Man flu

Man flu is a colloquial term referring to the perception that males can experience more severe symptoms when afflicted with the common cold or flu-like illnesses. Originating in Britain, the term has become widespread, and is frequently used in a deprecating manner.[1] Some scientific inquiries verify the existence of a unique response to the flu on the part of males as a constellation of effects, including the negative correlation between testosterone levels and antibody response,[2] while others have argued that the term relies on and perpetuates gender stereotypes that invite ridicule towards men who show weakness or seek help for medical conditions.[3]

Origins and Diffusion

The term 'man flu' is believed to have originated in the 1990s, with the earliest known use found in a message posted on the Usenet newsgroup misc.health.diabetes in 1999, as documented by the Oxford English Dictionary.[4]

An open-access poll featured in Nuts magazine in 2006 brought attention to this notion,[5] although it was widely criticized as unscientific.[6][7] The poll reported that men reported longer recovery times from flu-like illnesses compared to women, with men taking an average of three days to recover, while women recovered in 1.5 days.[8] A poll conducted for a painkiller manufacturer in 2008 suggested that such exaggeration is just as prevalent in women.[9]

A Boots advertisement featuring the tagline "when he's ill and you don't have time to be – get cold and flu products for just 99p at Boots", which may have been inspired by the concept of 'man flu',[10][11] was criticized by some for reinforcing gender stereotypes.[12]

Scientific inquiry

Scientific investigation into 'man flu' and its journalistic uptake have been disorderly. Some researchers refute outright the existence of man flu,[3] while one study[13] has suggested substantial evidence for the phenomenon while nevertheless remaining inconclusive on the question of its ultimate existence. Moreover, other scientific studies focused on gender differences in immune responses in contexts either broader than or separate from the flu have been cited in public discussion as evidence of the existence of 'man flu'.

One study, published in 2009, investigated the effects of the bacterium Listeria monocytogenes on genetically modified mice.[14] While the study did not pertain to cold or flu viruses, but rather to a bacterial disease, it gained widespread attention and was misinterpreted by various media outlets, including The Daily Telegraph, as supporting the existence of 'man flu' in humans.[15][16][17]

In a study published in the Journal of Psychosomatic Research, researchers affiliated with the University Of Innsbruck found that while women may recover from flu symptoms more quickly than men, a uniquely severe sensitivity to the flu on the part of men does not exist.[3] The researchers also criticized the potential of the term 'man flu' to reinculcate toxic masculinity and discourage men from seeking treatment for the flu. As the researchers summarize:

"... While women showed a tendency to self-report more symptoms, no differences were found in the physician-rated symptom severity. This means that while there is some indication that men might recover more slowly from the disease, based on our data, we would have to reject the popular conception of a male hypersensitivity to ARS. We recognize the importance of evidence-based gender-sensitive medicine to improve diagnostics and treatment in ARS and in medicine in general. In contrast, 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. The present study provides some evidence to discard the concept of ‘man flu’. Nevertheless, more research in this field is warranted."[3]

In the Christmas 2017 edition of The BMJ, a review of existing research highlighted significant differences in immune response and outcomes of influenza between men and women.[13] Epidemiological data indicated that men may have a higher risk of hospital admission and mortality from influenza compared to women. Specifically, data from 2004 to 2010 for seasonal influenza in Hong Kong showed a higher risk of hospital admission among adult men, and a US observational study from 1997 to 2007 reported higher rates of influenza-associated deaths among men, even when accounting for factors such as heart disease, cancer, chronic respiratory system disease, and renal disease.[18][19] Research on influenza vaccination suggested that women may be more responsive to vaccination than men, experiencing more local (skin) and systemic (bodywide) reactions, and exhibiting a better antibody response.[20][21] Testosterone levels in men were found to potentially play a role in their response to influenza vaccination, with men having the highest levels tending to show a lower antibody response.[20] This lower response may contribute to the possibility that vaccinated men experience more severe symptoms compared to women, as they may not respond to vaccination as effectively.[13] Furthermore, test tube studies of nasal cells infected with influenza revealed that exposure to estradiol reduced the immune response in cells from women but not in cells from men. Treatment with antiestrogen drugs counteracted this effect.[22] Since flu symptoms are largely attributed to the body's immune reaction, a lessened immune response in women may translate to milder symptoms.[23] Despite such findings, this BMJ article, in keeping with the a humorous tone of the journal's Christmas edition, is not intended to imply the existence of man flu.[24]

