Men are often overlooked in discussions about fibromyalgia because it seems to affect more women than men. However, FCI board president Bill Pastor’s article in the April 2011 issue of our quarterly magazine is further proof it is not just a woman’s disease.

A lot of people and even some doctors erroneously think that men don’t get fibromyalgia. This can cause special problems for men who have it, both in getting a diagnosis and in finding support. Societal expectations and stereotypes of men pose their own problems as well.

Experts disagree on the estimated ratio of women to men. A 2001 review of research placed the ratio at nine to one, but a later epidemiological study found the female to male ratio to be three to one. Based on inquiries received at FCI, we believe the ratio to be about two female to one male. An exact figure is difficult to determine because men are often reluctant to go to the doctor and doctors sometimes don’t diagnose men with fibromyalgia because they think it primarily affects women.

Symptom Differences

The subject of whose symptoms are worse – men’s or women’s – can foster a lively debate. The lower numbers could be because doctors are less likely to consider the diagnosis in the first place, and, what’s more, fibromyalgia may look slightly different in men than women. Some research has suggested that men tend to have less frequent flare-ups of their symptoms, which also are likely to last for shorter periods of time.

However, one Israeli study found that men with fibromyalgia actually had more severe symptoms, decreased physical function, and lower quality of life than women the same age with fibromyalgia.

One study found that men with fibromyalgia have fewer tender points and less fatigue, morning stiffness and irritable bowel. But another study found that men reported more severe symptoms, a greater decrease in physical function, and a lower quality of life.

Since symptom severity is pretty much a subjective measurement, it’s hard to compare any two patients, particularly when they are of opposite sexes.

It’s a Guy Thing

From a young age, boys are taught to be tough, to push through the pain, and not to complain. As men, they often tend to keep quiet about their pain and minimize the severity of their symptoms. Women, on the other hand, seem to feel more comfortable voicing their complaints and asking questions.

Although the roles of men and women in our society have been changing and the gender gap has been narrowing, some distinct differences remain. There still tends to be a “big boys don’t cry” attitude.

Whether it is taught or innate can be debated, most men have a strong sense of responsibility to provide for their families. A man’s sense of self-worth is often tied to his ability to work and achieve. When fibromyalgia enters the picture and men can no longer work as long, as hard and as well as they once did, they often struggle with feelings of failure.

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.

Hormonal Differences

The most obvious difference between fibromyalgia in men and 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.

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. Generally speaking, though, we do have evidence that male hormones impact pain in certain ways.

Serotonin

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.

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.

Sleep Abnormalities

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.

Bridging the Gender Gap

I’d also like to encourage fibromyalgia support groups to remember the men when they plan their meetings. While men are welcomed, the programs and discussions are often aimed at women because they are in the majority. When a man goes to a support group meeting, he frequently finds that he’s the only man there. Groups might consider planning and publicizing a meeting especially for men with FM.

Men who have fibromyalgia do share experiences, not to mention dozens of symptoms, with women. Men can learn a lot from women and men can teach women a lot, too.

Tips for men and women:

• Don’t allow yourself to fall into the trap of feeling like a victim.
• Take control of your life and your healthcare. You can take charge and manage your own self-help techniques.
• Educate yourself about fibromyalgia. FCI’s quarterly magazine Fibromyalgia Solutions is designed to help keep you informed.