Sex Steroids in COVID-19 Patients with Hypertension: An Exploratory Study

Area of Science:

• Endocrinology
• Immunology
• Infectious Diseases

Background:

• Sex and gender disparities significantly impact COVID-19 outcomes, with males experiencing higher hospitalization and mortality.
• Sex hormones (estradiol, progesterone, testosterone) are implicated in inflammation, immune response, and vascular health, but their role in COVID-19 severity, especially with hypertension, is unclear.

Purpose of the Study:

• To investigate circulating sex hormone levels and neuroactive metabolites in hypertensive COVID-19 patients.
• To determine the association between these hormonal profiles and COVID-19 disease severity.

Main Methods:

• Measurement of serum sex hormones (estradiol, progesterone, testosterone) and neuroactive metabolites.
• Analysis of hormonal levels in 116 hypertensive COVID-19 patients stratified by sex, menopausal status, and disease severity (hospitalization, ICU admission).

Main Results:

• Distinct sex-based hormonal profiles were observed. Males had higher estradiol and testosterone; postmenopausal females had higher progesterone.
• Hospitalized patients showed elevated estradiol and progesterone, while ICU patients had lower levels of all three hormones.
• Specific metabolite associations were found: elevated 3α-diol linked to hospitalization/ICU in males; lower allopregnanolone and estradiol correlated with hypoxia.

Conclusions:

• A dynamic, sex-specific hormonal response to COVID-19 progression occurs in hypertensive individuals.
• Early increases and late decreases in protective sex steroids suggest a complex regulatory mechanism.
• Findings may aid clinical risk stratification and sex-targeted COVID-19 therapies.