Why COVID-19 Affects Men and Women Differently

What are the main things to consider when we talk about health in terms of sex and gender?

Biological differences

There are sex- and gender-based biological differences in many aspects of health. We know that there are tremendous differences in the prevalence of disease by sex. Certain conditions are more common in women, such as osteoporosis, multiple sclerosis, autoimmune disorders, and depression. There are other conditions that are more common in men, such as coronary heart disease, Parkinson’s disease, and ALS (amyotrophic lateral sclerosis). So we already know about differences in disease prevalence, but it’s just as important to keep in mind that there are sex- and gender-based differences in how diseases manifest themselves. Think about the symptoms of heart disease, as an example. There is a great deal of overlap in symptoms, but there are also distinct differences: Heart attacks are generally known to cause crushing chest pain, but that’s a symptom more prevalent in men. Women are more likely than men to have symptoms such as nausea, shortness of breath, or pain in the jaw or neck.

We consider sex differences when we develop and prescribe medications because of how sex hormones interact with medications and because of differences in body size and the volume of distribution, metabolism, and excretion of drugs. Many drugs have different dose recommendations in men and women because of these differences. (For example, women are more sensitive to the sleeping medication Zolpidem [Ambien] and to anticlotting medications.) So there are differences not only in disease prevalence but also in symptom presentation and response to therapeutics.

“It’s also more common for men than women to have a sense of invincibility: ‘This will not affect me, so I don’t need to worry about it.’”

This is also relevant to infectious disease because there’s a biological basis for sex differences in the immune response. We know that some of the genes that determine our immune response are on the X chromosome. Hormonal differences can also account for the fact that women tend to have more robust immune responses than men. In addition, we know that those at the highest risk of poor clinical outcomes are older adults and those who have comorbidities, such as diabetes, obesity, hypertension, and coronary heart disease. And there’s a higher prevalence of coronary heart disease, emphysema, and some of these other risk factors in men than in women.

It’s also important to think about sex and gender when we talk about the influence of health conditions on emotional well-being. Women are known to be more susceptible to stress-related disorders, such as anxiety, depression, and post-traumatic stress disorders. In terms of the COVID pandemic, although men are more likely to die from COVID, women may be more susceptible to the long-term mental and emotional repercussions of prolonged isolation and the stress and fear associated with a pandemic virus.

Sociocultural and behavioral differences

There are many behavioral factors that could relate to the risk of contracting an infection as well as the risk of poor outcomes related to that infection. And of the behavioral factors that influence health as a whole, many of them are affected by sociocultural factors, including our perceived gender roles in society.

Some examples: the likelihood an individual will seek medical attention for their symptoms when they get sick, how vigilant they are about their medical appointments and taking their prescribed medications, and even handwashing and other preventive behaviors for transmissible disease. These are important for overall health as well as the risk of COVID-19. Some studies suggest gender differences favoring women in many of these areas. It’s also more common for men than women to have a sense of invincibility: “This will not affect me, so I don’t need to worry about it.”

Men may also be more likely to smoke—and in some countries there are enormous differences in smoking between men and women. Smoking is a risk factor for many health conditions, including severe COVID illness.

However, women have been particularly adversely affected by job loss and financial strains related to COVID, given that women are more likely to be employed in the service industries that have been most heavily impacted by the pandemic.