Already the very first studies on the SARS-CoV-2 coronavirus, conducted in January by the Chinese, showed that the death rate among the stronger sex from this infection is 2 times higher than for the beautiful half of humanity. Further observations over and over again confirm the existence of a gender bias — the virus clearly favors women and is more severe towards men. MedAboutMe found out what is the reason for such universal injustice against men?

Morbidity and mortality: nuances

Morbidity and mortality: nuances

Immediately it is necessary to dot the «and». It’s not about sickness. Women are infected with the coronavirus on an equal footing with men. Studies show that the proportion of infected women correlates with the proportion of women in the population structure. On average, about half — plus-minutes 1-2 percent.

But men are more likely to die from coronavirus. How often — the indicators vary.

The Chinese study says 64% of hospitalized male patients — two-thirds of the total. The mortality rate was 1.7% for women and 2.8% for men.

Studies conducted by scientists from the Istituto Superiore di Sanità (Italy) showed that 60% of people admitted to the hospital are men and only 40% are the weaker sex. On average, 8% of hospitalized men died in Italy at the end of March, compared to 5% of women admitted to the hospital, according to data from the Higher Health Institute in Rome at the end of March.

According to data from New York, mortality among men is 2 times higher than among women: 43 deaths from COVID-19 per 100,000 men and only 23 cases per 100,000 women.

Scientists remind that this is generally characteristic of coronaviruses: SARS-CoV-1, already known to us, which caused the 2003 epidemic, and MERS-CoV, which caused the 2013 outbreak, also kill men more often than women.

Features of male physiology

Receptors for coronavirus

In May, Canadian scientists from the University of Alberta published a study showing that men have higher plasma concentrations of the SARS-CoV-2 coronavirus receptor protein ACE2 than women. Men also have more protein TMPRSS2, which is also involved in the processes of introducing viral RNA into the cell.

Elevated ACE2 values ​​have also been associated with a higher history of cardiovascular disease and worse prognosis in heart failure compared to women. And this also affects the outcome of the disease COVID-19.

Immunity and infections

It is known that men have one sex X chromosome, and women have two. And each of these chromosomes carries genes associated with immunity. As a result, the weaker sex has an immunological advantage — women are better protected from infections. However, the flip side of the coin is that autoimmune diseases in women develop more often.

The small study, which was conducted by scientists in New York and Mumbai, involved 48 men and 20 women infected with the coronavirus. The fairer sex took 4 days to cope with the infection. Men were sick 1.5 times longer — 6 days. This ratio is also confirmed by observations of entire families infected with SARS-CoV-2.

Sex hormones and coronavirus

Well, firstly, the female sex hormone estrogen generally reduces the risk of developing heart and vascular diseases. It is not for nothing that before the onset of menopause, men confidently lead in the category of “cores”. But after estrogen in the female body ceases to be produced in large volumes, ladies quickly catch up with the stronger sex in heart pathologies. So, at least before menopause, women are less likely to be at increased risk of developing COVID-19.

Secondly, if estrogen plays a protective role, then testosterone, on the contrary, seems to work against men. Italian scientists, analyzing data on tens of thousands of people infected with coronavirus in Venice, found that 10% of the patients were treated for cancer, including prostate cancer. Surprisingly, more often than not, cancer increases the risk of death for a person with COVID-19, but not in this case. Patients who underwent treatment, not only tolerated the disease more easily, they also died 4-5 times less often than other patients.

Scientists believe that the whole thing is in antiandrogenic drugs that are prescribed to patients with prostate cancer. They block the production of testosterone by reducing the concentration of the TMPRSS2 protein we have already mentioned. That is why the coronavirus poses less of a threat to such people.

Are the testicles a safe haven for the virus?

One unusual theory claims that the coronavirus has a particular interest in male testicles. Research shows that ACE2 receptors are scattered throughout the body. There are also in the sex glands. But in women there are very few of them in the ovaries, but in men there are a lot of them in the testicles. True, data from semen studies testify against this theory — no coronavirus was found in it, but it should have been if the virus actively multiplied in the testicles. That is, after all, he prefers the respiratory tract.

Features of male psychology: strong but vulnerable

Features of male psychology: strong but vulnerable

After all, men generally die more frequently and at a younger age than women. For 9 out of 10 leading causes of death, men overtake the weaker sex — and this concept should definitely be quoted when we talk about survival, life expectancy and health in general.

Men smoke much more often and more than women — this reason for the gender predisposition of the virus was immediately among the first to be named by Chinese, Italian, and American scientists. And in the tissues of the lungs of smokers, ACE2 receptors are produced by 25% more than in non-smokers. Moreover, most of these receptors are in goblet cells, the very ones that the coronavirus prefers. Namely, these cells produce protective mucus for the lungs. According to scientists, smoking increases the number of «gates» for the coronavirus, allowing it to infect still healthy cells.

Also, smoking is the cause of various chronic lung diseases that play a significant role not in infection with coronavirus, but in the body’s ability to cope with COVID-19 and its most severe complications such as cytokine storm and acute respiratory distress syndrome — they are the ones that lead the patient to mechanical ventilation, sharply reducing his chances of survival.

Men are also more likely to ignore the risks and even manifestations of the disease. It is impossible not to note the increased propensity of men to take risks and break the rules. Psychologists talk about the “invincibility syndrome” that many men have, which makes them less accepting of restrictions, including the need for social distancing. Men also need society more often, they are more prone to close contacts, such as handshakes and hugs, active participation in public events (just remember the stands during football matches).


  • So, the risk of contracting coronavirus for men and women is the same. But further infections in their organisms behave differently. Men are significantly more likely to spread the virus throughout the body, develop COVID-19, and be hospitalized. And after hospitalization, their illness may be more severe, as a result of which they are more likely to be on a ventilator. Therefore, more men than women die after being hospitalized with COVID-19.
  • This means that it is the representatives of the stronger sex who today need to monitor the prevention of coronavirus infection as carefully as possible. If a man is still infected, he should make every effort not to “deteriorate” to the point of needing hospitalization.
  • Psychologists also recommend that men think about the safety of their families — this will allow them to realize the need to follow the rules of social distancing and hygiene during a pandemic.

Androgen-deprivation therapies for prostate cancer and risk of infection by SARSCoV-2: a population-based study (n=4532) / Montopoli M, Zumerle S, Vettor R, et al. // Annals of Oncology April 29, 2020

Gender Differences in Patients With COVID-19: Focus on Severity and Mortality / Jian-Min Jin, Peng Bai, et al. // front. public health April 29, 2020

Plasma angiotensin-converting enzyme 2: novel biomarker in heart failure with implications for COVID-19 / Gavin Y Oudit, Marc A Pfeffer // European Heart Journal 2020 May 14 Volume 41, Issue 19