Clinical significance of sex hormones in COVID-19

Nasser Mikhail* and Soma Wali

Background: Sex hormones may play a role in excess male lethality from coronavirus disease-2019 (COVID-19).

Objective: To clarify the implications of testosterone and estradiol in the course and prognosis of COVID-19 in men and women.

Methods: PUBMED search until September 7, 2020. Search terms included: COVID-19, sex hormones, testosterone, estrogen, androgen-deprivation, mortality. Due to lack of randomized trials, we included retrospective trials, case series, and pre-print studies.

Results: In men hospitalized with COVID-19, circulating testosterone levels are generally decreased and inversely correlated with pro-inflammatory cytokines. Low testosterone levels may be associated with severe COVID-19 and high mortality. Yet, androgen deprivation therapy as treatment of prostate cancer may be associated with decreased hospitalization and favorable clinical outcomes in COVID-19. In women hospitalized with COVID-19, high testosterone levels directly correlate with pro-inflammatory cytokines. In premenopausal women, estradiol serum levels above 70 pg/ml were associated with decreased risk of having severe COVID-19. Pre-menopausal women using combined oral contraceptives may have decreased risk of COVID-19. Conversely, post-menopausal women taking hormone replacement therapy may have increased risk. In general, pregnant women with COVID-19 seem to have similar disease course as non-pregnant women, but studies were lacking adequate control subjects. 

Conclusions: Preliminary data suggest that androgen deprivation therapy and estrogen could be beneficial as potential treatment of COVID-19 in men and women, respectively. However, the possible therapeutic role of these agents will be only confirmed by randomized trials. 

Keywords:

Published on: Sep 14, 2020 Pages: 60-63

Full Text PDF Full Text HTML DOI: 10.17352/jgro.000088
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