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Q: Do men really suffer more with the flu than women?

A: I’d never heard of “man flu,” but according to a new study of the topic, the term is so ubiquitous that it has been included in the Oxford and Cambridge dictionaries as “a cold or similar minor ailment as experienced by a man who is regarded as exaggerating the severity of the symptoms.”

As commonly used, the term “man flu” could describe a man who develops a cold or flu and then embellishes the severity of their symptoms, quickly adopts a helpless “patient role,” and relies heavily on others to help them until they recover.

Another possibility is that men actually experience more severe symptoms from respiratory viral illnesses than women do.

Men and women do differ

There are other examples of differences in how men and women experience disease. For example, with heart attacks or angina, men tend to have “classic” crushing chest pain, while women are more likely to have “atypical” symptoms such as nausea or shortness of breath.

Here are the highlights from the new study on man flu:

• Influenza vaccination tends to cause more local (skin) and systemic (body-wide) reactions and better antibody response in women. A better antibody response may lessen the severity of flu, so it’s possible that vaccinated men get more severe symptoms than women because they don’t respond to vaccination as well.
• In test tube studies of nasal cells infected with influenza, exposure to the female hormone estradiol reduces the immune response when the cells came from women, but not in cells from men. Since flu symptoms are in large part due to the body’s immune reaction, a lessened immune response in women may translate to milder symptoms.
• In at least one study, men were hospitalized with the flu more often than women. Another reported more deaths among men than women due to flu.

Together, these findings suggest that there may be more to “man flu” than just men exaggerating their symptoms or unnecessarily behaving helplessly. While the evidence is not definitive, they suggest that the flu may, in fact, be more severe in men.

The bottom line

Diseases can look different in men and women. That’s true of coronary artery disease. It’s true of osteoporosis, lupus and depression. And it may be true of the flu.

So I agree with the author of this new report, who states “…the concept of man flu, as commonly defined, is potentially unjust.” We need a better understanding of how the flu affects men and women and why it may affect them differently.

Until then, we should all do what we can to prevent the flu and limit its spread. Getting the flu vaccination, good handwashing, and avoiding others while sick are good first steps. And they’re the same regardless of your gender.

Robert H. Shmerling, M.D., is associate professor of medicine at Harvard Medical School and clinical chief of rheumatology at Beth Israel Deaconess Medical Center in Boston. For additional consumer health information, visit www.health.harvard.edu.

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