The hormone oestrogen stimulates the immune response rapidly and also suppresses COVID-19 virus replication, whereas the male hormone testosterone inhibits the body’s own immune response, says Dr Rahul Pandit, Director-Critical Care, Fortis Hospital, Mulund

While so much about the novel coronavirus remains unknown still, a question pertaining to gender-based fatality of the infection has crossed the minds of many: does COVID-19 affect men and women differently? And does gender have any role to play in how the body reacts to the virus?

Dr Rahul Pandit, Director-Critical Care, Fortis Hospital, Mulund says that since the beginning of pandemic, it has been noted that men tend to be more susceptible to infection, and the severity of their disease is much more. Though many recent studies have shown that women are infected as frequently as men, it is the severity of disease in men which is perplexing.

“It is commonly known that men have a higher incidence of co-morbidities like hypertension, diabetes and heart disease. Also, there is an increased trend towards smoking; also, possibly, men seek medical attention much later as compared to women. While these common observations do help in understanding the incidence of infection, it does not explain the severity. The data from India also shows that there is almost 65:35 per cent (male: female) death rate disparity ratio due to COVID-19,” he says.

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Dr Pandit explains that medically there are various theories which have been discussed — the three top theories being ‘Angiotensin Converting Enzyme-2’ (ACE-2) receptor, oestrogen or testosterone which affects the immune system, and genetic predisposition.

* ACE-2 receptors: It is now clearly understood that the ‘spike protein’ on the coronaviruses like COVID, SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome) have an affinity for the ACE-2 receptors; it is almost like the ACE-2 receptor is the gateway for these viruses. The concentration of ACE-2 receptors is present in abundance in males as compared to females. They are found in high concentration in the lungs, heart, intestine and gonads.

* Oestrogen and testosterone connection: The female is stronger with respect to immune response and resilience. The hormone oestrogen stimulates the immune response rapidly and also suppresses COVID-19 virus replication. Whereas the male hormone testosterone inhibits the body’s own immune response, hence making males more prone to severe infection. This quality of oestrogen is not only seen in COVID-19 cases, but also in other viral illnesses like influenza.

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* Genetic predisposition: The possible third reason for this phenomenon is that the genes which are responsible for identifying a pathogen in the body and mount a response to them, are present on the X chromosome. Since females have 2 X chromosomes, they are more likely to have a rapid immune response to a pathogen and offer better protection. On the other hand, because of oestrogen and rapid response to the immune system, women tend to have more autoimmune problems as compared to men, the doctor explains.

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