ReviewFrontiers in physiology2021
The Physiological Mechanisms of the Sex-Based Difference in Outcomes of COVID19 Infection.
Review in Frontiers in physiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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.
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Who cites it
25 citing papers in PubMed, 49 citations in OpenAlex.
- Self-Reported Post-COVID-19 Condition and Associated Factors Using Machine Learning Techniques: A Cross-Sectional Study.Medicina (Kaunas, Lithuania) · 2026Observational
- Roles of sex and SP-A genetic variants in modulating multiorgan injuries post viral infection.Frontiers in immunology · 2026Article
- Sex, hormones, and lung health.Physiological reviews · 2026Review
- Lung involvement percentage in patients with COVID-19 during the Omicron wave in China: a SHAP-explained machine learning study from a single center.Frontiers in public health · 2025Article
- Sex differences in airway disease: estrogen and airway surface liquid dynamics.Biology of sex differences · 2024Review
- Estradiol and Dihydrotestosterone Levels in COVID-19 Patients.Mayo Clinic proceedings · 2023Article
- Review
- Article
- The sex and gender dimensions of COVID-19: A narrative review of the potential underlying factors.Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases · 2022Review
- Article
- Higher premorbid serum testosterone predicts COVID-19-related mortality risk in men.European journal of endocrinology · 2022Article
- Disparities by Sex in COVID-19 Risk and Related Harms Among People with Opioid Use Disorder.Journal of women's health (2002) · 2022Article
- Basic mechanisms of SARS-CoV-2 infection. What endocrine systems could be implicated?Reviews in endocrine & metabolic disorders · 2022Review
- Polycystic ovary syndrome and risks for COVID-19 infection: A comprehensive review : PCOS and COVID-19 relationship.Reviews in endocrine & metabolic disorders · 2022Review
- Sexual dimorphism in COVID-19: potential clinical and public health implications.The lancet. Diabetes & endocrinology · 2022Review
- What are the Genomunities that Govern Sexual Dimorphisms?JSM sexual medicine · 2022Article
- COVID-19 and Preexisting Comorbidities: Risks, Synergies, and Clinical Outcomes.Frontiers in immunology · 2022Review
- Predicting respiratory failure in patients infected by SARS-CoV-2 by admission sex-specific biomarkers.Biology of sex differences · 2021Article
- Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A prospective transient elastography study.International journal of clinical practice · 2021Article
- Genetic and epigenetic control of ACE2 expression and its possible role in COVID-19.Cell biochemistry and function · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The scale of the SARS-CoV-2 pandemic has thrust a spotlight on the sex-based differences in response to viral diseases; morbidity and mortality are greater in men than women. We outline the mechanisms by which being female offers a degree of protection from COVID19, that persists even when confounders such as comorbidities are considered. The physiological and immunological mechanisms are fascinating and range from incomplete X chromosome inactivation of immune genes, a crucial role for angiotensin converting enzyme 2 (ACE2), and regulation of both immune activity and ACE2 by sex steroids. From this flows understanding of why lung and other organs are more susceptible to COVID19 damage in men, and how their distinct immunological landscapes need to be acknowledged to guide prognosis and treatment. Pregnancy, menopause, and hormone replacement therapy bring changed hormonal environments and the need for better stratification in COVID19 studies. We end by noting clinical trials based on increasing estrogens or progesterone or anti-testosterone drugs; excellent examples of translational physiology.
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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.