GALVESTON, Texas – Researchers from The University of Texas Medical Branch at Galveston explored the effects of estrogen and testosterone and their possible therapeutic effects in treating older patients with COVID-19. The findings are now available in Mayo Clinic Proceedings.

“Although there’s no specific therapies or vaccines available yet for COVID-19, reports have consistently shown that older adults and males are at increased risk of becoming severely ill or dying from COVID-19,” said Rasha Al-Lami, MD, Master of Clinical Science candidate in the UTMB department of Preventive Medicine and Population Health. “As the search for treatments continues, understanding the role of sex hormones in disease severity is very important.”

The most widely accepted main culprit of COVID-19-induced damage is the intense inflammatory response – a heightened immune response and cytokine storm – that can severely damage the lung tissue. This leaves some patients ill enough to require ventilation support and, in many cases, causes death.

There are documented differences between women and men in how their bodies respond to the inflammation that have been attributed, at least in part, to the sex steroid hormones estrogen and testosterone. And as with most infectious diseases, the female immune system responds more efficiently to pathogens, producing higher amounts of antibodies. For coronaviruses in particular, females have demonstrated a consistent survival advantage over males.

That being said, testosterone may also have a protective anti-inflammatory effect in younger men, similar to the effect of estrogen in younger women, albeit milder. It is reported to lower pro-inflammatory cytokines, as estrogen does.

However, this protective effect, driven primarily by estrogen, is dampened in post-menopausal women. Similarly, low levels of testosterone, as can occur in normally aging men, have also been linked with high inflammatory markers and may underlie their increased risk of lung damage.

“Researchers have also found that the age associated decreases in both sex hormones may increase the severity of a COVID-19 infection,” said Al-Lami. “In view of the well documented role of sex hormones in immune response, it’s important to consider their potential role in developing treatment strategies for COVID-19 patients, particularly for older adults and those with hormone deficiencies.”

Several small-scale clinical studies indicate that testosterone therapy may improve outcomes in hospitalized COPD patients. Future research is needed on this potential effect.

Other authors include UTMB’s Randall Urban, Elena Volpi, Ammar Algburi and Jacques Baillargeon.