Chagas Disease: Health Risks Across Gender
Elizabeth Meshell, Michael Bowling, Miros Morales Alvarez, Eddie Del Rio Garza
SOC 101 - 4001
Professor Flora Rudacille
December 9th, 2025
Chagas Disease: Health Risks Across Gender
Chagas disease (CD), caused by a parasite called Trypanosoma cruzi (T. cruzi), is an illness that is most commonly found in Latin America. However, in recent years, there has been an emergence of Chagas disease in other regions of the world, like North America, and even Europe. Chagas disease is gravely endemic in regions where healthcare is lacking and poverty levels are higher. This results in people who have limited medical treatment having more severe complications, making it more difficult to treat without detrimental complications to those already affected by Chagas (Triana, D. R. et al., 2016). Studies have shown that pregnant women often face negative and poor treatments (Avaria, A., & Plaza, C., 2024) and men often face higher risk of heart problems from the disease (Lassen, O et al., 2020). Not only is Chagas disease spreading in multiple new regions, but along with that, there is a concrete impression of inequality when it comes to healthcare between genders and socioeconomic groups.
There has been a plethora of new cases of the disease spreading northward, into the lower United States, along with the disease being carried across borders by infected immigrants. The latter of those two sees a persistent significance on the global scale as the disease can take root in its host and be passed down to children. While originally the parasitic infection was solely native to Latin America, more specifically being endemic to 21 Latin American countries, it is due to a multitude of factors that regions which were once regarded as nonendemic are now brought into question over if T. cruzi inflicts the area. Not limited to only bordered regions, kissing bugs—which are the medium for the infection—have been identified in 32 U.S. states (Beatty, et al., 2025). Meanwhile, as for the globalization of the disease itself, it is estimated that 3.5% of Latin American migrants, living in non-endemic countries, had the disease (Nepomuceno, et al., 2024). In other words, about three to four out of every one hundred Latin American migrants 3 across continents such as Europe, Australia, Asia, etc, are carriers of the disease.
Overall, while the migration of kissing bugs up north can be understood from an amalgamation of environmental causes, the migration of Latin Americans who carry CD is subject to patient monitoring and treatment. In a matter of advocacy, Chagas disease necessitates a global concern as its rates in non-endemic countries have substantially increased. To understand from a more quantitative form, “In 2009, it was estimated that about 68,318 to 123,078 immigrants living in Europe were infected by T. cruzi,” (Lidani, et al., 2019). With such a global prevalence, the contemporary international rates of the disease warrants some countries to rethink their non-endemic label. Afterall, taking the proper measures to screen and treat for the disease is preferable compared to neglecting it.
Chagas disease is spreading around the world, however, the effects seen from it differ greatly when it comes to gender. Men with CD have worse effects because of the Y-chromosome, most notably posing a higher risk of developing severe heart damage. Studies by Lassen and their team found unique health issues within the male gender: “300 unrelated men who consecutively attended the Hypertension Department of the Córdoba Hospital in the city of Córdoba, Argentina were randomly selected,” (Lassen, O., et al., 2020). While this case-control study was conducted, it was observed that men who did not have the haplogroup called R1b within their Y chromosome, while being infected by Chagas, were five times more likely to develop an enlarged heart. The men were also two and a half times more likely to have additional heart problems. Yet, there is a dilemma, because on average, only four out of ten men had R1b—the Y-chromosome type that dictates that a majority of men on average will see these worsened effects. While chromosome types in males do play a role in putting men at higher risk with cardiac problems, another issue was the “…the inhibitory role of testosterone in humoral 4 responses, particularly regarding TS-specific plasma antibodies in TS+A-vaccinated males. Testosterone depletion in this group enhanced IgG2a- and IgG1-specific responses, with TS-specific IgG2a levels in castrated TS+A-vaccinated mice reaching levels comparable to those in TS+A-vaccinated females…” (Balbi, C.B., S., et al., 2017). Males with normal testosterone levels will on average have reduced antibodies to respond to CD in response to this vaccine. When testosterone is removed, it is observed in male mice that the level of the IgG2a and IgG1 antibodies increases, showing that testosterone limits these antibodies that could help fight Chagas disease.
