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Dena Nader, MD, regional medical director at MedExpress, expands on the possible validity of "man flu."



Do men really complain more when they’re sick? Do they really act like big babies when they get the sniffles? That’s the subtext behind the “Man Flu,” that sarcastic phrase describing how men deliberately overplay symptoms of illnesses (like the common cold) to gain sympathy from their partner.

But is this comical perception that men handle illness worse than women accurate? Or is it just an insulting stereotype or urban myth?

Perhaps the Man Flu is more than just a dismissive, mocking term. What if it has merit? What if men actually do experience sickness in a different way than women?

Well, science is now playing a part in the discussion. According to medical professor Kyle Sue, MD, men might not be complaining just to get attention. They may actually feel as rotten as they claim.

Sue released a study on Dec. 11, 2017, entitled “The Science Behind ‘Man Flu’,” “to determine whether men really experience worse symptoms and whether this could have any evolutionary basis.”

It is worth noting that Sue’s study was published in The BMJ’s December Holiday Issue, which is the one issue a year when the journal takes a tongue-in-cheek approach to its subjects. Sue writes that he was inspired to do the study because he was “tired of being accused of overreacting.”

But despite the article’s comedic angle, Sue wrote that the no joke: “Men may not be exaggerating symptoms, but [they] have weaker immune responses to viral respiratory viruses, leading to greater morbidity and mortality than seen in women.”

So let’s take a look at the research to see why the Man Flu might not be such a laughing matter after all.

It’s all about the hormones.

Sue drew upon several studies of mice, which he declares are “good models for human physiology.” And his research revealed that female mice have stronger immune systems than male mice. The reason? Hormones.

Board certified infectious disease physician Amesh Adalja says that while more research needs to be done to validate Sue’s claims, his theory isn’t so far-fetched: “Men and women obviously have different levels of estrogen and testosterone, and those hormones do influence a person’s immune response. The majority of symptoms someone experiences with influenza are an interaction between the virus and the immune system. What some studies suggest are that the higher levels of testosterone that are found in men do cause a more robust immune response, therefore more severe symptoms. So there is biological plausibility for the experience of influenza being more severe for a male than a female.”

Dena Nader, MD, regional medical director at MedExpress Urgent Care, expands upon this, saying, “Men, in general, have weaker immune systems than women due to hormonal differences. Take the female hormone estrogen, for example."

"Estrogen boosts the immune system, which makes it easier for women to recover more quickly and may even help take the edge off of symptoms. The male hormone testosterone, on the other hand, suppresses the immune system and makes for a longer-lasting, more severe illness.”

What’s more, Nader says that Sue’s theory of an “immunity gap,” which suggests that sex hormonal differences may affect the effectiveness of flu vaccines “could also play a role in how well the immune system can do its job in protecting the body from viruses.”

It’s a numbers game.

Another factor that could support Sue’s theory is that men are more prone to illness. This evidence came to light in a separate study, done in 2010 by the University of Cambridge entitled “The Evolution of Sex-Specific Immune Defenses,” which used a mathematical model that posits that men get sick, and sicker more often, than women.

Olivier Restif, PhD, an epidemiology lecturer the University of Cambridge, discussed the study with The Telegraph, saying that “in many cases, males tend to be more prone to getting infected or less able to clear infection.

Ultimately, the study states that sex differences in immunities came about due to evolution, leading to “lower resistance in males, ultimately leading to the counterintuitive situation where males with higher susceptibility or exposure to infection than females evolve lower immunocompetence.”

It suggests that men were more concerned with mating than with recuperating, while women were more focused on staying healthy.

More statistics seem to bear this out, including this 2014 study that revealed more adult men suffered lethal cases of the flu virus than women (regardless of other underlying serious conditions) between 1997 to 2007, while a 2015 study entitled “Age and Sex Differences in Rates of Influenza-Associated Hospitalizations in Hong Kong” observed that men under 18 and most over 40 were admitted to hospitals at a higher rate than women in those same age ranges.

