'Can Estrogen and Other Sex Hormones Help Men Survive Covid-19?' diff viewer (16/17)

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Can Estrogen and Other Sex Hormones Help Men Survive Covid-19?	Can Estrogen and Other Sex Hormones Help Men Survive Covid-19?
2020-06-17 18:54:28 UTC	2020-06-23 10:56:27 UTC (6 days later)
As the novel coronavirus swept through communities around the world, preying disproportionately on the poor and the vulnerable, one disadvantaged group has demonstrated a remarkable resistance. Women, whether from China, Italy or the U.S., have been less likely to become acutely ill — and far more likely to survive.	As the novel coronavirus swept through communities around the world, preying disproportionately on the poor and the vulnerable, one disadvantaged group has demonstrated a remarkable resistance. Women, whether from China, Italy or the U.S., have been less likely to become acutely ill — and far more likely to survive.
Which has made doctors wonder: Could hormones produced in greater quantities by women be at work?	Which has made doctors wonder: Could hormones produced in greater quantities by women be at work?
Now scientists on two coasts, acting quickly on their hunches in an effort to save men’s lives, are testing the hypothesis. The two clinical trials will each dose men with the sex hormones for limited durations.	Now scientists on two coasts, acting quickly on their hunches in an effort to save men’s lives, are testing the hypothesis. The two clinical trials will each dose men with the sex hormones for limited durations.
Last week, doctors on Long Island in New York started treating Covid-19 patients with estrogen in an effort to increase their immune systems, and next week, physicians in Los Angeles will start treating male patients with another hormone that is predominantly found in women, progesterone, which has anti-inflammatory properties and can potentially prevent harmful overreactions of the immune system.	Last week, doctors on Long Island in New York started treating Covid-19 patients with estrogen in an effort to increase their immune systems, and next week, physicians in Los Angeles will start treating male patients with another hormone that is predominantly found in women, progesterone, which has anti-inflammatory properties and can potentially prevent harmful overreactions of the immune system.
“There’s a striking difference between the number of men and women in the intensive care unit, and men are clearly doing worse,” said Dr. Sara Ghandehari, a pulmonologist and intensive care physician at Cedars-Sinai in Los Angeles who is the principal investigator for the progesterone study. She said 75 percent of the hospital’s intensive care patients and those on ventilators are men.	“There’s a striking difference between the number of men and women in the intensive care unit, and men are clearly doing worse,” said Dr. Sara Ghandehari, a pulmonologist and intensive care physician at Cedars-Sinai in Los Angeles who is the principal investigator for the progesterone study. She said 75 percent of the hospital’s intensive care patients and those on ventilators are men.
And pregnant women, who are usually immunocompromised but have high levels of estrogen and progesterone, tend to have mild courses of the disease. “So something about being a woman is protective, and something about pregnancy is protective, and that makes us think about hormones,” Dr. Ghandehari said.	And pregnant women, who are usually immunocompromised but have high levels of estrogen and progesterone, tend to have mild courses of the disease. “So something about being a woman is protective, and something about pregnancy is protective, and that makes us think about hormones,” Dr. Ghandehari said.
Some experts who study sex differences in immunity, however, warned that hormones may fail to be the magic bullet that some are hoping for; even elderly women with Covid-19 are outliving their male peers, and there is a drastic reduction in levels of hormones for women after menopause.	Some experts who study sex differences in immunity, however, warned that hormones may fail to be the magic bullet that some are hoping for; even elderly women with Covid-19 are outliving their male peers, and there is a drastic reduction in levels of hormones for women after menopause.
The genesis of the estrogen trial at the Renaissance School of Medicine at Stony Brook University on Long Island stemmed from a similar observation, said Dr. Sharon Nachman, the trial’s principal investigator, who credited a Stony Brook surgeon, Dr. Antonios Gasparis, with the idea.	The genesis of the estrogen trial at the Renaissance School of Medicine at Stony Brook University on Long Island stemmed from a similar observation, said Dr. Sharon Nachman, the trial’s principal investigator, who credited a Stony Brook surgeon, Dr. Antonios Gasparis, with the idea.
The trial enrolled its first patient this past week, and preliminary results could be available in a few months, she said.	The trial enrolled its first patient this past week, and preliminary results could be available in a few months, she said.
“It’s totally out of the box, which is how good ideas often start,” said Dr. Nachman, associate dean for research at the Renaissance School, which is part of the State University of New York.	“It’s totally out of the box, which is how good ideas often start,” said Dr. Nachman, associate dean for research at the Renaissance School, which is part of the State University of New York.
