Sex differences in COVID-19: the role of androgens in disease severity and progression

M. Mohamed, T. Moulin, H. Schiöth,

Purpose: Throughout the SARS-CoV2 pandemic, multiple reports show higher percentages of hospitalization, morbidity, and mortality among men than women, indicating that men are more affected by COVID-19. The pathophysiology of this difference is yet not established, but recent studies suggest that sex hormones may influence the viral infectivity process. Here, we review the current evidence of androgen sensitivity as a decisive factor for COVID-19 disease severity. Methods: Relevant literature investigating the role of androgens in COVID-19 was assessed. Further, we describe several drugs suggested as beneficial for COVID-19 treatment related to androgen pathways. Lastly, we looked at androgen sensitivity as a predictor for COVID-19 progression and ongoing clinical trials on androgen suppression therapies as a line of treatment. Results: SARS-COV2 virus spike proteins utilize Transmembrane protease serine 2 (TMPRSS2) for host entry. Androgen receptors are transcription promoters for TMPRSS2 and can, therefore, facilitate SARS-COV2 entry. Variants in the androgen receptor gene correlate with androgen sensitivity and are implicated in diseases like androgenetic alopecia and prostate cancer, conditions that have been associated with worse COVID-19 outcomes and hospitalization. Conclusion: Androgen’s TMPRSS2-mediated actions might explain both the low fatalities observed in prepubertal children and the differences between sexes regarding SARS-COV2 infection. Androgen sensitivity may be a critical factor in determining COVID-19 disease severity, and sensitivity tests can, therefore, help in predicting patient outcomes. © 2020, The Author(s).


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  • 1. Version of Record от 2021-04-27


Об авторах
  • M. Mohamed
    Functional Pharmacology Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
  • T. Moulin
    Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
  • H. Schiöth
Название журнала
  • Endocrine
  • 71
  • 1
  • 3-8
Ключевые слова
  • androgen; serine proteinase; TMPRSS2 protein, human; adult; child; disease exacerbation; epidemiology; female; human; male; pandemic; pathology; physiology; severity of illness index; sexual characteristics; virus entry; Adult; Androgens; Child; COVID-19; Disease Progression; Female; Humans; Male; Pandemics; SARS-CoV-2; Serine Endopeptidases; Severity of Illness Index; Sex Characteristics; Virus Internalization
  • Springer
Тип документа
  • Review
Тип лицензии Creative Commons
  • CC
Правовой статус документа
  • Свободная лицензия
  • scopus