Effect of sex hormones on coronavirus disease 2019: an analysis of 5,061 laboratory-confirmed cases in South Korea

Abstract

Objective: To evaluate the effect of female sex hormones on the clinical outcomes of coronavirus disease 2019 patients using national claims data. Methods: This retrospective cohort study used the Health Insurance Review and Assessment data of 5,061 adult patients with laboratory-confirmed coronavirus disease 2019 in South Korea from January 20 to April 8, 2020. To evaluate the effect of hormone therapy on clinical outcomes among women, subgroup analyses using age-matched case-control data were performed. Results: Coronavirus disease 2019 was most prevalent in women in the 20-39 years age group (1,250 [44.14%]). Men were more likely to receive oxygen therapy (144 [6.46%] vs 131 [4.63%], P = 0.004), be admitted to the intensive care unit (60 [2.69%] vs 53 [1.87%], P = 0.049), and have a longer length of stay after admission to the intensive care unit (19.70 ± 11.80 vs 14.75 ± 9.23, P = 0.016). However, there was no significant difference in the mortality rate (men vs women: 42 [1.88%] vs 42 [1.48%], P = 0.267). In the multivariable Cox analysis, older age and underlying comorbidities, but not sex, were independent risk factors for mortality. Hormone therapy was not significantly associated with clinical outcomes. Conclusions: This study, using nationwide data, suggests that female sex hormones are not associated with the morbidity and clinical outcomes of coronavirus disease 2019 in South Korea.

Sex- and gender-related differences linked to SARS-CoV-2 infection among the participants in the web-based EPICOVID19 survey: the hormonal hypothesis

“…A study investigating 152,637 female users of a COVID Symptom Tracker Application in the UK reported that postmenopausal women had a higher rate of predicted COVID while pre-menopausal women taking the contraceptive pill had a significantly lower rate of predicted COVID-19 and hospitalizations with respect to their post-menopausal counterparts [17] . The authors of a study carried out in South Korea did not find any association between females who had been taking HT over the past year and morbidity and clinical outcomes of COVID-19 [19] . Although it is impossible to exclude that postmenopausal females are more susceptible to SARS-COV-2 infection due to age-related factors and comorbidities rather than to lower oestrogen levels, our data suggest that HT may play a protective role against COVID-19 in older females.…”

“…Conversely, androgens may predispose males to a more severe COVID-19 progression [16] . To the best of our knowledge, only a few studies have investigated the sex- and gender differences linked to the SARS-CoV-2 infection [ 2 , 3 , 5 ] and the potential therapeutic role of sex hormones [17] , [18] , [19] , [20] .…”

Is menopause a potential risk factor for severity of COVID-19: A retrospective cross-sectional study?

“…13 Lee et al, did not find a positive correlation between menopause with severe disease. 14 On the other hand, Neha et al, 12 found a statistically significant difference in oxygen demand, hospital stay, and progression to severe illness in the menopause group compared to the non-menopause group. Our analysis also observed similar conclusions that the Covid-19 is more severe among postmenopausal women.…”

Role of Short-Term Estradiol Supplementation in Symptomatic Postmenopausal COVID-19 Females

“…failed to show any beneficial effect of menopausal hormone therapy (MHT) on COVID-19 postmenopausal women. [ 29 ] Similarly, Bonaccorsi et al . could not find any evidence that women on MHT have a lower risk than untreated women.…”