Really alopecia Androgenic increases the risk of COVID-19?
Although this may seem strange, science could offer a plausible explanation (that's new).
Let's see we are going to be serious, nowadays every symptom or problem is attributed to COVID-19, so I had a lot of reluctance to write this article at the beginning of our super quarantine.
But why am I writing it now?
While having my delicious cup of coffee, I started as a joke to look for information on the subject for the last article, which by the way if you have not read… I order you to read it clicking here.
And what do they believe?
That there was already enough information, not only from the Cosmopolitan, TvNotas and Hola magazine, but also serious and interesting information, so I decided to write ...
How did this whole love bond between COVID-19 and androgenic alopecia start?
Some recently published small studies suggest that the majority of men hospitalized with COVID-19 are bald, which has caused a stir worldwide.
That's how the gossip started ...
COVID-19 emerged just over six months ago, and in this short period of time, researchers have found much about the disease. Until now, it is known that men, fully grown adults (or as we used to say "the oldest" in my town) and those with comorbidities have a higher risk of suffering more serious coronaviruses.
As the new coronavirus continues to spread around the world, one of the most puzzling aspects of the pandemic has been the reason why the symptoms are so severe for some patients and milder for many others.
Certainly age and underlying health conditions play a role, but they are not the cause of death among younger patients, who are otherwise healthy.
Doctors and scientists continue to publish case data, and an obvious trend is that the severity and deaths of COVID-19 tend to be higher among men than women.
Recently, a group of researchers suggested that men with male pattern baldness (or androgenic alopecia) are more likely to develop severe COVID-19. The link has been proposed based on two different studies on patients in Spain mainly.
Researchers call this risk factor the "Gabrin sign" after Dr. Frank Gabrin, the first American doctor to die of COVID-19. Dr. Gabrin had androgenic alopecia and was also fighting bilateral testicular cancer.
Men suffer more than women from COVID-19
It has been obvious since the beginning of the pandemic. Men are at greater risk of serious infection and death from COVID-19 than women.
There are several possible factors at play here. For one thing, men are more likely to suffer from chronic conditions that are known to be at increased risk of serious COVID-19 disease. These include heart disease and diabetes.
Another is that the immune system of men is not as good as that of women in preventing the severe effects of viral infections.
These factors are indirectly influenced by sex hormones. It now appears that sex hormones could also have a direct effect on the ability of SARS-CoV-2 to enter our cells and establish infection.
What studies are there?
Study Number 1
For the first study, 41 COVID-19 patients with bilateral pneumonia were analyzed. They were all Caucasian men. Of these, 71% had alopecia androgenic (AGA) clinically significant, while the remaining 29% had some signs of AGA. A total of 39% had severe AGA.
Study Number 2: Baldness and COVID
For the second study, the researchers studied 175 COVID-19 patients. The ratio of men to women was 2.3: 1. Of the group, about 79% of men and 42% of women had androgenic alopecia. However, most women were in the older age group compared to men.
Let's call it Study 3
In a recent analysis of 13 US states reporting the number of deaths between men and women, men died more frequently in all cases.
In a letter to the editor of the journal Dermatologic Therapy, Carlos Wambier, associate professor of dermatology and clinical educator at the Warren Alpert School of Medicine at Brown University, and other researchers laid the groundwork for his new hypothesis.
Contributors to the letter are from New York University, Applied Biology, Inc., and universities in Spain, India, and Italy.
Study 4 or Study not very PRO
SARS-CoV-2 enters our cells by binding to ACE2 receptors.
A preliminary study, not peer reviewed, that correlated the androgen levels of hundreds of people in the UK with the severity of COVID-19 supports this theory. A higher androgen level was associated with the susceptibility and severity of COVID-19 in men (but not in women, who have much lower androgen levels in their blood).
The same researchers demonstrated that inhibition of androgen receptors reduced the ability of the SARS-CoV-2 top protein to bind to ACE2 receptors in cultured stem cells.
More things to consider
In the first study, the authors mentioned that it was only based on a visual diagnosis and that no information was available on whether any of the people in the study had already received antiandrogen treatment, as this would change the outcome of the study.
However, it was suggested that given the association, antiandrogen therapy may be beneficial for COVID-19 patients.
The study also noted that hydroxychloroquine (HCQ), the most debated drug for COVID-19, has shown some reducing action of androgens (specifically, testosterone) in mice and that a combination of HCQ and itraconazole is currently being studied for the prostate cancer treatment.
