What men need to know about COVID-19
Men, if you haven't heard yet - COVID-19 affects us more than women.
Globally, men who contract the coronavirus are hospitalized more often than women and are almost two and a half times more likely to die from it. Men also tend to dismiss the need for masks and other protective equipment.
Experts still have a lot to learn about both COVID-19 and how it affects men, but as more is learned about the disease, the focus is on men. We spoke to five health care providers about what could put men at greater risk and what they can do about it.
Comment from an emergency physician from a university hospital:
Men enter the emergency department as patients with more complications and require lung ventilation more often than women. Some men end up in the ER later in the course of the virus. This can lead to more severe breathing problems and require the use of more invasive measures to facilitate breathing.
Men should actually wear a mask, and if they get sick or get sick and their symptoms get worse, they should see a doctor. For example, if they are discharged from the ER, they must return if their respiratory symptoms worsen. If this happens, it will usually happen between the 10th and 13th days of the illness. What I find helps the men I see: I tend to be up front and meet them on 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 recognize the frustration they feel because they have no control over the situation, and I listen to them
Len H., internist and pulmonologist:
Because there is no natural immunity to COVID-19, all men are susceptible to the infection unless they have had the disease before. Those who smoke, have diabetes, hypertension, coronary artery disease, and underlying autoimmune diseases are particularly susceptible to complications from COVID-19, such as hypoxia, etc. Obesity is also a risk factor.
Obvious strategies for wearing masks, social distancing and hand washing are essential.
I try to encourage men to form a "bubble" with their household contacts and avoid contact with those who can infect them (crowds, travel, sporting events). The male instinct 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, but for the sake of their families."
Travis D. Westbrook, 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? This is complicated. One factor could be related to masculinity and social influences 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 "masculinity" or masculinity, wearing a mask or avoiding large gatherings may appear to him as a sign of fear and weakness.
While masculinity and the avoidance of losing masculinity—as judged by a man—may be part of this, distrust of authority may also contribute to some men's decision to defy public health guidelines. It is also safe to say that men tend to downplay risk more than women. It's not just because of COVID-19. Men are also less likely to wear seat belts and die in accidents more often.
Simply put, no single factor is likely to account for all the differences in men's risk-taking behavior. One possible solution to trying to address these attitudes on an individual level could be to better understand a man's values. For example, a man who values his family and their safety could be shown specific ways in which the use of masks contributes to the safety of his loved ones whom he wants to protect."
Matthew G. Heinz, MD, hospitalist:
"How to tell men about their increased risk?" I hope the facts you already know about COVID-19 help. Because men usually do worse than women. It goes without saying.
We don't fully understand why, but differences in hormones and an enzyme called ACE2 may be responsible for a large part of our decisions. The hormone estrogen makes women more cautious, but men only have a very small amount of estrogen. Men may also have higher ACE concentrations. This enzyme binds to a so-called spike protein in the virus, which makes it easier for COVID-19 to enter the lungs. Although we don't know the exact numbers, we do know that the more viral particles you are exposed to, the more likely you are to become infected.
So what should men do to protect themselves? Wear a mask, wash your hands, maintain social distance. Also, men should remember that they model the behavior of their family members. Remember that your children will behave as you behave. Follow public health guidelines and encourage others to follow your example. Tai protects everyone".
Matthew Rettig, MD, and David Geffen Professor of Medicine and Urology at the Comprehensive Cancer Center:
"We believe that male hormones such as testosterone make men more susceptible to COVID-19, and that these hormones also make it more likely that men infected with the virus will experience more severe symptoms. The question we want to answer in the study, called the HITCH study, is whether suppressing male hormones will reduce the length of time men spend in hospital, the need for intubation, or death. All participants in our study are hospitalized male patients.
Why might it work? Male hormones increase the activity of a gene called TMPRSS2, which the virus needs to enter human cells, including lung cells. So if we block TMPRSS2 by stopping hormone production in men who are hospitalized for COVID-19, it may help them recover faster.
Another reason why male hormones may be important is that they may trigger a different immune system response than female hormones, which may also help explain why men are more likely to develop more severe disease than women. The HITCH trial, which we expect to complete in the next three months, will determine whether the male hormone suppression approach is truly beneficial in hospitalized men with COVID-19.