A somewhat tongue-in-cheek BMJ article argues that men might experience worse cold and flu symptoms than women, and explores possible explanations

The fight against the ridicule of “man flu” has been taken up by a doctor who says, somewhat tongue-in cheek, that he delved into the issue after growing tired of being accused of overreacting.

In a treatise based on previous studies – some scientific, some notably less so – the Dr Kyle Sue not only puts the case that men might indeed experience worse cold and flu symptoms than women, but also explores why such a difference might have evolved.

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“I do think that the research does point towards men having a weaker immune response when it comes to common viral respiratory infections and the flu,” said Sue, a clinical assistant professor in family medicine from the Memorial University of Newfoundland. “This is shown in the fact that they [have] worse symptoms, they last longer, they are more likely to be hospitalised and more likely to die from it.”



But others were not persuaded by Sue’s arguments, pointing out that many different factors can affect how bad a bout of cold or flu is.



The article, published in the British Medical Journal, involved a wry look at previous studies and put forward a number of strands of evidence that suggest men might really experience worse symptoms than women when it comes to viral respiratory illnesses.

Among them, the author points out that mouse studies have suggested that testosterone could dampen immune response to influenza, while certain female sex hormones could boost it. What’s more, some studies on a small group of humans revealed that cells from pre-menopausal women showed different immune responses to the type of virus behind the common cold to those of men of the same age – the difference was not seen when cells from men were compared to those of post-menopausal female peers.

The study also notes that research from the US showed men had higher rates of deaths linked to flu compared to women of the same age, while data from Hong Kong shows men had a higher risk of winding up in hospital with seasonal flu than women. It also pushes back against the idea that men crumble at the first sneeze – pointing to a study which found women were more likely than men to cut down activities when it came to minor respiratory illnesses.

The article also reveals that a survey in a popular magazine found that men took twice as long to recover from such viral illnesses as women.

“Since about half of the world’s population is male, deeming male viral respiratory symptoms as ‘exaggerated’ without rigorous scientific evidence could have important implications for men, including insufficient provision of care,” Sue writes.

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Sue admitted the studies didn’t take into account other differences between men and women, such as how much individuals smoked, or that men have been found to be worse at looking after themselves and seeking medical care than women.



“There need to be more studies, higher quality studies that control for other factors between men and women before we can definitely say that this difference in immunity exists,” he told the Guardian. “Is it that women are more resilient, that they are able to juggle more when they are ill, or is it that they don’t have as severe symptoms? That we are not too sure about. But I think everyone should be given the benefit of the doubt when they are ill.”

Sue also explored whether there was an evolutionary explanation for why men might experience worse symptoms than women when it comes to viral respiratory infections.



Among the theories put forward, Sue notes higher testosterone levels might offer upsides when it comes competing against other males that outweigh the possible negative impact on the immune system, or that being more under the weather keeps males bedbound and hence potentially out of the way of predators.

“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,” Sue suggests.

“I am hopeful that next time men are being criticised as exaggerating their symptoms they can say ‘hey, look at this study, there is some proof that I am not!’” he added.

But not everyone is bowled over by Sue’s arguments, including Peter Barlow, associate professor of immunology and infection at Edinburgh Napier University.



“There are a significant number of factors which can contribute to the severity of an influenza infection,” he said. “As the author of the article alludes, it is currently impossible to say whether there are sex-specific differences in susceptibility to influenza virus, or in the progression of the infection.”

