Former studies have revealed intersex variability in immune response to infectious diseases, including Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological surveillance of the ongoing pandemic has demonstrated a male vulnerability to morbidity and mortality, despite similar infection rates between the two sexes. Divergence in the frequency of comorbidities between males and females, differences in hormonal profile, chromosomal composition and gender behavior have all been proposed as potential causative factors. Data deriving from the immunization process indirectly support the existence of a sex-specific response to SARS-CoV-2, since females apparently produce higher numbers of antibodies while simultaneously exhibiting higher rates of side effects, indicating a stronger immune reactivity to the vaccine's elements. Interpreting intersex differences in immune response to SARS-CoV-2 could lead to a deeper understanding of the COVID-19 pathophysiology and enable healthcare professionals to conduct a more accurate patient risk assessment and better predict the clinical outcome of the disease. This narrative review aims to discuss the pathophysiological and behavioral basis of the disproportionate male morbidity and mortality observed in COVID-19, in the context of most research findings in the field.

先前的研究揭示了双性人对传染病的免疫反应的变异性，包括由严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 引起的 2019 年冠状病毒病 (COVID-19)。尽管两性之间的感染率相似，但对正在进行的大流行的流行病学监测表明，男性易受发病率和死亡率的影响。男性和女性合并症频率的差异、激素谱的差异、染色体组成和性别行为都被认为是潜在的致病因素。来自免疫过程的数据间接支持对 SARS-CoV-2 的性别特异性反应的存在，因为女性显然会产生更多的抗体，同时表现出更高的副作用率，表明对疫苗的成分有更强的免疫反应性。解释双性人对 SARS-CoV-2 免疫反应的差异可以更深入地了解 COVID-19 的病理生理学，并使医疗保健专业人员能够进行更准确的患者风险评估并更好地预测疾病的临床结果。这篇叙述性综述旨在结合该领域的大多数研究结果，讨论在 COVID-19 中观察到的男性发病率和死亡率不成比例的病理生理学和行为基础。解释双性人对 SARS-CoV-2 免疫反应的差异可以更深入地了解 COVID-19 的病理生理学，并使医疗保健专业人员能够进行更准确的患者风险评估并更好地预测疾病的临床结果。这篇叙述性综述旨在结合该领域的大多数研究结果，讨论在 COVID-19 中观察到的男性发病率和死亡率不成比例的病理生理学和行为基础。解释双性人对 SARS-CoV-2 免疫反应的差异可以更深入地了解 COVID-19 的病理生理学，并使医疗保健专业人员能够进行更准确的患者风险评估并更好地预测疾病的临床结果。这篇叙述性综述旨在结合该领域的大多数研究结果，讨论在 COVID-19 中观察到的男性发病率和死亡率不成比例的病理生理学和行为基础。