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Objectives: While low testosterone (T) was described as a predictor of unfavorable coronavirus-disease 19 (COVID-19) outcome in men, data concerning the role of T in women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are scant and limited to small cohorts. This study aimed to investigate the relationship between serum T values and outcomes of COVID-19 in a large female hospitalized cohort. Methods: One-hundred-sixty-eight adult women (median age 77, range 18-100 years; 154 in post-menopause) hospitalized for COVID-19 were assessed for PaO2/Fio2 ratio, serum T and inflammatory parameters. Results: Median duration for hospital stay was 14.2 days (range 1-115) with overall mortality of 26% (n=44). Subjects who died were significantly older (p< 0.001), had significantly more comorbidities (p=0.015) and higher serum T (p=0.040), white blood cells (p=0.007), c-reactive protein (CRP; p<0.001), interleukin-6 (IL-6; p< 0.001), procalcitonin (PCT; p<0.001), lactate dehydrogenase (LDH; p=0.001), D-dimer (p=0.035), fibrinogen (p=0.038) and lower serum free-triiodothyronine (FT3; p<0.001) and luteinizing hormone (LH; p=0.024) values. In post-menopausal women, significant associations were observed between T levels and serum CRP (rho: 0.23; p=0.002), IL-6 (rho: 0.41; p<0.001), LDH (rho: 0.34; p<0.001), D-Dimer (rho: 0.21; p=0.008), PCT (rho: 0.26; p=0.001) and HDL cholesterol (rho: -0,22, p = 0.008). In multivariate regression analyses, serum T maintained the significant association with mortality after correction for age, coexistent comorbidities and serum LH and FT3, whereas it was lost after correction for inflammatory parameters. Conclusions: In females, high serum T levels might be a mirror of inflammatory phenotype and worse COVID-19 course. Conflicts of Interest: Walter Vena received a project grant from IBSA. All other authors declare they do not have conflict of interest that is relevant to the subject matter or materials included in this work. [ABSTRACT FROM AUTHOR]