Fibromyalgia is often thought of as a "women's condition," but men can have it as well.
Men with fibromyalgia are definitely outnumbered -– with women making up about 90% of cases –- but that doesn't mean the diagnosis shouldn't be considered in men. After all, according to National Fibromyalgia Association estimates, that 10% could mean one million men are living with illness.
Because of the gender disparity, however, we know a lot more about how fibromyalgia affects women. Many studies are done with exclusively female participants, and most doctors have a lot more practical experience with female fibromyalgia patients.
A lot of people and even some doctors erroneously think that men don't get fibromyalgia. This can cause special problems for men who are living with it, both in getting a diagnosis and in finding support. Societal expectations and stereotypes of men pose their own problems as well.
A 2012 study suggested that fibromyalgia is underdiagnosed in general, and even more underdiagnosed in men. It was a relatively small study and it didn't examine the reasons behind the underdiagnosis, but now that the issue has gotten this kind of attention, it's possible that we'll learn more about it in the coming years.
Gender & Symptoms
This is an area that needs more research, but some research is beginning to suggest that men's symptoms may be quite different than women's. One study showed several differences in pain symptoms.
In that study, men tended to have:
- Lower reported pain intensity
- Lower tender-point count
- Lower depression rates
- Longer duration of symptoms when making the first complaint to a doctor
- Higher overall disability due to symptoms
Also, ongoing pain in men was especially linked to pressure-triggered hyperalgesia (amplified pain) in the neck.
Future research will need to determine why men have different symptom profile, but some of the physiological differences discussed below may be involved.
The most obvious difference between fibromyalgia in men versus women is hormonal. In women, flares are often tied to the menstrual cycle, and hormonal events such as menopause or hysterectomy may trigger symptoms.
Certainly, men don't have such obvious hormonal events to focus on. So far, studies examining male hormonal fluctuations or abnormalities in fibromyalgia simply haven't been done, so we don't know what role, if any, these hormones play. Generally speaking, though, we do have evidence that male hormones impact pain in certain ways.
Testosterone, the primary male hormone, is thought to play a beneficial role when it comes to pain in general. Research suggests that it may help prevent muscle fatigue and, in combination with a certain protein, may help repair muscles after exercise. Male hormones may also modulate other biological processes related to fatigue and pain.
We also know of gender-based differences in the stress hormone cortisol, which research suggests is low in fibromyalgia. One study published in Health Psychology in 2008 showed that cortisol levels were different in happily married women than in their unhappily married counterparts, while men didn't exhibit any differences based on marital happiness. Researchers speculated that this could explain why conditions involving low cortisol are more likely in women.
The brains of men and women are not identical. One difference that may influence what fibromyalgia is like for each gender is the neurotransmitter (chemical messenger) serotonin.
Serotonin is believed to play a key role in fibromyalgia. Its areas of influence include pain, sleep, anxiety and depression. Some research suggests that the serotonin system works differently in men than in women.
A 2008 study published in Neuroimage showed that men have fewer serotonin receptors (brain cells that respond to it) than women. However, the process of reuptake –- which is essentially "recycling" so the neurotransmitter can be used again -– may be more efficient in men.
Drugs that slow reuptake are commonly prescribed for fibromyalgia. They're called SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin norepinephrine reuptake inhibitors. Two of the three drugs approved for this condition are SNRIs: Cymbalta (duloxetine) and Savella (milnacipran).
Because of the gender differences in the serotonin system, some doctors have suggested that these drugs be tested on men and women separately. This hasn't happened yet, but we do have anecdotal evidence that men and women respond differently to these drugs.
A separate study published in Biological Psychiatry in 2007 showed that lowering the body's serotonin levels doesn't affect men and women in the same way. In women, it caused worsening mood and increased cautious behavior. Men didn't have mood changes at all but became more impulsive, the researchers say.
These kinds of differences, which we don't fully understand, could make fibromyalgia harder to spot for doctors accustomed to seeing mood problems in their female patients.
Is Sleep More Important in Men?
A study published in 2012 in Psicothema looked at gender differences in the major fibromyalgia symptoms, including pain, sleep, fatigue, psychological disorders, emotional distress, and function.
Researchers found that sleep quality was the best predictor of pain in men but not in women.
Fibromyalgia is known to involve sleep abnormalities and often overlaps with one or more sleep disorders. This research suggests that identifying and treating sleep problems may be more important for men.
Psychological & Social Impact
Our society has certain expectations of men and specific ideas about what it is to be masculine. Even in a two-income household, the man is often thought of as the primary breadwinner. Men are supposed to be hard-working, tough, and oblivious to pain.
Everyone with fibromyalgia faces the misconception that we're crazy, lazy or both. When a man has a debilitating pain condition, people may also view him as weak and think especially badly of him if he doesn't have a job. He may view himself this way as well.
Men with fibromyalgia report feeling like they've failed as a husband, father, and provider. It's a huge blow to the ego to be knocked down with what's sometimes considered a "women's condition."
It's important to remember that illness is not weakness. Instead, the ability to keep functioning at any level when you're sick shows tremendous strength.
Also remember that it's not weakness to need mental-health counseling to deal with these issues. It may help you overcome mental and emotional barriers to getting better.
Getting a Diagnosis
If you suspect you have fibromyalgia, bring it up to your doctor, as he or she may not consider it because they're so accustomed to seeing it in women.
If your doctor dismisses the idea based on your gender, you may need to be persistent about it or see another doctor.
Local support groups and online forums for fibromyalgia have always been dominated by women, which can make it hard for men to feel included and really understood. Several websites now offer information and support specifically for men, including Men With Fibro. You may also be able to find male-focused groups or pages on social networking sites.
However, you do share experiences, not to mention dozens of symptoms, with the other 90% of people with fibromyalgia. You can learn a lot from them and teach them a lot, too.
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