Gender-based differences in COVID-19: a key role for testosterone

A new study, coordinated by Sapienza University in collaboration with Campus Bio-Medico University of Rome, has demonstrated the key role of the male hormone in SARS-CoV-2 viral entry. The outcomes, published on Metabolism Journal, indicates testosterone as sentinel-hormone to prevent and treat Coronavirus infection in men.

Covid-19 affects men more than women. Several studies have demonstrated that about 60% of people hit by the virus are, in fact, males. Why this difference?

A new work coordinated by Andrea Lenzi of the Department of Experimental Medicine in collaboration with Paolo Pozzi of Campus Bio-Medico, University of Rome provides an answer. The study, published on Metabolism Journal, analysed the specific role of testosterone, identifying it as sentinel-hormone to prevent and treat Covid-19 in male individuals.

"In our hypothesis, we have addressed the problem of testosterone, the male hormone par excellence, which can be higher or lower covering a wide range of variation in male populations – says Paolo Pozzi, Professor of Endrocrinology at Campus Bio-Medico, University of Rome and Director of Endocrinology and Diabetology at Campus Bio-Medico university general hospital. We know that testosterone levels decrease with age, so elderly individuals, that is, those more affected by Coronavirus, are also those with lower testosterone levels".

The study shows how low testosterone levels may cause a reduction in respiratory muscle activity, in their overall strength and mode of operation, whereas regular circulation of this male hormone shows ameliorative effect in breathing. Moreover, a low level of testosterone in the blood causes an increase in inflammatory processes resulting in a worsening of the Covid-19 prognosis.

"On the other hand – notes Andrea Lenzi, Professor of Endocrinology at Sapienza University and coordinator of the Endocrine-Metabolic and andrological area at the Umberto I general hospital of Rome – an extreme androgenic activity may be harmful in those individuals whose testosterone works too much, that is, where there is a different capability in its receptor in transmitting its signal. Since one of the proteins the virus uses to access the cells, called TMPRSS2, is very sensitive to androgens, nowadays the activity of the male hormone on the viral entry is taken into great consideration. As a matter of fact, this protein, regulated by testosterone and therefore already studied in prostatic neoplasia pathology, in the future, might become a possible therapeutic target for male individuals affected by COVID-19".


Testosterone, a key hormone in the context of COVID-19 pandemic - Paolo Pozzilli, Andrea Lenzi - Metabolism Clinical and Experimental Published: April 27, 2020 DOI:


Further Information:

Andrea Lenzi
Dipartimento di Medicina sperimentale

Monday, 04 May 2020

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