Androgens promote the growth of prostate cancer, so those with the disease receive hormone therapy to reduce the production or use of androgens in the body.
Androgenic Alopecia, Androgens, and SARS-CoV-2
Androgenic alopecia is the most common cause of hair loss in men. Although it also occurs in women, the pattern of hair loss differs in both genders.
In men, hair loss occurs at the "entrances" and the crown initially and leads to a receding of the hairline.
Meanwhile, in women, this hair loss occurs throughout the head and there is no receding of the hairline. It commonly occurs from the midline; that is, it is more noticeable when combing the parting in the middle.
The condition can lead to complete baldness in men but is very rare for women.
Although the exact cause of the condition is unknown, experts suggest it is due to variations in the androgen receptor gene located on the X chromosome.
Androgens are male hormones like testosterone and dihydrotestosterone (DHT). These variations increase the activity of androgen receptors.
Increased expression of the androgen receptor gene has been shown to lead to increased activity of a protein that activates the leading protein of the SARS-CoV-2 virus, which in turn helps it bind to ACE-2 receptors.
I don't know if they remember the WhatsApp networks, but that's why they said that those who took blood pressure medication were leaving us to visit Aunt Coco.
How does this link make biological sense? The good is coming… we will become scientists
SARS-CoV-2 enters human lung cells when a virus surface protein (the top protein) attaches to protein receptors (ACE2 receptors) embedded in the cell surfaces.
How does this work?
Scientists recently discovered that an enzyme called TMPRSS2 cuts the top protein of SARS-CoV-2, allowing it to bind to the ACE2 receptor. This allows the virus to enter the cell.
The gene encoding TMPRSS2 is activated when male hormones, particularly DHT, bind to the androgen receptor (a protein on the surface of cells, including hair cells and lung cells).
Therefore, the more male hormone, the more androgen receptors bind, the more TMPRSS2 is present, and the easier it is for the virus to enter.
A possible treatment option?
If the androgen link is maintained, exploration of antiandrogens would be encouraged as a way to prevent and treat COVID-19.
Many antiandrogens are already approved for the treatment of other diseases. Some, like baldness treatments, have been used safely for years or decades. Some, like cancer treatments, can be tolerated for months.
A study examining men hospitalized with COVID-19 in Italy showed that the infection rate was four times lower in prostate cancer patients with ADT than in untreated ones.
Perhaps a single dose given to someone who tests positive for SARS-CoV-2, or who has been recently exposed, would be enough to decrease the chance of the virus taking hold.
But we need an investigation to confirm this. Several androgen suppressant drugs are undergoing clinical trials to determine if they reduce complications among men with COVID-19.
It will be important to verify that antiandrogen treatment works in both the lungs and prostate, and that it is effective in cancer-free patients. We would also need to find out what dose is effective, and when it should be administered.
Antiandrogen treatments have several side effects in men, including enlarged breasts (gynecomastia) and sexual dysfunction, which is why medical supervision is a must.
Conclusions from me to you
How difficult, how difficult ... where do I start.
The researchers hypothesize that the same male hormones that cause hair loss may be related to patients' vulnerability to SARS-CoV-2, the virus that causes COVID-19.
Although more research is needed to test that hypothesis, a link between androgen hormones and COVID-19 is said to help explain the increased severity for men and have implications for how healthcare providers test and treat the patients.
So it is possible that high levels of androgens increase the risk of severe infection and death from COVID-19.
This hypothesis is important for identifying people at risk and raises the possibility of new treatment strategies for COVID-19.
Link with androgens
It will be important to find out whether, as the androgen hypothesis predicts, patients with excessive or insufficient production of male hormones are at greater or lesser risk of contracting COVID-19.
The androgen link could go a long way toward explaining why men are more susceptible to COVID-19 than women. It could also explain why boys under the age of ten appear to be very resistant to COVID-19 because, until puberty, both boys and girls produce few androgens.
The more we know about who is most at risk of contracting COVID-19, the better we can guide the investigation.
The link to androgens also opens a pathway for the discovery of drugs that could mitigate some of the impact of COVID-19 as it continues to wipe out the world.
The truth sounds cool that you could treat the COVID-19 with hair loss medications (would be a expert in COVID too), but I think this is very much in its infancy and many studies and more scientific rigor are needed in them.