I know that this post is not related to hip fracture, but I’m curious and wonder whether anyone can re-assure me that they’re already researching the following, or tell me why I’m wrong!

Around the World to date, deaths among men contracting coronavirus occur up to twice as commonly as they do among women, and we’re not quite sure why.

It has been suggested that this may be because many more (Chinese and Italian) men smoke than women, but this is not the case in all populations (e.g. UK gender smoking ratio 44%F/56%M).

It’s the same picture with alcohol. Men generally drink more than women, but gender alcohol intake ratios do not appear to correlate strongly with gender fatality rates in many countries.

What about relative ill health? On average, men die earlier than women in most countries and have more co-morbidities, particularly of the cardiorespiratory systems that are so adversely affected by coronavirus infection, so this would seem to be a possibility.

But what about other relative factors? Lack of exercise? Lack of routine medical check-ups? Risky behaviour? Loneliness and lack of social support?

In other words, what about testosterone?

After all, some of the above gender differences are hormonal in their aetiology, at least in part.

I wonder, then, whether there is a ‘triple-whammy’ hormonal mechanism contributing to the higher relative case fatality rate in men infected with coronavirus:

  1. Higher testosterone levels when young contribute to biopsychosocial changes that pre-dispose to severe coronavirus infection (e.g. smoking, drinking, cardiorespiratory disease)
  2. Low testosterone levels when older contribute to pathophysiology that ‘weaponises’ impaired immune function (e.g. altered Th1/Th2 balance, diabetes, obesity)
  3. Coronavirus, like other viruses, may enter the testes and impair testosterone secretion further

Pubmed ‘testosterone’ and ‘COVID-19’/’coronavirus’ and nothing pops up. Ditto Google.

Is anyone measuring hormonal differences between survivors/non-survivors? Is there any mileage in early testosterone replacement therapy? I know it’s unlikely to be a magic bullet, but is this something worth looking at? Am I absurdly reductionist?

Immunologists/endocrinologists … over to you!

Stay safe.