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Estradiol and Dihydrotestosterone Levels in COVID-19 Patients

Published:January 16, 2023DOI:
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      To determine differences in plasma sex hormone levels in male and female COVID-19 patients and healthy volunteers (HVs), since cell entry of SARs-CoV-2 virus occurs via the ACE-2 receptor which is downregulated by 17β-Estradiol.

      Patients and Methods

      Citrated plasma samples were collected from 101 COVID-19 patients upon presentation to the Emergency Department and from 40 HVs between November 1, 2020, through May 30, 2021. Plasma 17β-Estradiol and 5α-dihydrotestosterone (DHT) levels were measured using ELISA (pg/mL). Data presented as median and quartiles [Q1, Q3]. Wilcoxon rank sum test, p<.05 significant.


      COVID-19 patients (median age 49 years) included 51 males and 50 females (25 post-menopausal). Hospital admission was required for 59% of male patients and 48% of female patients (16 post-menopausal). HVs (median age 41 years) included 20 males and 20 females (9 post-menopausal). Female COVID-19 patients were found to have decreased 17β-Estradiol levels (18.5 [10.5, 32.3]; 41.4 [15.5, 111.0], p=.025), and lower 17β-Estradiol to DHT ratios (0.073 [0.052, 0.159]; 0.207 [0.104, 0.538], p=.015) than female HVs. Male COVID-19 patents were found to have decreased DHT levels (302.8 [249.9, 470.8]; 457.2 [368.7, 844.3], p=.005), compared to male HVs. DHT levels did not differ between female COVID-19 patients and female HVs, while 17β-Estradiol levels did not differ between male COVID-19 patients and male HVs.


      Sex hormone levels differ between COVID-19 patients and HVs, with sex-specific patterns of hypogonadism in males and females. These alterations may be associated with disease development and severity.

      Key Words


      ACE (angiotensin converting enzyme), COVID-19 (coronavirus disease 2019), DHT (5α-dihydrotestosterone), ED (emergency department), IFN-γ (interferon-γ), IL (interleukin)