Men who have lower levels of testosterone are at greater risk to die from the coronavirus, according to an alarming new German study. Researchers at the University Medical Center Hamburg-Eppendorf studied the first 45 COVID-19 patients, 35 men and 10 women who were admitted to its intensive care unit, the Science Times reported. Nine men and three women from the group died.

Meanwhile, seven patients required oxygen and 33 required the use of ventilators, according to the report. Of the 35 men, more than two thirds about 69 percent had low levels of the male sex hormone, which helps control the body’s immune response, while 60 percent of the women had elevated testosterone levels.  Without an ample supply of the hormone, the body can’t regulate its immune response, which could lead to a deadly “cytokine storm,” which occurs when the immune system goes haywire as it tries to kill the pathogen.

Low levels of the hormone can’t control the immune response in men, but the study found that among female patients, higher levels were linked to a higher inflammatory response. “Men with normal testosterone levels do not present a cytokine storm and thus are more likely to survive,” Professor Gülsah Gabriel from the Leibniz Institute for Experimental Virology in Hamburg, who was involved in the research, told the Daily Mail.

Thus, low testosterone levels in men seem to be a risk factor for severe and even fatal disease outcome in men upon infection with so-called ‘cytokine inducing’ respiratory viruses,” he said. Ali Daneshkhah, a research fellow at Northwestern University who was not involved in the study, told the news outlet:

This is what seems to kill a majority of COVID-19 patients, not the destruction of the lungs by the virus itself. It is the complications from the misdirected fire from the immune system.” Some men are born with hypogonadism, the condition in which the body doesn’t produce enough testosterone, while others develop it later in life, usually from infection or injury, according to the Science Times.

Some types of the condition may be treated with testosterone replacement therapy. “With SARS-CoV-2 continuing to infect humans worldwide, it was repeatedly reported that men with COVID-19 are at higher risk to develop severe and even lethal outcome compared to women, independent of age,” the scientists behind the research wrote, according to the UK’s Independent. “Thus, it has become of utmost importance to understand why men are more likely to die from Covid-19 than women,” they added. The study has not yet been peer-reviewed.

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