COVID-19 Pandemic: What About the Gonads?

The document reviews the potential effects of COVID-19 on gonadal function and the observed differences in disease outcomes between genders. It suggests that COVID-19 may impact the gonads, potentially influencing sex steroids and fertility, with ACE2 expression in testicular cells raising concerns about male fertility. Women seem to have lower susceptibility and mortality rates, possibly due to genetic, hormonal, and immunological factors, and stronger immune responses. Estrogen may regulate ACE2 expression and could be beneficial in COVID-19 treatment strategies. There is no evidence of significant impact on female fertility or vertical transmission from mother to newborn. Men may experience worse outcomes, potentially due to lifestyle habits, comorbid diseases, and biological differences. The document also notes that COVID-19 might affect the hypothalamic-pituitary-testicular axis and suggests monitoring gonad function and fertility in recovered patients. Trials are investigating the role of estrogens and androgen-modulating drugs in treating COVID-19.