Man flu

Term for the male experience of a cold

Man flu is a colloquial term referring to the perception that men experience more severe symptoms when afflicted with the common cold or flu-like illnesses. Primarily British, it is frequently used in a self-deprecating manner.[1] This term has sparked both public interest and scientific inquiry into potential sex differences in the experience of respiratory illnesses.[2]

## Origins and cultural impact

[edit]

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.[3] Since then, the term gained recognition in popular culture and became the subject of discussions surrounding the perceived severity of symptoms experienced by men during respiratory illnesses.

An open-access poll featured in Nuts magazine in 2006 brought attention to this notion,[4] although it was widely criticized as unscientific.[5][6] 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.[7] A poll conducted for a painkiller manufacturer in 2008 suggested that such exaggeration is just as prevalent in women.[8]

The concept of 'man flu' has sparked controversy, notably in 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."[9][10] This ad ignited debate about gender stereotypes and perceptions of illness in popular culture.[11]

## Scientific inquiry

[edit]

While initially dismissed as a cultural trope, the notion of 'man flu' has prompted scientific investigation into potential physiological differences between men and women in their response to viral infections.

One study, published in 2009, investigated the effects of the bacterium Listeria monocytogenes on genetically modified mice.[12] 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.[13][14][15]

Subsequent research has yielded more nuanced insights into the interplay between sex, hormones, and immune responses. 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.[16] 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.[17]

The scientific community continues to research the validity and significance of perceived sex differences in symptom severity and immune response to viral illnesses.

### 2017 BMJ medical review

[edit]

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.[18] 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.[19][20]

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.[21][22] 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.[21] 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.[18]

Furthermore, test tube studies of nasal cells infected with influenza revealed intriguing findings regarding the role of the female hormone estradiol. Exposure to estradiol reduced the immune response in cells from women but not in cells from men. Treatment with antiestrogen drugs counteracted this effect.[23] Since flu symptoms are largely attributed to the body's immune reaction, a lessened immune response in women may translate to milder symptoms.[24]

Despite addressing significant scientific findings, the BMJ article maintained a light-hearted tone in keeping with the traditions of its Christmas edition, and as such, is not directly intended to infer the existence of man flu.[25]

## Implications for healthcare

[edit]

The concept of 'man flu' has significant implications for healthcare, particularly in ensuring equitable access to medical treatment and dispelling misconceptions surrounding illness. Research indicates that men are less inclined to seek medical attention when unwell and may underreport symptoms when they do.[26] Understanding the interplay between gender, biology, and societal perceptions is essential in shaping our comprehension of illness. By promoting public awareness and engaging in evidence-based dialogue, society can encourage healthier attitudes and healthcare-seeking behaviors for both genders. It's crucial to adopt evidence-based, gender-sensitive approaches to medicine to enhance diagnostics and treatment.[27] Stereotypical portrayals of men as weak or exaggerating patients may deter them from seeking medical help, thus perpetuating toxic masculinity.[28] The notion of 'man flu' should be critically examined; further research is warranted in this area.

## See also

[edit]

* Gender bias in medical diagnosis
* Sex differences in humans

## References

[edit]

1. ^ "Man Flu: A Man's Illness?". ABC News Medical Unit. Retrieved 24 July 2011.
2. ^ Alleyne, Richard (24 March 2010). "Man flu is no myth as Swedish scientists prove men suffer more from disease". The Daily Telegraph. London. Archived from the original on 27 March 2010. Retrieved 4 November 2011.
3. ^ "Man Flu, N", Oxford English Dictionary, Oxford UP, December 2023, doi:10.1093/oed/1063166065, retrieved 7 March 2024
4. ^ "'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)
5. ^ 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.
6. ^ 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.
7. ^ 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.
8. ^ "'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.
9. ^ "Boots signs comedians in festive strategy shift". www.campaignlive.co.uk. Retrieved 7 March 2024.
10. ^ Boots. "Here Come the Girls 'I'm Fine' TV ad". YouTube. Archived from the original on 18 April 2012.
11. ^ "Boots ad 'should not have been made' | Men's Health Forum".
12. ^ 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.
13. ^ 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.
14. ^ "media - Bad Science". Retrieved 23 May 2009.
15. ^ "Man flu: real or myth?". NHS. Archived from the original on 16 February 2010. Retrieved 24 July 2011.
16. ^ 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.
17. ^ 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.
18. ^ a b Sue, Kyle (2017). "The science behind 'man flu'". BMJ. 359: j5560. doi:10.1136/bmj.j5560. PMID 29229663. S2CID 3381640.
19. ^ 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.
20. ^ 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.
21. ^ 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.
22. ^ 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.
23. ^ 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.
24. ^ Shmerling, Robert H. (4 January 2018). "Is "man flu" really a thing?". Harvard Health. Retrieved 7 March 2024.
25. ^ "The Best of the British Medical Journal's Goofy Christmas Papers". Smithsonian Magazine. Retrieved 27 December 2017.
26. ^ 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 (inactive 5 December 2024). ISSN 0042-9686. PMC 4147416. PMID 25197149.`{{cite journal}}`: CS1 maint: DOI inactive as of December 2024 (link)
27. ^ 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.
28. ^ 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.