Table 1.

Factors contributing to sexual dimorphism related to COVID-19 morbidity and mortality.

Comorbidities Higher frequency in males: •Hypertension •Cardiovascular disease •Obesity •Diabetes

Sex Hormones • Estrogen • Modulator in lung inflammation • Interaction with ACE2 gene • Shield against coagulopathy • Testosterone • Dual role in inflammation • Possible upregulation of TMPRSS2

Genetic - The X chromosome •Greater dosage of immune-related genes •Greater diversity due to mosaic of paternal and maternal alleles

Gender behavior Greater female engagement in: •Mask wearing •Hand washing •Social distancing

Abbreviations: ACE2: Angiotensin-converting enzyme 2; TMPRSS2: Transmembrane serine protease 2.