Recent studies linking male sex hormones to severe coronavirus infections point to a potential predictor of disease severity: baldness.

International researchers studying global data on COVID-19 patients have found that in general, the more male hormones called androgens someone has, the easier it is for SARS-CoV-2 to enter and take over their immune systems.

And bald men have more of these hormones than men with full manes, and women.

The findings could explain why more men are getting infected by and dying from COVID-19 than women, and why prepubescent children aren’t as affected by the disease.

The link could also provide another avenue of COVID-19 drug treatments that resemble those taken by people with hair loss disorders. However, some experts warn that more research is needed to fully understand the pros and cons, including harmful side effects.

“We really think that baldness is a perfect predictor of severity,” Carlos Wambier, co-author on two studies on the topic and a Brown University assistant professor of dermatology, told The Telegraph. “We think androgens or male hormones are definitely the gateway for the virus to enter our cells.”

Evidence of gender disparities in coronavirus-related deaths and infections is plentiful.

Differences in social behavior such as increased smoking, poorer hygiene compared to women and the fact that men are more likely to have chronic health conditions could explain the gap.

Sex hormones were always thought to play an indirect role in disease severity, but now they might be directly controlling how easily the pathogen enters your body.

Among 122 men with severe COVID-19 admitted to hospitals in Madrid, Spain, about 79% had androgenic alopecia, or permanent hair loss, according to a study published in the Journal of the American Academy of Dermatology.

That’s “about double the population frequency,” Jenny Graves, a distinguished professor of genetics at Australia’s La Trobe University, wrote in The Conversation.

That study followed a previous, smaller one with many of the same authors that showed among 41 Caucasian men with severe COVID-19 admitted to Spanish hospitals, about 71% were bald.

Why might bald men suffer from more severe COVID-19?

A spiky protein on the surface of coronavirus particles helps the pathogen enter people when it latches onto a receptor on human cells called ACE2, which men have been found to have more of, McClatchy News previously reported.

Before that happens, scientists say an enzyme called TMPRSS2 splits the spike protein, giving it the power to enter human cells, Graves wrote.

The gene responsible for producing TMPRSS2 is activated in the presence of male hormones, particularly dihydrotestosterone, which is “strongly associated” with male pattern baldness, according to Graves.

So, the more male hormones, the more TMPRSS2 “and the easier it is for virus to get in,” Graves said.

A non-peer reviewed study revealed a similar connection between high androgen levels in men and increased severity of COVID-19, according to a paper published in May in bioRxiv.

Women don’t have as much androgen in their blood as men, which could explain why they don’t seem to get it as badly in some cases, Andy Goren, president and chief medical officer at Applied Biology Inc. and co-investigator of the study, told The Brown Daily Herald in April.

And before puberty, both boys and girls have lower levels of androgen, Goren added, explaining why children are more protected from the virus’s wrath than adults.

“The more we know about who is at heightened risk from COVID-19, the better we can target information,” Graves wrote in the Conversation.

Potential COVID-19 treatments using anti-androgens

People with hair loss and some with cancer are given androgen-suppressing drugs to either promote hair growth or slow cancer growth.

Now, some researchers are looking at these drugs to prevent and treat COVID-19.

A study from Italy showed that men with prostate cancer receiving androgen-deprivation therapy had a rate of infection four times lower than men on other treatments, according to a study of 9,280 patients in Italy published in May in the Annals of Oncology.

“Our idea is to go to the healthcare system, identify (COVID-19) patients who have already been on anti-androgens, like Finasteride for hair loss, and look at the rate of hospitalization of this group compared to an aged matched control” group not taking these medications, Goren told The Brown Daily Herald.

But some experts err on the side of caution.

“There have been several recent pieces of research which indicate there may be a link between male hormones and increased risk of COVID-19,” Karen Stalbow, Head of Policy at Prostate Cancer UK, told The Telegraph. “However, most of the research so far has been in the lab, and there is conflicting evidence over whether the hormone therapies have the same impact in the lungs as they would in prostate cells.”

There are clinical trials underway to determine if androgen-suppressing drugs improve symptoms in hospitalized COVID-19 patients.

“Much more evidence is needed before we can know whether these hormone therapies would be an effective treatment for COVID-19,” Stalbow said.

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