TLDR Females have stronger immune responses to COVID-19 than males, leading to better outcomes.
This review examined the biological mechanisms behind sex-based differences in COVID-19 outcomes, finding that males experienced more severe illness and higher mortality rates than females. Females had a more robust immune response due to X inactivation and the presence of two X chromosomes, which provided redundancy and variability in immune responses. In contrast, males, with one X chromosome, had fewer heterozygous loci, potentially increasing infection risk. Low testosterone levels in males were linked to a dysregulated inflammatory response and poorer outcomes. Additionally, gender differences in health behaviors and social norms influenced these disparities. Understanding these differences was crucial for developing preventative measures, treatment decisions, and personalized therapies for COVID-19 patients.
22 citations
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January 2021 in “Clinical Therapeutics” 
121 citations
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November 2020 in “Endocrine” Male hormones like testosterone may make COVID-19 worse, and testing for sensitivity to these hormones could help predict how severe a patient's symptoms might be. Treatments that reduce these hormones are being explored.
119 citations
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May 2020 in “Journal of The American Academy of Dermatology” Most COVID-19 patients in hospitals have androgenetic alopecia, more in men, suggesting a link between androgen sensitivity and severe COVID-19 symptoms.
134 citations
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April 2020 in “Journal of Cosmetic Dermatology” Male pattern hair loss could hint at androgens affecting COVID-19 severity.
16 citations
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December 2021 in “Frontiers in Endocrinology” Sex hormones may affect COVID-19 severity, with estrogen possibly reducing risk and testosterone potentially increasing it.
15 citations
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April 2022 in “Immunology” Men and women get COVID-19 at similar rates, but men tend to get sicker and have a higher risk of dying, while women usually have stronger immune responses and vaccine reactions.
25 citations
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June 2023 in “Biomedicines” Men generally face more severe COVID-19 outcomes than women, partly due to hormonal differences.
125 citations
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August 2020 in “Frontiers in Immunology” Men generally have more severe COVID-19 cases and higher death rates than women due to biological differences.
19 citations
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November 2021 in “Reviews in endocrine and metabolic disorders” Sex hormones like estrogen and testosterone may affect COVID-19 severity differently in men and women, potentially influencing prevention and treatment strategies.