The gender gap in coronavirus survival became apparent early in the pandemic. Reports from China indicated men were dying at higher rates, but the disparity was attributed to higher smoking rates. But the outcomes were consistent in other countries, with men in Italy dying at higher rates than women, and men in New York City dying at nearly double the rate of women.	The gender gap in coronavirus survival became apparent early in the pandemic. Reports from China indicated men were dying at higher rates, but the disparity was attributed to higher smoking rates. But the outcomes were consistent in other countries, with men in Italy dying at higher rates than women, and men in New York City dying at nearly double the rate of women.
Scientists who study sex differences say that both biological differences in immunity, as well as behavioral factors are at play. Men smoke more almost everywhere, they say; men also wash their hands less. While women appear to have more robust immune systems, these experts say, the causes are complex and multifactorial, and hormones are only part of the picture.	Scientists who study sex differences say that both biological differences in immunity, as well as behavioral factors are at play. Men smoke more almost everywhere, they say; men also wash their hands less. While women appear to have more robust immune systems, these experts say, the causes are complex and multifactorial, and hormones are only part of the picture.
If such sex hormones were the primary protective factor for women, then elderly women with Covid-19 would fare as poorly as elderly men, because women’s reproductive hormones plummet after menopause, said Sabra Klein, a scientist who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health.	If such sex hormones were the primary protective factor for women, then elderly women with Covid-19 would fare as poorly as elderly men, because women’s reproductive hormones plummet after menopause, said Sabra Klein, a scientist who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health.
But that’s not the case, she said.	But that’s not the case, she said.
“We see this bias across the life course,” Dr. Klein said. “Older men are still disproportionately affected, and that suggests to me it’s got to be something genetic, or something else, that’s not just hormonal.”	“We see this bias across the life course,” Dr. Klein said. “Older men are still disproportionately affected, and that suggests to me it’s got to be something genetic, or something else, that’s not just hormonal.”
“Estrogen has immune modulatory properties — don’t get me wrong,” she continued. “You could get a beneficial effect in both men and women. But if women are better at recovery at 93 years old, I doubt it’s hormones.”	“Estrogen has immune modulatory properties — don’t get me wrong,” she continued. “You could get a beneficial effect in both men and women. But if women are better at recovery at 93 years old, I doubt it’s hormones.”
Research has shown estrogen may have an effect on a protein known as angiotensin-converting enzyme 2 (ACE2), for example. The coronavirus uses ACE2 receptors on the surfaces of cells as an entry route, and ACE2 is regulated differently in men and women, said Kathryn Sandberg, director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University.	Research has shown estrogen may have an effect on a protein known as angiotensin-converting enzyme 2 (ACE2), for example. The coronavirus uses ACE2 receptors on the surfaces of cells as an entry route, and ACE2 is regulated differently in men and women, said Kathryn Sandberg, director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University.
In studies with rats, Dr. Sandberg and her colleagues have shown that estrogen can reduce ACE2 protein expression in their kidneys, so it is possible the hormone may reduce ACE2 expression in men as well.	In studies with rats, Dr. Sandberg and her colleagues have shown that estrogen can reduce ACE2 protein expression in their kidneys, so it is possible the hormone may reduce ACE2 expression in men as well.
Dr. Nachman said, “We may not understand exactly how estrogen works, but maybe we can see how the patient does,” adding that estrogen plays a complex role, both in the early immune response that can help clear a viral infection, as well as in a secondary clean up or repair response, which can evolve into a cytokine storm.	Dr. Nachman said, “We may not understand exactly how estrogen works, but maybe we can see how the patient does,” adding that estrogen plays a complex role, both in the early immune response that can help clear a viral infection, as well as in a secondary clean up or repair response, which can evolve into a cytokine storm.
“While we see women do get infected, their responses are different,” Dr. Nachman said. “We see fewer of them having the second, disregulated immune response.”	“While we see women do get infected, their responses are different,” Dr. Nachman said. “We see fewer of them having the second, disregulated immune response.”
~~Updated June ~~16,~~ 2020~~	Updated June 22, 2020
	A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.	The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.	The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The Stony Brook estrogen trial is recruiting 110 patients who come to the hospital’s emergency room with symptoms like fever, cough, shortness of breath or pneumonia, and who have either tested positive for Covid-19 or are presumed to have the illness, as long as they do not require intubation.	The Stony Brook estrogen trial is recruiting 110 patients who come to the hospital’s emergency room with symptoms like fever, cough, shortness of breath or pneumonia, and who have either tested positive for Covid-19 or are presumed to have the illness, as long as they do not require intubation.
The trial is open to adult men as well as to women aged 55 and older, since they have low levels of estrogen. Half of the participants will be given an estradiol patch for one week, while the other half will serve as a control group, and researchers will follow them to see whether estrogen reduces the severity of their disease.	The trial is open to adult men as well as to women aged 55 and older, since they have low levels of estrogen. Half of the participants will be given an estradiol patch for one week, while the other half will serve as a control group, and researchers will follow them to see whether estrogen reduces the severity of their disease.