26.4 million people in the U.S suffer from an autoimmune disease and 78% of that population is women. Some of these autoimmune diseases are rheumatoid arthritis, systemic lupus erythematosus and psoriatic arthritis. These conditions are ten times more likely to occur in women.
Why are women more susceptible to autoimmune diseases over men?
The answer might be in the immune system.
Women produce more antibodies in response to infections, vaccinations or trauma. This is called TH2 predominant immune response. The nurses health study from 1976 to 1990 found that women who took oral contraceptives' were twice as likely to develop lupus or SLE.
Men with rheumatoid arthritis were found to have a higher than normal frequency of low testosterone, low DHEA and higher level of estradiol.
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In women with rheumatoid arthritis who are pregnant, they improve with symptoms during pregnancy because they are immunosuppressed. After pregnancy, 90 percent of these women have an autoimmune flare within 3 months postpartum.
Estrogen seems to stimulate TH2 antibody production.
It's all about balance.
Our white blood cells contain 2 types of estrogen receptors. ER -alpha and ER -beta. This enhances cell proliferation, reduces cell apoptosis (programmed cell death) , stimulates B cell proliferation and directly stimulates pro-inflammatory interleukins. Certain estrogens are associated with inflammatory states in both rheumatoid arthritis and lupus.
Progesterone and testosterone downregulate the immune system response. Testosterone promotes TH1 mediated immune responses which decreases autoimmune diseases but makes men more susceptible with severe complications from infections. This may be why men were more likely to have risks or complications from Covid-19.
Reference:
Hormones & Autoimmune Arthritis. (2020). NDNR, 16(12), 1–3. https://www.ndnr.com