Biological Sex Differences in Long COVID
Key Takeaways
- Researchers are beginning to connect Long COVID’s lingering effects with known patterns in immune and hormonal regulation.
- Evidence from 2023 points to overlaps with other infection-associated chronic illnesses, suggesting shared biological roots.
- Understanding how sex influences inflammation, autoimmunity, and hormone balance could guide more precise diagnostics and treatments.
Recent research is shedding light on how biological sex shapes immune responses and long-term recovery after COVID-19.
Key Takeaways
- Researchers are beginning to connect Long COVID’s lingering effects with known patterns in immune and hormonal regulation.
- Evidence from 2023 points to overlaps with other infection-associated chronic illnesses, suggesting shared biological roots.
- Understanding how sex influences inflammation, autoimmunity, and hormone balance could guide more precise diagnostics and treatments.
A 2023 review in Frontiers in Rehabilitation Sciences examined reproductive and hormonal aspects of Long COVID. The authors identified reports of menstrual irregularities, premature menopause, and possible effects on ovarian function and fertility. They also noted overlaps with other infection-associated chronic conditions such as ME/CFS, POTS, and connective tissue disorders, which share immune and hormonal characteristics and predominantly affect women.
An editorial in The Lancet called for stronger international collaboration to study Long Covid’s biological causes, including viral persistence, autoimmunity, and inflammation, and to incorporate sex-based differences into research and care.
Earlier work by Takahashi and Iwasaki described how immune responses differ between sexes. Estrogen can enhance antiviral defense and modulate inflammation, while testosterone may dampen certain immune pathways. However, women’s stronger immune activation may also increase the risk of persistent inflammation or autoantibody production, potential mechanisms behind Long COVID’s chronic effects.
Together, these studies and more highlight the importance of sex-specific research and greater attention to hormonal and immune factors in understanding and managing Long COVID.
Citations
Pollack, B., von Saltza, E., McCorkell, L., Santos, L., Hultman, A., Cohen, A. K., & Soares, L. (2023). Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review. Frontiers in rehabilitation sciences, 4, 1122673. https://doi.org/10.3389/fresc.2023.1122673
Takahashi, T., & Iwasaki, A. (2021). Sex differences in immune responses. Science (New York, N.Y.), 371(6527), 347–348. https://doi.org/10.1126/science.abe7199
The Lancet (2023). Long COVID: 3 years in. Lancet (London, England), 401(10379), 795. https://doi.org/10.1016/S0140-6736(23)00493-2