So, because testosterone suppresses antibodies that could be crucial in fighting back against Chagas, men’s “harder” in the sense that their biology makes Chagas disease not only. Not only does testosterone suppress immune responses, but it also makes males more susceptible to getting contaminated by Chagas and makes males have a harder time combating Chagas as well. Considering all this, both genetic and hormonal factors directly influence how Chagas disease affects males and because of this, exclusively men are more at risk when it comes to cardiac complications. Regular testosterone levels, along with the lack of the R1b Y-chromosome in men, also result in men having worse immune system response against Trypanosoma cruzi. Not only does testosterone in males lower the combative effects of the disease, but men are also subjected to worse symptoms.
While men are likely to be more susceptible to chagas disease because of genetic and hormonal factors, women face an equally concerning set of health risks specifically regarding vertical transmission. Vertical transmission is where the Trypanosoma cruzi parasite is passed from mother to offspring during the gestational period throughout pregnancy. This passageway of transmission calls attention to the importance of screening pregnant women to prevent the 5 spread of congenital CD in infants, as an early diagnosis and treatment would significantly reduce infant mortality (Hinton, S., 2024; Edwards, M., & Montgomery, S., 2021). Studies conducted by Morven Edwards and Susan Montgomery stress how essential pregnancy-based screening is, despite its lacking implementation in endemic regions.
Along with the biological risks, there are societal and health access barriers that further complicate the process for women. Studies in Chile show that pregnant women with Chagas are often misdiagnosed and neglected in healthcare environments, which can lead to the spread of the disease or delayed treatment (Avaria, A., & Plaza, C., 2024). This is due to the lack of gender-sensitive healthcare and socioeconomic discrepancies, which limits women’s access to opportune diagnosis and treatment. These issues continue to affect women who reside in low-income housing, where exposure to kissing bugs is higher, leading to a greater risk of infection. These factors highlight the necessity in learning about the severity of Chagas disease and how it affects men and women. This prompts the question of how these gender-based differences influence both the clinical and developmental outcomes of this illness.
Chagas disease is often described as a generalized public health challenge, although research reveals significant sexual dimorphism in how the disease is acquired, transmitted and how it progresses. Understanding these sex specific differences is crucial for effective diagnosis and treatments. Overall, analyzing general prevalence data across endemic and non endemic regions suggests that men and women face similar infection rates, with some studies showing slightly higher infection rates among women in certain immigrant populations (Irish, A.B., Montgomery, S.P, & Marcus, R, 2022). However, this overall equality masks the fundamental differences in risk factors of men living in vector-endemic areas. Men in these areas face a higher risk of infection due to occupational activities involving outdoor and agricultural jobs which 6 involve greater exposure to the kissing bug (Balbi, C.B., S., et al., 2017).
The most critical divergence in transmission methods relates to women’s unique role in perpetuating the disease. Congenital transmission from mother to fetus during the pregnancy remains a major pathway of transmission at approximately 4.7% per pregnancy (Balbi, C.B., S., et al., 2017). This only highlights the need for screening women of childbearing age and preventing pediatric cases. Perhaps, the most clinically significant dimorphism lies in the progression and severity. Research focusing on host immune responses strongly suggests that sex hormones influence the severity of Chagas cardiomyopathy, the potentially fatal heart damage caused by the parasite. This signifies that, because women produce estradiol (estrogen), female hosts tend to exhibit greater resistance to severe acute and chronic infection in comparison to men. This is due to the fact that estrogen is linked to an enhanced anti-body mediated immune response and better at managing the disease. On the contrary, the testosterone in men is attributed to increased susceptibility and immunosuppressive effects on humoral immunity which leads to higher risks of severe cardiac complications (Balbi, C.B., S., et al., 2017).
In summary, Chagas disease is not a monolithic condition and its impact on public health varies significantly by sex. While overall infection rates may be comparable, women are distinctively targeted by the critical congenital transmission pathway, and men face a higher physiological risk of severe cardiac progression due to hormonal influences on the immune system. The treatments in the feature should consider the dimorphic aspect of this disease and how it transmits. Public health strategies should consider incorporating the development of treatments modalities that account for the hormone driven differences in immune response and severity, specifically in male patients. While studies are still being done, comprehensive screening for pregnant women to eliminate congenital transmission is what is now being recommended.
References
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