This article is the English version of original version in Bahasa Indonesia (April 22, 2020) on the possibility of using Estrogen to reduce the death of COVID-19 - with some update of data and a trial that is ongoing in LA, USA (Source)
Summary: Although the risk of getting infected by SARS-CoV-2 does not discriminate among men and women, the number of fatality cases around the world shows the men are definitely more at risk to develop severe symptoms leading to death. Co-morbid patients both men and women are at higher risk of acquiring the virus infection due to elevated activity of enzyme ACE2 (as results of some anti hypertension medicine), furthermore risk of fatality of these group also increases.
Among the COVID-19 fatal cases due to acute respiratory distress syndrome (ARDS), immunity responses were often preceded with “cytokine storm”. While anti-cytokine drugs are in the market, e.g. tocilizumab (anti IL-6) which being studied in China (will be completed May 3, 2020), price of the medicines makes the availability limited only to certain people. High estrogen level in reproductive women responses aggressively, fast and targeted during innate immunity system responses as well proportional during adaptive immunity response, preventing cytokine storm.
Complexity of men testosterone level and immunity response is yet to be concluded, study has shown that elevated level of testosterone in men resulted lower antibody level acquired following the flu-vaccine shot, on the other hand strong responses were observed in women and men with lower level of testosterone.
The Estrogen (E2: estradiol) inhibits expression of pro-inflammatory cytokines in various type of cell. Women in menopause, in which the level of E2 has dropped drastically, the E1 (Estrone) takes over the function of E2 in immunosuppression. Similar repressive effect on IL-6 and other pro-inflammatory cytokines is although to be the case when phytoestrogens from dietary intake from food like soy (tempeh).
Strong and accurate immune response seen in women antigen SARS-CoV-2 is probably through E2 modulated immune response. If the estrogens are the key in preventing the cytokine storm, fatality cases due to ARDS can be reduced by increasing the level of estrogen (especially E2) from outside body by E2 hormone injection or as simple as taking birth control pills (Estrogen and Progresteron).
Regardless there are ample data showing the possibly adverse effect of the estrogens therapy, short-term use of estrogen in saving patient life outweighs the risk of developing adverse effect in the future. So, it is worth a try, at least for elderly women.
Risk of Infection. Data from various sources show that gender is not correlated with the risk of being infected with SARS-CoV-2. However, patients with COVID - 19 who ended fatally were more on male patients who were> 60 years old. The risk of infection and death becomes greater if SARS-Co-V-2 infects comorbid patients both male and female, e.g. patients with diabetes, high blood pressure, heart disease, asthma and other degenerative diseases.
Finally, data from the most severely affected areas in Italy, Lombardy, showed that 82% of patients entering ICU were male and 70% of COVID-19 deaths were male. Data from USA, male-female segregated data is only the City of New York, as of April 14, 2020, the largest number of deaths was in patients older than 75 years (48%), then 25% for the age range 65-74 years and 23% for the range 45 -64 years old.
