Men, in case you haven’t already heard – COVID-19 hits us harder than it does women. Around the world, men who get the novel coronavirus more often wind up in the hospital than women, and they are nearly two and a half times more likely to die from it. Men also tend to discount the need for masks and other protective measures.
Experts still have a lot to learn about men and COVID-19, but the whys and hows of its heightened impact on men are coming into sharper focus as they learn more about the disease. We talked to five health care providers about what might put men at higher risk and what they need to do about it.
Eric Cioe-Peña, MD, MPH , Director of Global Health, Northwell Health, New Hyde Park, NY, and emergency medicine physician at Staten Island University Hospital, Staten Island, NY:
“Anecdotally, men come to the emergency room when they're sicker, with more complications, and with a greater need for ventilator support than women. And some men do come to the ER later in the course of the virus. That can lead to more severe respiratory issues and less time to use non-invasive means of support to aid their breathing.
What men really need to do is wear a mask, and they need to see a doctor when they get sick or if they are sick and start to feel worse. For example, if they’re discharged from the ER, they need to come back if their respiratory symptoms get worse. If that’s going to happen, it’ll usually occur on days 10 to 13 of their illness. What I find helps with the men I see: I tend to be up front and meet them at their level. I don’t want to patronize them or try to scare them or act like a “tough guy” telling them what to do. I acknowledge the frustration that they feel because they don’t have control over the situation, and I listen to them.”
Len Horovitz, MD , internist and pulmonologist, Lenox Hill Hospital, NYC:
“Since there is no natural immunity to COVID-19, all men are susceptible to infection unless previously infected. Those who smoke, have diabetes, hypertension, coronary artery disease and underlying auto-immune problems are particularly susceptible to complications of COVID-19, such as requiring oxygen or hospitalization. Obesity is also a risk factor.
The obvious mitigation strategies of masks, social distancing, and hand washing are fundamental.
I try to encourage men to form a ‘bubble’ or ‘pod’ with their household contacts, and to avoid contact with those who may be exposing them (in crowds, travel, sporting events). The instinct of men to protect their families by adopting this behavior has been effective, and I make sure to tell my male patients to follow the recommended preventive measures if not for themselves than for the sake of their families.”
Travis D. Westbrook, PhD , clinical psychologist and Assistant Professor, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center:
“When asked if they wear masks or practice social distancing, more men than women say no. Why? That’s complicated. One factor could relate to masculinity and social influence on men’s attitudes and behavior. For example, men are socialized to suppress negative emotions and maintain a ‘strong’ outward appearance. If a man strongly identifies with these definitions of ‘manliness’ or masculinity, then wearing a mask or avoiding large gatherings may seem to him to be a sign of fear and weakness.
And while masculinity and avoidance of losing masculine status—being seen as less of a man—may be part of it, lack of trust in authority and government also may contribute to some men’s decision to ignore public health guidelines. It is also safe to say that men tend to downplay the risk more than women. That’s not exclusive to COVID-19. Men also are less likely to wear seatbelts and they are more likely to die in accidents more broadly.
Simply put, no single factor likely accounts for all the variance in men’s risky behaviors. One potential solution when attempting to address these attitudes on an individual level could be to better understand the man’s values. For example, a man who values caring for and safeguarding his family could be shown specific ways that mask use contributes to the safety of his loved ones who he wants to protect.”
Matthew G. Heinz, MD , Hospitalist (hospital physician), internist in Tucson, AZ:
“How do you get the message to men about their heightened risks? I hope that getting educated and learning about COVID-19, listening to the facts and science will help. Because men do tend to do worse than women. That’s now pretty clear.
We don’t completely understand why, but much of it is likely due to differences in hormones and an enzyme called ACE2. The hormone estrogen may give women a protective edge, but men only have a very small amount of estrogen. Men may also have higher concentrations of ACE2. This enzyme binds with what’s called a spike protein contained in the virus, which allows COVID-19 to more easily get into the lungs. And while we don’t know the exact numbers, we do know that the greater number of viral particles that you’re exposed to, the sicker you’re likelier to get.
So, what should men do to protect themselves? Wear a mask, wash your hands, maintain social distance. But more than that, men should remember that they model behavior for their family members. Keep in mind that your kids look to you for what to do. Follow public health guidelines and encourage others to follow your lead. That protects everyone.”
Matthew Rettig, MD , professor of medicine and urology at the David Geffen School of Medicine at UCLA and UCLA Jonsson Comprehensive Cancer Center:
“We think that male hormones such as testosterone make men more susceptible to COVID-19 and that those hormones also increase the odds that men who get the virus will have a more severe illness. The question we want to answer with our research, known as the HITCH study, is whether suppressing male hormones will shorten men’s time in the hospital, reduce their need for intubation, and prevent them from dying. All of our study participants are hospitalized male veterans.
Why might this work? Male hormones happen to increase the activity of a gene called TMPRSS2, which the virus requires in order to gain entry into human cells, including lung cells. So, if we block TMPRSS2 by shutting down the production of male hormones among men hospitalized for COVID-19, that may help them recover more quickly.
Another reason male hormones could be important: They may trigger different responses from the immune system than female hormones, and that too may help explain why men are likelier to have a more severe form of the illness than women. The HITCH study, which we hope to complete within the next three months, will determine if the approach of suppressing male hormones is truly beneficial to hospitalized men with COVID-19.”