Androgen sensitivity in COVID ‐19 and antiandrogens: Prospective data are still needed

Abstract: Title: Androgen sensitivity in COVID-19 and antiandrogens: prospective data are still needed. Author´s list: Mayra Ianhez1, Paulo Müller Ramos2, Andy Goren3, Hélio Amante Miot2 Author´s Affiliations: 1 Department of Tropical Medicine and Dermatology, Federal University of Goiás, Goiânia - GO, Brazil Address: 1a Avenida, s/n, St Leste Universitário, CEP: 74605-020, Goiânia-GO, Brazil 2 Department of Dermatology and Radiotherapy, São Paulo State University – UNESP, Botucatu - SP, Brazil Address: Av. Prof. Mário Bairro: UNESP 18618687, Botucatu, SP - Brasil 3 Rubens Guimarães Campus Montenegro, s/n de Botucatu Applied Biology, Irvine - California, USA Address: 17780 Fitch, Irvine, CA 92614, Estados Unidos Acknowledgements: none Keywords: alopecia; antiandrogen; SARS-CoV-2; COVID-19; therapy-systemic Running head: Antiandrogens in COVID-19 Funding: None Correspondence: Mayra Ianhez, MD, PhD Department of Tropical Medicine and Dermatology Federal University of Goiás This article is protected by copyright. All rights reserved. 1ª avenida, s/ no, Setor Leste Universitário, Goiânia-GO CEP: 74605-020 Email: (*ianhez@hotmail.com) Phone/FAX: +55 62 985315443 Men are disproportionately affected by COVID-19 and have an increased risk of ICU admittance as well as mortality. In contrast, prepubescents appear to be largely protected from COVID-19 severe symptoms1. The androgen receptor regulates the transcription of the transmembrane protease, serine 2 (TMPRSS2), and angiotensin converting enzyme 2 (ACE2) which are required for the COVID19 infectivity; thus, raising the hypothesis of androgen sensitivity as a risk factor2,3. The recent association of androgenetic alopecia (AGA) with COVID-19 severity strengthens the androgen theory2. Testosterone levels are low not only in prepubescents but also in elderly men4 and recent observations point out that disease severity may be best correlated with specific gene loci, rather than ACE2 or TMPRSS2 receptors5. Furthermore, serum androgens do not always correlate with tissue androgens or androgen mediated disease. For example, AGA and prostate cancer can be exacerbated by elevated tissue androgen in genetically predisposed patients6. In order to elucidate the effect of androgens on COVID-19 outcomes, some epidemiological studies were conducted. Since TMPRSS2 are expressed in the lungs, the use of antiandrogens or androgen-depleting therapies (ADT), This article is protected by copyright. All rights reserved. currently used for prostate cancer, represent an appealing target for prevention or treatment of COVID-19 4. An Italian study compared infectivity and outcomes of COVID-19 in prostate cancer patients treated with or without ADT (androgen deprivation therapies). The study concluded that ADT was associated with reduced risk of infection and with reduced COVID-19 disease burden7; however, to-date, no large epidemiological study attempted to evaluate the potential protective role of diverse antiandrogens in COVID-19 infection. To gather large scale data, we performed a population survey through snowball sampling. Participants were invited to complete an electronic questionnaire comprising baseline demographic, COVID-19 status (never, suspected or confirmed), disease severity (home, hospitalization without mechanical ventilation, intensive care unit/mechanical ventilation – ICU/MV), use of antiandrogen therapy (ADT for prostate cancer, finasteride, dutasteride, flutamide, bicalutamide,..