Just in time for flu season, a new article in the Christmas issue of the British Medical Journal explores the science behind a debate that has annoyed sniffling, coughing men and infuriated women for years.
Is the "man flu" an actual medical condition? Do men suffer from worse flu symptoms than women?
Or, are men simply whinier than women and act sicker when they have a bug? Adding insult to injury for men, the term "man flu" has made it into the Oxford Dictionary: "A cold or similar minor ailment as experienced by a man who is regarded as exaggerating the severity of the symptoms."
Dr. Kyle Sue, a clinical assistant professor in family medicine at Memorial University in St. John's, decided to study the available research to see if he could settle the debate with science.
His conclusion? There's evidence, albeit limited, that the man flu is actually nothing to sneeze at.
"I think the symptoms are real," Sue said. "And they're worse."
'The whole point of doing this article is to prove that men are not wimps.' - Dr. Kyle Sue
For the Canadian doctor, it was all about the science — but it was personal, too.
"I've been criticized for exaggerating my symptoms when I had the flu," he told CBC News from Arviat, Nunavut, where he's the community's only doctor. "I thought. You know what? This would be an interesting topic to look into."
In the journal, he points out that no scientific review has examined whether the term man flu "is appropriately defined or just an ingrained pejorative term with no scientific basis."
"Since about half of the world's population is male, deeming male viral respiratory symptoms as 'exaggerated' without rigorous scientific evidence could have important implications for men," he wrote.
Most of the studies he found involved mice, and several of them showed female mice have stronger immune responses than males.
A study that isolated cells from 63 healthy people and infected the cells with a common virus found the cells from women had a stronger immune response than those from men.
Other findings included:
- A seasonal flu study from 2004-10 in Hong Kong found men had a higher risk of hospital admission.
- A U.S. observational study from 1997-2007 showed men had higher rates of flu-associated deaths compared to women.
- Women are more responsive to vaccination than men.
- In an unscientific survey, men suffering from a flu reported taking more time off from work than women.
'Benefit of the doubt'
He says the studies actually point to men having weaker immune systems than women.
"Testosterone is a hormone that actually acts as an immunosuppressant. Whereas estrogen works in the opposite direction. They stimulate the immune system," he told CBC News. "So men with higher testosterone actually end up being more susceptible to viral respiratory and tend to get them worse."
Sue admits the evidence is limited, particularly since much of it involved mice. He says more higher-quality research needs to be done to determine conclusively whether man flu is an actual medical phenomenon.
Nevertheless, he says, the available evidence does suggest men suffer more with the flu than women.
"The whole point of doing this article is to prove that men are not wimps," he said in an interview. "Actually, we are suffering from something we have no control over ... [We] should be given the benefit of the doubt rather than being criticized for not functioning well during the flu or the common cold."
But, in keeping with the cheerful spirit of the season — and with tongue firmly planted in cheek — Sue also wrote about the benefits to having a "less robust immune system." In times of illness, it allows men to conserve their energy by lying on the couch or not getting out of bed.
"Perhaps now is the time for male-friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort."