answers are unlikely. Female hormones, for example? They level off in old age, but a male/female disparity holds in seniors. Smoking? Makes sense, except that smokers appear to be underrepresented in COVID-19 cases.

More data needed

“A gender lens is critical for understanding the patterns that we are currently seeing,” Patricia Rieker, a medical sociologist and visiting professor at Boston University, told Time magazine. “I would like to see a better portrait of the men who died compared to the women who died,” she says, but gathering years’ worth of health and behavior information isn’t easy. “It’s a far more complex story for which we don’t really have data.”

As always, human biospecimens provide “the data” in a lot of biomedical research. We’ll be watching. And helping.

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