Adalja adds that men make it worse for themselves since they’re less likely to go to the doctor than women: “There’s definitely a discrepancy between male and female health behaviors. …It’s hard to untangle some of the biology from some of the cultural differences between males and females. It’s true that if you wait longer to go to the doctor, your symptoms are going to be worse, and you have to couple that that there are some hormonal defensive issues with how males and females handle influenza viruses.”

It’s all in the mind.

It’s not just hormones or lack of self-care that suggests Man Flu might be for real. The mind could also be a major factor with how men process illness. And according to a 2016 study from Stanford University, another reason men may experience more severe flu or cold symptoms is about how big their brains are. Or at least, the size of their preoptic area.

It turns out that this portion of the brain, which helps regulate fevers during infections, is larger in men than women. This could potentially result in symptoms feeling more severe for men.

And there could be another mental issue at play: a separate study from the University of Glasgow suggests that men are less in touch with their biofeedback signals (which help us understand how our body feels), and that could result in reporting their symptoms are more severe than they truly are.

So…is the Man Flu real or not?

Can we now definitively say there is a Man Flu? And do men overstate their symptoms when they get sick? The debates continue.

Unsurprisingly, Sue’s study has had more than its fair share of critics. Ed Cara of Gizmodo took Sue to task for trying to sell satire as medical research, only to have the doctor double down on his observations. “The research is all real,” the doctor responded, “despite the humorous lens it’s being examined through.”

In an interview with CNN, Sabra L. Klein, PhD, associate professor at Johns Hopkins University’s Bloomberg School of Public Health, says that Sue’s research doesn’t factor in age, noting that while young men (pre-puberty) and men over 65 are consistently hospitalized more than women of the same ages; females are hospitalized more during their reproductive years as pregnant women have more severe reactions to the flu virus.

She also adds that studies in countries where women have less access to medical care could result in statistics that aren’t fully representative of their population: “In my opinion, we do not yet have enough science to conclude that ‘man flu’ is real.”

Adalja tends to think the notion of Man Flu is also a misnomer, as the study specifically looks at how both sexes react to influenza, not some separate strain of flu only men are prone to. In other words, if we’re going to seriously suggest men react stronger to symptoms, such a divisive, farcical term may be counterproductive.

Nader adds that even if Man Flu doesn’t technically exist, it’s worth acknowledging that the sexes do experience health issues quite differently: “For years, we’ve known that men are more prone to certain diseases, like diabetes and cardiovascular disease, and we test them earlier and treat them differently than we would a woman because of that. Why would the cold or flu be any different?”

How to Treat the Man Flu (If It’s Really a Thing)

So, to play devil’s advocate—if Man Flu is real (or if men experience the flu more severely, according to Adalja), what’s the best method of treatment?

Sue offered his own prescription in the conclusion of his study, which drew chuckles from some and eye rolls from others: “Perhaps now is the time for male-friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.”

In the end, there are tried and true methods to treat the flu (or other respiratory infections), and they work for both genders: Drink plenty of fluids, get lots of rest, use humidifiers (or take hot showers to breathe in steam), and take cough suppressants and fever reducers if needed.

And if you’re still not better in five to seven days, head to your doctor for a checkup.

The Man Flu may be a source of humor to some and annoyance to others, but perhaps we can come together over the realization that it’s just no fun being sick, and no one wants to suffer in silence.

Maybe that last bit is key, according to Jennifer Capezzuti, DO, an internist with Tenet Florida Physician Services, who adds that to be fair to men, a 2010 survey showed that “women call in sick twice as often as men do.”

However, men shouldn’t feel too emboldened by that factoid, because: “Women are 10 times more likely than men to stay at home to care for sick children and elderly relatives.” She suggests that to truly examine whether the Man Flu is a thing, perhaps it is worth contemplating, “If a man has the flu in a forest and no one is around, is it still the Man Flu?”


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