We are all scrambling during this pandemic, trying to figure out how to keep ourselves healthy under the threat of COVID-19. I love searching out any new clinical research that may help us put our health in perspective and perhaps help us strengthen our bodies, not only against COVID-19 but against any other invader lurking around the corner waiting to pounce once it gets half a chance. The immune system is and should be our number one priority right now, especially with an invisible enemy on our tails.
Current literature suggests that hormones may be protective of our immune system. If you are perimenopausal, menopausal, or andropausal, and on hormone replacement therapy, you may be immune protected and not realize it.
The immune system is complex and essential. It is made up of cells, proteins, and chemical reactions that enable us to ward off infection and keep us healthy. White blood cells make up a large part of the immune system; they are manufactured in the bone marrow and move through blood and tissue throughout the body. We are constantly being attacked by invaders like viruses, bacteria, fungi, etc. Each time the immune system destroys an invader, the invader is remembered; if the same invader enters the body again, it is quickly destroyed because of the unique ability of the immune system to identify it as a foreign entity. Proteins called antibodies assist in neutralizing the infections or toxins that some invaders produce.
Another important and complex component of the immune system is the lymphatic system. This system is made up of hundreds of lymph nodes that trap microbes. Lymph nodes filter lymph fluid and trap bacteria, viruses, and other substances. White blood cells called lymphocytes then destroy these trapped substances. B lymphocytes help to identify the invading microbe. If the microbe has been defeated before, the lymphocytes know which antibodies are required to kill the microbe. Other cells like helper cells help the B lymphocytes produce antibodies. Killer cells are produced to attract the infection. Suppressor cells assist in stopping the immune system response once the pathogen has been destroyed. But because viruses constantly mutate, our immune system doesn’t recognize many viruses. This causes an upset in the immune system’s homeostasis, and, as a result, we fall ill.
A general decline in immune function is seen with aging, leading to what is known as immunosenescence. Aging is accompanied by a remodeling of the immune system. Over time this leads to a decline in immune efficacy, resulting in increased vulnerability to infectious diseases, diminished responses to vaccination, and a susceptibility to age-related inflammatory diseases. The role of sex hormones, such as estrogen, progesterone, and testosterone, on the immune system has been investigated over the years. The reduction in these hormones during menopause and andropause has been attributed, to some degree, to a decline in immune function.
After menopause, estrogen levels fall dramatically. They remain around 90% lower than in the premenopausal period. Low estrogen levels seem to be associated with a weak immune system. For example, in postmenopausal women, the following observations have been reported in medical studies.
>> The CD4/CD8 cell ratio is reduced. CD4 cells are a specific type of lymphocyte — white blood cells — that summon other cells such as macrophages, CD8 lymphocytes and B lymphocytes to fight off an infection.
>> There are higher circulating levels of inflammatory cytokines, such as interleukin- 6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). These are signs of chronic inflammation. IL-6 has numerous complex functions in the inflammatory response. TNF-alpha is a cytokine with a key role in cell destruction and clearance of dead cells.
>> The immune response to infection is slower or impaired. For example, CD4, T and B lymphocytes, and natural killer(NK) cell functions are all reduced.
According to gynecologist Dr. Barb DePree, “COVID-19 is not likely to be a significant additional risk to menopausal women per se, but menopause is a time women begin to have increased risk for heart disease and type 2 diabetes once they lose the protective effects of estrogen. These co-morbidities definitely increase risk for women who may contract COVID-19.” Moreover, The CDC has stated that age, heart disease, and diabetes can all increase the chance of being severely ill with the coronavirus. In addition, weight gain caused by menopause can complicate matters. Furthermore, for women in menopause, a decrease in estrogen can cause increased vulnerability to severe symptoms. Dr. DePree commented, “There is some investigational research data suggesting estrogen may be somewhat protective for women exposed to the coronavirus.”
The hormone estrogen is shown to have a protective role in women, so women who are not on hormone therapy during menopause might be more at risk. Menopause is also linked to cancer risk and a decrease in T-cells, the immune system’s cells that work to fight off cancer cells and foreign pathogens, which can also bolster the immune response in general. Furthermore, according to studies, as women age, inflammatory levels increase, leading to pain, weight gain, autoimmune conditions, and susceptibility to illness and disease. It may not be menopause in and of itself that puts you at risk, but the health factors associated with menopause can create complications.
Progesterone has been shown to have a direct effect on immune cells, thereby boosting the immune function. Evidence suggests that progesterone can be beneficial in maintaining immune health through various important mechanisms.
>> Progesterone inhibits the production of pro-inflammatory markers like COX-2, IL-6, iNOS, and TNF-α.
>> Progesterone regulates the activity of the natural killer (NK) cells of the immune system.
>> Progesterone modulates the activity of the T cells of the immune system.
In addition, studies also show that progesterone reduces inflammation and promotes repair of the respiratory epithelium against influenza A virus infection, which could translate into respiratory protection against SARS-COV-2.
Low serum testosterone levels may predispose older men to worse COVID-19 outcomes and could explain the higher coronavirus case fatality rate among men, as compared with women, according to a literature review. According to Vito A. Giagulli, MD, PhD, head of the outpatient clinic for endocrinology and metabolic diseases at Conversano Hospital in Bari, Italy, “Research suggests that lower levels of plasma testosterone, which may be common among older men or men with obesity, as well as among men with other chronic diseases, could lead to systemic inflammation, impaired CV function, thromboembolism, and worse COVID-19 outcomes.”
In conclusion, there are medical findings that show hormone replacement therapy in postmenopausal women or men in andropause can reduce levels of inflammatory cytokines, improve CD4/CD8 ratio, and increase the number of circulating natural killer cells and B lymphocytes. This all translates into improved and strengthened immune functioning that can help you fight any foreign invader that comes your way.
Be aware that hormone replacement therapies are not all created equal, and hormone balance is your goal in any hormone replacement program. If you have questions or are considering hormone replacement therapy for symptomatic relief or overall wellness, give TLC Medical Centre Pharmacy a call and make your appointment to discuss your options with our integrative and functional medicine pharmacist. Your health is in your hands.