According to researchers at the University of Cambridge, evolutionary factors may have led women to develop more rigorous immune systems than men due to differing reproductive strategies.[25] In addition, a 2011 study conducted at the University of Queensland suggests that female hormones, such as oestrogens, aid pre-menopausal women in fighting infections, but the protection is lost after menopause.[26]

Research indicates that men are less inclined to seek medical attention when unwell and may underreport symptoms when they do.[27][28]

See also

References

  1. ^ "Man Flu: A Man's Illness?". ABC News Medical Unit. Retrieved 24 July 2011.
  2. ^ "The science behind "man flu"". The British Medical Journal. Retrieved 21 January 2026.
  3. ^ a b c d Riedl, D.; Labek, K.; Gottfried, T.; Innerhofer, V.; Santer, Matthias; Weigel, B.; Dejaco, D. (December 2022). "Man flu is not a thing – Gender-specific secondary analysis of a prospective randomized-controlled trial for acute rhinosinusitis". Journal of Psychosomatic Research. 163 111047. doi:10.1016/j.jpsychores.2022.111047. PMID 36228432.
  4. ^ "Man Flu, N", Oxford English Dictionary, Oxford UP, December 2023, doi:10.1093/oed/1063166065
  5. ^ "'Man flu' really exists". Archived from the original on 5 January 2007. Retrieved 8 February 2007.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  6. ^ Boynton, Petra (2006). "Are reports of "man flu" just Nuts?". BMJ. 333 (7578): 1128.1–1128. doi:10.1136/bmj.39041.590556.59. PMC 1661725.
  7. ^ Boynton, Petra (14 November 2006). "'Man Flu' – manufacturing an illness to sell a magazine". Archived from the original on 26 April 2012. Retrieved 8 February 2007.
  8. ^ Boynton, Petra (25 November 2006). "Are reports of "man flu" just Nuts?". BMJ. 333 (7578): 1128.1–1128. doi:10.1136/bmj.39041.590556.59. ISSN 0959-8138. PMC 1661725.
  9. ^ "'Man flu' just as prevalent in women". The New Zealand Herald. 20 May 2007. Archived from the original on 29 September 2007. Retrieved 12 September 2011.
  10. ^ "Boots signs comedians in festive strategy shift". www.campaignlive.co.uk. Retrieved 7 March 2024.
  11. ^ Boots. "Here Come the Girls 'I'm Fine' TV ad". YouTube. Archived from the original on 18 April 2012.
  12. ^ "Boots ad 'should not have been made' | Men's Health Forum".
  13. ^ a b c Sue, Kyle (2017). "The science behind 'man flu'". BMJ. 359 j5560. doi:10.1136/bmj.j5560. PMID 29229663. S2CID 3381640.
  14. ^ Yeretssian, G; Doiron, K; Shao, W; Leavitt, B. R; Hayden, M. R; Nicholson, D. W; Saleh, M (2009). "Gender differences in expression of the human caspase-12 long variant determines susceptibility to Listeria monocytogenes infection". Proceedings of the National Academy of Sciences of the United States of America. 106 (22): 9016–20. Bibcode:2009PNAS..106.9016Y. doi:10.1073/pnas.0813362106. PMC 2690057. PMID 19447924.
  15. ^ Alleyne, Richard (12 May 2009). "Men succumb to manflu because women have stronger immune systems, claim scientists". The Daily Telegraph. London. Archived from the original on 17 May 2009. Retrieved 23 May 2009.
  16. ^ "media - Bad Science". Retrieved 23 May 2009.
  17. ^ "Man flu: real or myth?". NHS. Archived from the original on 16 February 2010. Retrieved 24 July 2011.
