Is "man flu" a real thing? Here's what the research says

When it comes to getting a cold or the flu, there is a commonly held belief that men take it harder than women, exaggerating their symptoms and basically acting like big ol' babies. But is this phenomenon of "man sick" a real thing? We investigate.

These days, it seems like I can't get on a transatlantic flight without getting sick. Blanket and pillow? Sure. Headphones? No thanks I have my own. Pretzels? You bet. RSV? COVID? Bronchitis? Well, uh … I guess you just choose because I'll be taking one off the plane with me.

Such was my fate after returning to my home in Portugal after attending a wedding in Pennsylvania last week. Pretty much the day we landed, I started to feel achy, sniffly, lousy, and all the other words that end in "y" that indicated I had come down with something. I got a bit yuckier feeling every day physically, but my mood also took a turn for the worse when my wife said she had told some friends that I had to miss a gathering because I was "man sick."

"No, I'm legitimately sick," I thought. But I know the answer would have been, "you're not really that sick, you're just behaving like you are." It's a conversation we've had many times as, I suspect, have many couples. So to try to figure out if I was just being a wimp or if there was something to this gender discrepancy in the way men and women get sick, this science-journalist husband decided to dig into the research.

Man flu

This concept of being "man sick" or having the "man flu" has been around for quite a while. According to Wikipedia, "man flu's" "earliest known use was found in a message posted on the Usenet newsgroup misc.health.diabetes in 1999, as documented by the Oxford English Dictionary." But is there any legitimate science behind the idea?

Well, yes and no. As you might imagine when it comes to something as subjective as how you feel when you're sick, rigorous studies are hard to carry out. That said, there has been some work done on the topic.

One of the most comprehensive reviews on studies relating to gender differences and immunity was published in the Annual Review of Immunology (ARI) in 2022. That report found that there was indeed quite a bit of difference in how men and women respond to bacterial and viral invaders.

For starters, the review found that women generally get fewer viral infections than men. Some of this might have to do with the fact that men generally take fewer precautions than women in terms of getting sick such as mask wearing and hand washing. But the ARI paper revealed that there are also significant biological differences for the finding, including the fact that women tend to mount a more robust immune response to viruses.

After HIV-1 infection, for example, the immune cells known as plasmacytoid dendritic cells (pDCs) from women produce more levels of a chemical known as IFN-α than men do. This cytokine – an inflammation-controlling protein – is a critical component of the antiviral response and women produce it faster than men, meaning they get busy fighting off infections sooner than guys do.

The study also found that in the face of H1N1 infection, women had higher levels of antibodies in their systems than men. Women were also found to have "more robust memory CD8+T cell responses," meaning their immune systems would be better equipped to fight off the same viral invader in the future.

Finally, and perhaps most relevant to my own investigation, the study also found that women tend to have lower viral loads than men when infected with the same bugs, meaning that their symptoms would naturally be less severe.

Blame Darwin

Researchers have postulated that there's both an evolutionary and biological explanation for the stronger immune systems in women. Because many immune-regulating functions come from the X chromosome, it would make sense that women, who have two of them, would have a stronger immune system. Also, some studies have suggested that estrogen boosts immunity while testosterone suppresses it.

From an evolutionary point-of-view, women's stronger immune systems make sense, as they need to remain healthy to bear children and raise them without getting themselves or their offspring sick. Once men have done their part in the procreation process, they could just go sulk away in a cave if they got sick and emerge – or not – when they felt better.

So there's some hard-and-fast evidence that men have weaker immune systems than women, therefore get sicker than women, and therefore, likely complain more than women about their illnesses. But the research doesn't quite back that up either.

A study reported in the Journal of Psychosomatic Research (JPR) in 2022 found that although women recovered faster from acute rhinosinusitis (ARS) than men, they reported a higher degree of symptoms.

Likewise, in a 2019 study reported in the British Medical Journal, researchers infected 15 men and 15 women with the E. coli bacteria at a strong enough dose to induce flu-like symptoms. They found that women exhibited a stronger pro-inflammatory response and had low levels of vascular reactivity, which was higher in men. This measure indicates that IV medication would have a better effect on women than men. The key finding though, was that both sexes rated their severity of symptoms identically.

Moans and groans

That being said, another study that was reported on in the British Medical Journal looked at 1,700 men and women who had the common cold and found that men did indeed over-rate their symptoms about 6% more than women did.

But perhaps more interestingly, the researchers reporting on that study conducted one of their own in which they deliberately infected people with an endotoxin that caused them to develop flu-like symptoms. In that study, both sexes reported their symptoms equally and exhibited the same amount of moans and complaints. However, the men tended to have a higher frequency of sighs and deep breaths which could be construed as a higher level of complaining.

So, IS there such a thing as the man flu?

It certainly seems that there are reasons why guys get sicker more frequently and have more severe symptoms when they do succumb to a bug. In fact, when it comes to COVID-19 it's been reported that men had more severe symptoms than women and contracted the virus and died at a rate over 15% higher than women. That's definitely something worth complaining about.

But marital jibes aside, my research showed that there's a more sinister side to suggesting that when men get sick they overreact because, thanks to that stigma, many guys will be hesitant to take their own symptoms seriously and seek medical attention for them, which is a dangerous trend. Or, as the JPR researchers put it …

"The pop-cultural portrayal of men as overly weak and hysterical patients when facing a simple flu may hinder men from seeking for appropriate medical treatment because of a fear to be ridiculed. To avoid a culture of toxic masculinity, stereotypical portrayals of gender roles should be avoided."

Now excuse me while I go curl up in a ball in bed and pass out, because I'm SICK and this article has really wiped me out!