King's College London

Research portal

Sexual dimorphism in COVID-19: potential clinical and public health implications

Research output: Contribution to journalReview articlepeer-review

Nicole Bechmann, Andreas Barthel, Andreas Schedl, Stephan Herzig, Zsuzsanna Varga, Catherine Gebhard, Manuel Mayr, Constanze Hantel, Felix Beuschlein, Christian Wolfrum, Nikolaos Perakakis, Lucilla Poston, Cynthia L. Andoniadou, Richard Siow, Raul R. Gainetdinov, Arad Dotan, Yehuda Shoenfeld, Geltrude Mingrone, Stefan R. Bornstein

Original languageEnglish
Pages (from-to)221-230
Number of pages10
JournalThe lancet. Diabetes & endocrinology
Volume10
Issue number3
DOIs
Published1 Mar 2022

Bibliographical note

Funding Information: We thank Susan Richter (Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden) for the scientific discussion and editorial review. The authors are supported by the Deutsche Forschungsgemeinschaft within the CRC/Transregio 205, project number 314061271 - TRR205 “The Adrenal: Central Relay in Health and Disease” (NB, SH, CLA, and SRB) and project HA 8297/1-1 (CH). Funding Information: We thank Susan Richter (Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universit?t Dresden) for the scientific discussion and editorial review. The authors are supported by the Deutsche Forschungsgemeinschaft within the CRC/Transregio 205, project number 314061271 - TRR205 ?The Adrenal: Central Relay in Health and Disease? (NB, SH, CLA, and SRB) and project HA 8297/1-1 (CH). Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Publisher Copyright: © 2022 Elsevier Ltd

King's Authors

Abstract

Current evidence suggests that severity and mortality of COVID-19 is higher in men than in women, whereas women might be at increased risk of COVID-19 reinfection and development of long COVID. Differences between sexes have been observed in other infectious diseases and in the response to vaccines. Sex-specific expression patterns of proteins mediating virus binding and entry, and divergent reactions of the immune and endocrine system, in particular the hypothalamic-pituitary-adrenal axis, in response to acute stress might explain the higher severity of COVID-19 in men. In this Personal View, we discuss how sex hormones, comorbidities, and the sex chromosome complement influence these mechanisms in the context of COVID-19. Due to its role in the severity and progression of SARS-CoV-2 infections, we argue that sexual dimorphism has potential implications for disease treatment, public health measures, and follow-up of patients predisposed to the development of long COVID. We suggest that sex differences could be considered in future pandemic surveillance and treatment of patients with COVID-19 to help to achieve better disease stratification and improved outcomes.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454