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Is ‘man flu’ real? Study examines science behind men’s complaints
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A researcher looking for potential scientific explanations behind men’s seemingly exaggerated complaints over common respiratory illnesses — termed “man flu” — said he found some evidence that they may experience worse symptoms than women.
The findings appear in the Christmas issue of the British Medical Journal — a yearly edition of the peer-reviewed medical journal that is meant to be playful. Editors of the journal say they welcome “light-hearted fare and satire” for the Christmas issue but not fake science. Papers go through the normal review process.
Kyle C. Sue, MD, CCFP, MHM, clinical assistant professor in family medicine at Memorial University of Newfoundland, in St. John’s, Canada, said some of the conclusions and comments in his paper, titled, “The science behind ‘man flu,’” were meant to be tongue-in-cheek in the spirit of the issue. But he said the evidence illustrates an “important unexplained avenue of research” and that “the concept of man flu” — that men exaggerate symptoms of illness — “is potentially unjust.”
“For clinicians, this study won’t necessarily change the way they practice — colds and flus are still treated symptomatically — but perhaps if anyone asks them about ‘man flu,’ they can point to some of the evidence found in this study,” he told Infectious Disease News.
Sue said he reviewed relevant research for evidence that “man flu” is real and could have an evolutionary basis. The term is real at least in the sense that it appears in both the Oxford and Cambridge dictionaries and suggests that men tend to overreact to minor illnesses.
Sue cited several animal studies showing that female mice have higher immune responses than males and that sex-dependent hormones might play a role in this difference. Lab studies suggested a link between female hormones and more robust immune system responses to influenza and rhinovirus.
“Although animal and in vitro studies are weak sources of evidence, human research also points to different responses to influenza in men and women,” he wrote.
Sue noted, for instance, that data from studies in Hong Kong and the United States showed men have a higher risk for influenza-related hospital admission and higher rates of influenza-associated deaths than women in the same age groups, regardless of underlying medical conditions. Other studies showed similar findings for respiratory infections besides influenza.
Moreover, according to Sue, studies have shown that women are more responsive to the influenza vaccine, and data from one study indicated that testosterone may be immunosuppressive. Sue said there is evidence that “clearly supports men having higher morbidity and mortality from viral respiratory illness than women because they have a less robust immune system.”
“I am not surprised that there may be immunological differences between men and women that are mediated by hormonal differences as there are already so many physiological differences between men and women,” Sue said. “Does this mean that vaccinations in the future might need to be dosed differently for men and women? What about dosing for something like Tamiflu? All of that needs to be clarified in future research.”
Sue said future research also will need to stratify men and women based on factors other than comorbidities, such as smoking rates — more men smoke than women — drinking rates, and willingness to see a physician.
For now, he wrote that men “may not be exaggerating” their symptoms but that the literature lacks evidence of “man flu” in the form of rigorous trials or meta-analyses. He said his paper is the only systematic review of the subject of which he is aware.
“However, the evidence that does exist seems to point to men having weaker immune responses to viral respiratory illnesses, and epidemiologic studies that didn’t control for smoking, etc., seem to agree,” Sue said. “Mice studies and test tube studies are convincing, but we all know that they are only models for real humans, not substitutes. So, at this point, nobody can say definitively that what I’ve found is indeed the truth. It is only suggestive.” – by Gerard Gallagher
Reference:
Sue K. BMJ. 2017;doi:10.1136/bmj.j5560.
Disclosure: Sue reports no relevant financial disclosures.
Perspective
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Aaron E. Glatt, MD
This paper is certainly tongue-in-cheek and very whimsical, but there are no accurate data being presented that would strongly support any claims to significant differences between men and women in the way they handle influenza, other than nonmedical, sociological or other reasons.
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