Covid-19: Why do men die more often?

Lisa Vogel studied departmental journalism with a focus on medicine and biosciences at Ansbach University and deepened her journalistic knowledge in the master's degree in multimedia information and communication. This was followed by a traineeship in the editorial team. Since September 2020 she has been writing as a freelance journalist for

More posts by Lisa Vogel All content is checked by medical journalists.

The numbers are now clear: men are more likely to die of Covid-19. But why? Scientists pursue different assumptions.

Men have a worse prognosis than women when it comes to coronavirus disease. They are often more severely ill with Covid-19 and more likely to die. What initially appeared to be a phenomenon from China with its high number of smoking men has now been confirmed worldwide. Data from the Global Health 50/50 research initiative from more than 20 countries show that women are infected with the same frequency as men. In terms of death rates, however, the distribution is around one-third to two-thirds.

"It definitely affects more men"

"We see that here in Germany too. We have a lot of male patients," says Clemens Wendtner, chief physician at the Infectious Disease Clinic at Munich Clinic Schwabing, who treated the very first corona patients in Germany in February. And Christoph Spinner from the Klinikum rechts der Isar at the Technical University of Munich (TUM) also says: "There are definitely more men affected".

According to the situation report from the Robert Koch Institute (RKI) on June 21, at least twice as many men as women died across all age groups up to 70 to 79 year olds. Only then does the ratio initially equalize and reverse from the age group of 90 to 99 year olds. Possibly because there are more very old women than men. Regarding the reasons, the RKI only says that there are many unanswered questions. It will take some time before a reliable assessment is possible.

Men live less healthily

One guess: the often unhealthy lifestyle of men. Especially men of the older generation, in whom less attention was paid to diet and lifestyle, could suffer more from previous illnesses. It is also conceivable that men simply go to the doctor later - and therefore procrastinate illnesses longer.

More docking points for the virus?

But the most talked about is the so-called ACE2 receptor, through which the Sars-CoV-2 virus can penetrate the lungs. According to a study, it occurs in higher concentrations in men. The team from the University Medical Center Groningen had investigated the connection between ACE2 and chronic heart failure and determined the gender difference. The reason for the higher concentration of ACE2 in men is not known, the researchers write in the "European Heart Journal".

The enzyme, which appears in the lungs, kidneys, blood vessels, heart and gastrointestinal tract, is considered the entry point for coronaviruses - for common colds as well as for the coronavirus-triggered diseases Covid-19, Sars and Mers. At Mers, too, men were more severely affected, says Bernhard Zwißler, Director of the Clinic for Anesthesiology at the LMU Klinikum.

It is currently being investigated whether the administration of ACE inhibitors as antihypertensive agents leads to the fact that cells increasingly produce the ACE2 receptor and are therefore more susceptible to infection. That is certainly conceivable, but it has not yet been proven.

Risk factor: heart problems

Cardiovascular diseases are a risk factor for Covid-19 anyway - and men are more affected by it than women. "Globally speaking, men are more likely to die of cardiovascular disease. But we don't know whether that is the key," explains Spinner. He also sees a possible explanation in the different regulation of the ACE2 receptor, but also urges caution when interpreting the previous findings.

Women have strong defenses

Some experts also see the female hormone estrogen with its protective mechanism of action or the stronger immune system of women as factors for the different courses - without there being any clear evidence here.

According to virologists, the fact that the immune system of women reacts faster and stronger to viral infections than that of men is also evident in other viral diseases, such as the flu, Sars and Mers. Or with simple colds - jokes about the "men's cold" seem to contain a real core. On the other hand, women more often suffer from auto-immune diseases in which the immune system overshoots and attacks their own cells - a possible complication also with Covid-19.

Countless studies are currently running around the world on Covid-19, including the gender-specific differences. Doctors hope that clarifying this question will also open up new ways of treatment. (lv / dpa)

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