The role of androgens in COVID-19

Abstract

Background and aim The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency. According to the findings, male patients with COVID-19 infection are at an increased risk for severe complications than females. The causes of this issue are unknown and are most probably multifactorial. Sexual hormones affect the immune system, so estrogen strengthens the immune system, and testosterone suppresses it. Due to the reports of the high prevalence of androgenic alopecia in hospitalized patients with COVID-19 and a higher risk of respiratory disease and increased use of allergy/asthma medications among patients with polycystic ovary syndrome (PCOS) as a hyperandrogenism condition compared with non-PCOS women, this review aimed to evaluate androgens role in COVID-19. Methods 42 related articles from 2008 to 2020 were reviewed with the keywords of androgens, hormonal factors, and hair loss in combination with COVID-19 in medical research databases. Results The evidence of transmembrane protease, serine 2 (TMPRSS2) expression in lung tissue, which is an androgen-regulated gene and expressed mainly in the adult prostate may interpret the increased susceptibility of the male gender to severe COVID-19 complications. Moreover, angiotensin-converting enzyme 2 (ACE-2) acts as a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and male hormones are effective in the ACE-2 passageway and simplify SARS-CoV-2 entry into host cells. Conclusion Further studies on the severity of symptoms in patients with COVID-19 in other hyperandrogenism conditions compared to the control group are recommended.

Polycystic ovary syndrome: Pathways and mechanisms for possible increased susceptibility to COVID-19

“…To gain cell entry, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the host’s angiotensin-converting enzyme 2 (ACE2), in synergy with the host’s transmembrane protease, serine 2 (TMPRSS2); the latter’s expression is androgen-regulated[ 61 , 62 ]. It has been proposed that PCOS, given this condition’s hyperadrogen-emic environment, may entail higher susceptibility to coronavirus disease 2019 (COVID-19)[ 63 - 65 ]. Furthermore, PCOS may also increase susceptibility to COVID-19 via its associated comorbidities (NAFLD, obesity, MetSy and alterations in the gut microbiome) (Figure 2 ).…”

Influência da suscetibilidade genética na incidência e mortalidade de COVID-19 (SARS-CoV-2)

“…O gene ACE2 é encontrado no cromossomo Xp22 e compreende 18 exons. Este atua como um receptor funcional para a síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) (Choudhary et al, 2020;Moradi, Enjezab & Ghadiri-Anari, 2020). O SARS-CoV-2 entra nas células pela interação entre a proteína spike do SARS-CoV-2 e a molécula receptora da enzima conversora da angiotensina 2 (ACE2) expressa na superfície das células alvo, de modo que os polimorfismos e o nível de expressão de ACE2 influenciam a suscetibilidade e consequente patogênese do SARS-CoV-2 (Phillips et al, 2020).…”

Gynecological endocrinology: from the past to the future

“…The higher incidence of the disease in men as compared to women has focused the attention of the scientific community on the particular role of estrogens, androgens and progesterone in the pathogenesis of the disease, mainly in the modulation of the immune system in COVID-19 affected individuals and in the binding strategy of the COVID-19 virus to human respiratory tract cells [3,4]. This rises the attention to the gender differences in the sensitivity to the viral infection and the role of sex steroids in such mechanisms and their impact on women's health.…”