Thread by @LongCovidAdvoc

🧵 Important new study out in Cell Reports Medicine (Shahbaz et al. 2025):
👉 Long Covid with ME/CFS isn’t the same in women and men - biologically.
👉 And it’s not “fatigue.” It’s immune, hormonal, and neurological chaos.

Let’s break it down layperson style 👇

1️⃣ Researchers studied people with Long Covid who meet criteria for ME/CFS i.e. the more severe group, often housebound or unable to work.

They found deep biological differences between women and men - not psychological ones.

2️⃣ In women, the immune system stays stuck in overdrive:
🔥 higher inflammation
🧬 more activated immune cells
💥 fewer regulatory (“calming”) T-cells

This immune chaos may drive ongoing damage and exhaustion.

3️⃣ There’s also gut barrier dysfunction - meaning particles from the gut leak into the bloodstream, fueling inflammation.

Markers like Galectin-9, Reelin, and Artemin (linked to pain and brain fog) were higher, especially in women.

4️⃣ Hormones are out of sync too.
🩸 Women had low testosterone and cortisol
🩸 Men had low oestrogen
→ both affect immune balance, energy metabolism, and brain function.

These aren’t “stress hormones gone wrong” - they’re part of the biological disruption.

5️⃣ The study also found neuroinflammatory gene signatures in women - clues to why brain fog and cognitive dysfunction hit harder.

These are molecular traces of inflammation inside the nervous system.

6️⃣ In short:
Long Covid + ME/CFS =
🧠 Neuroinflammation
💥 Immune activation
⚖️ Hormonal imbalance
🩸 Disrupted blood and oxygen balance

And women are hit hardest.

7️⃣ The authors say we need sex-specific treatments, including possible hormone-based approaches - not one-size-fits-all medicine.

It’s time to stop telling patients it’s in their heads. The evidence is in their cells.

8️⃣ This study adds to growing proof that Long Covid is a biological, systemic disease, not deconditioning or anxiety.

Persistent inflammation, hormonal collapse, and neuroimmune damage explain what patients have been saying all along.

9️⃣🔔 Women have rarely been warned that they are at higher risk of severe Long Covid‑ME/CFS. The science now shows: far from equal, the odds and biology are stacked against them.

1️⃣0️⃣📖 Paper: Shahbaz et al., Cell Reports Medicine (2025)
“Integrated immune, hormonal, and transcriptomic profiling reveals sex-specific dysregulation in Long Covid patients with ME/CFS.”
cell.com/cell-reports-m…