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Clinical Research and Public HealthIn-Press PreviewImmunologyInfectious disease Open Access | 10.1172/jci.insight.200877

Gonadal steroids as predictors of sex differences in tuberculosis outcomes

Djeneba Dabitao,1 Bocar Baya,1 Ibrahim Sanogo,1 Amadou Somboro,1 Mamadou Wague,1 Mamadou D. Coulibaly,1 Isaac Koloma,1 Mahamadou Kone,1 Mohamed Nantoume,1 Nadie Coulibaly,1 Behinan Stephane,1 Mariam Coulibaly,1 Mamadou Perou,1 Moumine Sanogo,1 Ayouba Diarra,1 Seydou Samake,1 Bassirou Diarra,1 Mahamadou Diakite,1 Souleymane Diallo,1 Yacouba Toloba,1 Chad J. Achenbach,2 Jane L. Holl,3 Seydou Doumbia,1 Robert L. Murphy,2 William R. Bishai,4 and Sabra L. Klein5

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Dabitao, D. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Baya, B. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Sanogo, I. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Somboro, A. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Wague, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Coulibaly, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Koloma, I. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Kone, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Nantoume, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Coulibaly, N. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Stephane, B. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Coulibaly, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Perou, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Sanogo, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Diarra, A. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Samake, S. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Diarra, B. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Diakite, M. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Diallo, S. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Toloba, Y. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Achenbach, C. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Holl, J. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Doumbia, S. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Murphy, R. in: PubMed | Google Scholar

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Bishai, W. in: PubMed | Google Scholar |

1University Clinical Research Center (UCRC), Faculty of Pharmacy and Faculty, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali

2Division of Infectious Diseases and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, United States of America

3Biological Sciences Division, University of Chicago, Chicago, United States of America

4Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America

5W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America

Find articles by Klein, S. in: PubMed | Google Scholar |

Published June 16, 2026 - More info

JCI Insight. https://doi.org/10.1172/jci.insight.200877.
Copyright © 2026, Dabitao et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published June 16, 2026 - Version history
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Abstract

Recent evidence suggests a role for biological factors to explain increased risk for active pulmonary tuberculosis (PTB) among men. We conducted a prospective cohort study in Mali of treatment naive males and females with laboratory-confirmed PTB and latent TB infection (LTBI) and healthy controls of similar ages to determine the relationship between alterations in gonadal steroids, tuberculosis (TB) disease status, and treatment outcomes. Prior to treatment, males with PTB had lower testosterone concentrations compared to males with LTBI or healthy males. Reduced testosterone concentrations in males with PTB were transient, returning healthy ranges by month 2 of treatment, which corresponded to the end of intensive TB treatment. Estradiol concentrations in females were not altered by PTB or infection status yet increased at month 6 of treatment. Testosterone, but not estradiol, was a strong predictor of cure during treatment. Testosterone, but not estradiol, concentrations in PTB cases were inversely correlated with IFN-γ, IL-6, and IL-2. Concentrations of IL-17 and IL-10 were lower in males than females at the end of TB treatment. Our results suggest that TB-induced changes in testosterone concentrations during PTB and in response to treatment occur in males and could contribute to sex differences in TB pathogenesis.

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