  18. ^ Wang, Xi-Ling; Yang, Lin; Chan, Kwok-Hung; Chan, King-Pan; Cao, Pei-Hua; Lau, Eric Ho-Yin; Peiris, J. S. Malik; Wong, Chit-Ming (15 August 2015). "Age and Sex Differences in Rates of Influenza-Associated Hospitalizations in Hong Kong". American Journal of Epidemiology. 182 (4): 335–344. doi:10.1093/aje/kwv068. ISSN 0002-9262. PMID 26219977.
  19. ^ Quandelacy, Talia M.; Viboud, Cecile; Charu, Vivek; Lipsitch, Marc; Goldstein, Edward (15 January 2014). "Age- and Sex-related Risk Factors for Influenza-associated Mortality in the United States Between 1997–2007". American Journal of Epidemiology. 179 (2): 156–167. doi:10.1093/aje/kwt235. ISSN 1476-6256. PMC 3873104. PMID 24190951.
  20. ^ a b Furman, David; Hejblum, Boris P.; Simon, Noah; Jojic, Vladimir; Dekker, Cornelia L.; Thiébaut, Rodolphe; Tibshirani, Robert J.; Davis, Mark M. (14 January 2014). "Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination". Proceedings of the National Academy of Sciences. 111 (2): 869–874. Bibcode:2014PNAS..111..869F. doi:10.1073/pnas.1321060111. ISSN 0027-8424. PMC 3896147. PMID 24367114.
  21. ^ Beyer, W. E. P.; Palache, A. M.; Kerstens, R.; Masurel, N. (June 1996). "Gender differences in local and systemic reactions to inactivated influenza vaccine, established by a meta-analysis of fourteen independent studies". European Journal of Clinical Microbiology & Infectious Diseases. 15 (1): 65–70. doi:10.1007/BF01586187. hdl:1765/15036. ISSN 0934-9723. PMID 8641306.
  22. ^ Peretz, Jackye; Pekosz, Andrew; Lane, Andrew P.; Klein, Sabra L. (1 March 2016). "Estrogenic compounds reduce influenza A virus replication in primary human nasal epithelial cells derived from female, but not male, donors". American Journal of Physiology. Lung Cellular and Molecular Physiology. 310 (5): L415–L425. doi:10.1152/ajplung.00398.2015. ISSN 1040-0605. PMC 4773846. PMID 26684252.
  23. ^ Shmerling, Robert H. (4 January 2018). "Is "man flu" really a thing?". Harvard Health. Retrieved 7 March 2024.
  24. ^ "The Best of the British Medical Journal's Goofy Christmas Papers". Smithsonian Magazine. Retrieved 27 December 2017.
  25. ^ Restif, O; Amos, W (2010). "The evolution of sex-specific immune defences". Proceedings of the Royal Society B: Biological Sciences. 277 (1691): 2247–55. doi:10.1098/rspb.2010.0188. PMC 2880154. PMID 20335214.
  26. ^ Carroll, Melanie L; Yerkovich, Stephanie T; Pritchard, Antonia L; Davies, Janet M; Upham, John W (2010). "Adaptive immunity to rhinoviruses: Sex and age matter". Respiratory Research. 11 (1): 184. doi:10.1186/1465-9921-11-184. PMC 3024249. PMID 21194432.
  27. ^ Baker, Peter; Dworkin, Shari L; Tong, Sengfah; Banks, Ian; Shand, Tim; Yamey, Gavin (1 August 2014). "The men's health gap: men must be included in the global health equity agenda". Bulletin of the World Health Organization. 92 (8): 618–620. doi:10.2471/BLT.13.132795. ISSN 0042-9686. PMC 4147416. PMID 25197149.
  28. ^ Ference, Elisabeth H.; Tan, Bruce K.; Hulse, Kathryn E.; Chandra, Rakesh K.; Smith, Sean B.; Kern, Robert C.; Conley, David B.; Smith, Stephanie Shintani (January 2015). "Commentary on Gender Differences in Prevalence, Treatment, and Quality of Life of Patients with Chronic Rhinosinusitis". Allergy & Rhinology. 6 (2): 82–88. doi:10.2500/ar.2015.6.0120. ISSN 2152-6567. PMC 4541639. PMID 26302727.
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