The role of immunological differences between females and males in the responses to SARS-CoV-2 infection appears to be justified. There is ample evidence that antiviral immunity differs between the sexes. These are caused by e.g., sex steroid hormone signaling (i.e., testosterone, estrogens, and progesterone), genetics (e.g., immune function genes that escape X inactivation), and sex-specific composition of the microbiome. Sex differences in immunosenescence and immune function not only impact immunity to viruses, but to vaccines and immunotherapies, as well. In the context of SARS-CoV-2, these differences could impact susceptibility and initial response to the virus as well as choice of acute and long-term therapy of the COVID-19 pathology. In current and future trials for COVID-19, sex as a biological variable should be factored in and understood, along with the wider gendered implications of the COVID-19 crises, with the broader concept of how biological factors intersect with gendered differences in exposure, transmission, and socio-economic means. Consequently, the pandemic may not just lead to differences in disease susceptibility and manifestation between men, women, and people with non-binary identities, but also exacerbate unequal access to treatment and long-term vulnerabilities
Bischof, E., Oertelt-Prigione, S., Morgan, R., Klein, S.L., The Sex and Gender in COVID19 Clinical Trials Working Group (SGC), Gender and COVID19 Working Group (2020) Towards Precision Medicine: Inclusion of Sex and Gender Aspects in COVID-19 Clinical Studies—Acting Now before It Is Too Late—A Joint Call for Action. Int. J. Environ. Res. Public Health 2020, 17, 3715.