Abstract
Objective: To evaluate sex differences in immune response to COVID-19 related to hormonal influence. Methods: A bibliographical, exploratory research, integrative review type was carried out. The search for articles was performed in the electronic databases PubMed, Biblioteca Virtual em Saúde (BVS) and Scientific Electronic Libray Online (SciELO) from February to May 2021. Original articles, published between 2020 and 2021 and written in Portuguese, English or Spanish were included. Any publication that was not an original scientific article was excluded, complete scientific article and that distanced itself from the discussion was excluded. Results: Estrogen decreases the expression of the angiotensin converting enzyme 2 (ACE2) receptor, while testosterone increases expression in airway smooth muscle cells. Androgens regulate the expression of ACE2 receptors, cell surface transmembrane protease serine 2 (TMPRSS2) and androgen receptor (RA) on lung epithelial cells. Testosterone concentrations are inversely associated with disease severity and circulating inflammatory cytokine concentrations in men. Final considerations: Sex hormones act on the immune response, having a great influence on the existing gender disparity in the vulnerability and mortality of COVID-19.