This is why men are at a higher risk of severe COVID-19 courses


Updated March 25, 2021 at 11:04 p.m.

  • Men have a significantly higher risk of developing COVID-19 seriously and are also more likely to die from the consequences of the infection.
  • These are the figures from the Global Health 50/50 database, which collects gender-specific data on Sars-Cov-2 worldwide.

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According to her, a man is 31 to 47 percent more likely to die from COVID-19 than women. According to data from the Robert Koch Institute, 3.1 percent of men in Germany die after a corona infection, while 2.7 percent of women are infected. The gender difference is particularly noticeable among those over 80 years of age. Of them, 27 percent of men died after being infected with SARS-CoV-2, compared with only 16 percent of women.

Gender differences in many viral infections not only corona

Various factors are responsible for the body’s own response to the virus, which varies according to the sexes. To this end, Marcus Altfeld is researching at the University Hospital Hamburg Eppendorf. The previously known gender-specific differences in virus defense can be transferred to the coronavirus SARS-CoV-2, according to the scientist. “There are gender differences for most viral infections. It would have been surprising if it had been different with COVID-19,” says the expert. “Because it is precisely the mechanisms with which the immune system can recognize viruses and respond to them that differ between the sexes.”

The immune system of women recognizes viruses faster and can therefore fight infections better. One reason for this lies in the genes. “The fact that women have two X chromosomes and men only one is crucial,” said Altfeld. Much of the information needed to identify viruses would lie on genes on the X chromosome. “Because women have a second X chromosome, the genes there can be read twice,” says the immunologist. As a result, the body receives more information about the invading virus more quickly than is the case with men, who each have an X and a Y chromosome. In women, a higher concentration of messenger RNA (messenger ribonucleic acid) as a messenger substance as well as the proteins of molecules, which then trigger an immune reaction of the body against the virus, is formed more quickly.

Estrogen can strengthen immune cells

In addition, the sex hormones estrogen and testosterone can play a role in how the bodies of men and women react to SARS-CoV-2. “Most of our immune cells have receptors that enable them to recognize sex hormones and respond to them,” says Altfeld. “Put simply, one could say that the female sex hormone estrogen in most cases increases the function of immune cells, while the male testosterone weakens them. This seems to contribute to the fact that men and women react differently to viral infections.”

However, it should be remembered that severe Covid 19 courses mostly affect patients over 50. “Women are then mostly past menopause, so that the estrogen level drops. However, you know that the immune system can remember. So it would be possible that it also remembers the previous hormone level. But that is an area that still exists has not been adequately researched, “said the scientist. “I think it will take a lot more research to understand exactly what the role of sex hormones is in COVID-19.” However, the advantage that women have in virus detection through their two X chromosomes persists even at an advanced age, regardless of the estrogen level.

Men’s immune systems age earlier

Men’s immune systems also age faster. This could be another factor that makes them more likely to get COVID-19 from the age of 50. “There is research into ‘aging of the immune system’. According to him, there is data showing that the immune system in men begins to age five to eight years earlier than it does in women,” says Altfeld.

But when it comes to the question of why men are more likely to get seriously ill with COVID-19, it is not only biological factors that have to be taken into account. They tend to lead an unhealthy lifestyle, which can weaken the immune system and favor previous illnesses. These include alcohol and nicotine, an unhealthy diet, lack of exercise and being overweight. These factors are often the main causes of lung and cardiovascular diseases such as thrombosis and vascular occlusion. In combination with SARS-CoV-2, this creates a combination that is very unfavorable for the course of the disease. Women, on the other hand, work more often as carers, nurses or kindergarten teachers. This could make them more likely to be in contact with viruses, which could also help immunize them.

Women are more likely to suffer from autoimmune diseases

The fact that the body of women reacts more quickly to viral infections also means that they develop stronger immune responses to vaccines more often, but also show more violent vaccination reactions and side effects. Your immune system then reacts more strongly to the artificially induced confrontation with virus particles or other vaccine components such as RNA vaccines. With their immune system, which is easier to activate, this is why women are more likely to develop autoimmune diseases such as rheumatism and lupus compared to men, according to Altfeld.

About the expert: Prof. Dr. Marcus Altfeld heads the Virus Immunology Department at the Heinrich Pette Institute, Leibniz Institute for Experimental Virology. He is also director of the Institute for Immunology at the University Medical Center Hamburg Eppendorf and coordinator of the research area HIV in the German Center for Infection Research.


  • Conversation with Prof. Dr. Marcus Altfeld
  • Gender Differences Database in COVID-19
  • Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission
  • Robert Koch Institute: Epidemiological profile on SARS-CoV-2 and COVID-19

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men higher risk severe COVID19 courses


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