ReviewJournal of endocrinological investigation2021
Gender susceptibility to COVID-19: a review of the putative role of sex hormones and X chromosome.
Review in Journal of endocrinological investigation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
71 citing papers in PubMed, 1 synthesis or guideline pooled it, 124 citations in OpenAlex.
- Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis.AIDS research and therapy · 2022Pooled it
- Cardiac Tissue Damage in a Female Animal Post-COVID Model: Relevance of Chemokine-Mediated Inflammation.Viruses · 2025Article
- Age, sex and seasonal differences in COVID-19 viral load: a Lebanese cross-sectional study.BMC infectious diseases · 2025Article
- COVID-19 Hijacking of the Host Epigenome: Mechanisms, Biomarkers and Long-Term Consequences.International journal of molecular sciences · 2025Review
- Understanding sex and gender disparities in COVID-19 mortality: a narrative review beyond biology.Biology of sex differences · 2025Review
- Association between vaccination status and clinical characteristics among young adults infected with COVID-19.BMC infectious diseases · 2025Article
- Safety comparison of mRNA, viral vector, and inactivated Covid-19 vaccines: incidence of adverse events following primary and booster doses among medical professionals in Malaysia.BMC infectious diseases · 2025Article
- The nasal microbiome modulates risk for SARS-CoV-2 infection.EBioMedicine · 2025Article
- The first assessment of Angiotensin-Converting Enzyme 1 (ACE1) D/I polymorphism and demographic factors in association with COVID-19 outcomes in the Moroccan Population.Molecular biology reports · 2025Article
- Characteristics of Oral Adverse Effects following COVID-19 Vaccination and Similarities with Oral Symptoms in COVID-19 Patients: Taste and Saliva Secretory Disorders.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Review
- Retrospective Analysis of the Effect of Postmenopausal Women Medications on SARS-CoV-2 Infection Progression.Life (Basel, Switzerland) · 2024Article
- Mapping the vast landscape of multisystem complications of COVID-19: Bibliometric analysis.Heliyon · 2024Article
- Nine-Month Trend of IgG Antibody Persistence and Associated Symptoms Post-SARS-CoV-2 Infection.Healthcare (Basel, Switzerland) · 2024Article
- Identification of biomarkers and pathways for the SARS-CoV-2 infections in obstructive sleep apnea patients based on machine learning and proteomic analysis.BMC pulmonary medicine · 2024Article
- Single-Cell Transcriptomics Reveals Pre-existing COVID-19 Vulnerability Factors in Lung Cancer Patients.Molecular cancer research : MCR · 2024Article
- Insights into estrogen impact in oral health & microbiome in COVID-19.BMC microbiology · 2024Article
- A Narrative Overview of Coronavirus Infection: Clinical Signs and Symptoms, Viral Entry and Replication, Treatment Modalities, and Management.Current topics in medicinal chemistry · 2024Review
- Short-term side effects of BNT162b2 vaccine in primary care settings in Qatar: a retrospective study.Frontiers in public health · 2024Article
- Potential protective role of interferon-induced protein with tetratricopeptide repeats 3 (IFIT3) in COVID-19.Frontiers in cellular and infection microbiology · 2024Article
- SARS-CoV-2 vaccine-induced antibodies protect against Omicron breakthrough infection.iScience · 2023Article
11 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe recent emergence of COVID-19 poses a global health emergency. One of the most frequently reported data is sex-related severity and mortality: according to the last available analysis on 239,709 patients in Italy, lethality is 17.7% in men and 10.8% in women, with 59% of total deaths being men. Interestingly, the infection rate is lower in males than in females, with 45.8% and 54.2% of positive cases, respectively, suggesting that gender-related factor may worsen disease evolution. A tentative hypothesis to explain these findings is the role of angiotensin-converting enzyme 2 (ACE2) and serine protease TMPRSS2 involved in viral infection. PURPOSE: In this review, we summarize the available evidence pointing to gender-related differences in ACE2 and TMPRSS2 expression, from both genetic and endocrine points of view.
resultsAltogether, available evidence points toward two not-mutually exclusive mechanisms in gender susceptibility to COVID-19 by sex hormonal regulation of ACE2 and TMPRSS2. On one hand, ACE2 expression could be increased in women, either by estrogens or constitutively by X chromosome inactivation escape or by reduced methylation, providing a larger reservoir of ACE2 to maintain the fundamental equilibrium of RAS regulatory axis. On the other, low levels of androgens in women may keep at low levels TMPRSS2 expression, representing a further protective factor for the development of COVID-19 infection, despite the increased expression of ACE2, which represents the Trojan horse for SARS-CoV-2 entry.
conclusionsBoth mechanisms consistently point to the role of sex hormones and sex chromosomes in the differential severity and lethality of COVID-19 in men and women.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.