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Sex differences in COVID-19 course and outcome: progesterone should not be neglected

to the editor: Almost immediately after the pandemic outbreak in China, sex differences in COVID-19 vulnerability and clinical presentation were observed (9, 17, 23), indicating some protective mechanism in females. A reasonable biological explanation was offered by well-known estrogen ability to boost immune response and likely modulate angiotensin-converting enzyme 2 (ACE2) expression (4, 6, 18, 22), which should imply a lower rate of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in females because of the more robust immune response. However, recent retrospective studies using large, pooled sex- disaggregated data from countries worldwide find no differences in the number of COVID-19 cases between the sexes, but higher severity [according to the number of hospitalizations and intensive care unit (ICU) admissions] and case fatality in males (7, 16)

COVID-19sex differences ; progesterone

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