There is a widespread belief that men, due to physiological characteristics, tolerate ARVI worse than women. We checked whether this is supported by scientific evidence.
The fact that colds are more severe in men than in women, report sites medical clinics and publications for men, doctors in radio broadcast and in Telegram channels, as well as federal media. Over the years, publications on this topic have been published in TASS, RBC, "Gazeta.ru", Sports.ru and other publications. Numerous memes are dedicated to men helpless due to a mild cold.
Acute respiratory viral infections (ARVI) are group diseases caused by influenza and parainfluenza viruses, rhinoviruses, coronaviruses, respiratory syncytial virus (RSV), adenoviruses and metapneumovirus. People usually call them the collective word “cold.” These diseases amaze mainly the respiratory organs - both the upper and lower respiratory tracts. ARVI is among the most common diseases in the world that affect representatives of all age groups. By assessment According to scientists, children get colds from six to ten times a year, adults - from two to four. For sick leave due to ARVI, like testifies statistics account for up to 80% of all missed educational time among schoolchildren and up to 50% of missed work time among adults.
Typical symptoms conditionally share into local (respiratory) and general. The first group includes sneezing, nasal congestion and discharge, sore throat, cough (dry or with phlegm), hoarseness or loss of voice and discomfort in the ears. The most common general symptoms are fever and chills, headache and muscle pain, general weakness and fatigue. However, the clinical manifestations of ARVI may vary depending on the specific pathogen, the patient’s age, the state of the immune system and the presence of concomitant diseases. But can the gender of the patient influence the severity of the disease?
Observations of the immune response to influenza vaccination, which were carried out in 2013 by scientists from the USA and France, showedthat in men it is generally less pronounced than in women. Moreover, study participants with the highest testosterone levels produced the worst antibodies. Scientists explained this by saying that testosterone likely impairs the immune response. The study authors also noted that the difference in immune responses between men and women was more pronounced among young people than among older people. It turns out that young men with high levels of this hormone will be the least protected by vaccination and are likely to be more susceptible to the disease.
However, the researchers then conducted an additional test. Using a microneutralization reaction, they studied how effectively cell cultures of volunteers who had undergone vaccination coped with the pathogens against which the vaccination was supposed to protect them. It turned out that sex differences were observed only in the case of the H3N2 strain (influenza A), while the immune systems of people of both sexes responded equally to the H1N1 strain (the pathogen responsible for the Spanish flu and swine flu) and influenza B.
Female sex hormones are also involved in the functioning of the immune system. For example, estrogen found out American scientists in 2022, has an anti-inflammatory effect and promotes recovery from infection and wound healing. A 2015 experiment conducted by Johns Hopkins University School of Public Health showedthat another female sex hormone, estradiol, also helps fight viruses. Nasal epithelial cells from female donors treated with this hormone suppressed influenza A virus better than untreated ones. At the same time, the hormone did not help the cells from male donors. Scientists see this as an evolutionary defense mechanism - the level of estradiol increases during pregnancy, protecting the woman and fetus from severe viral diseases.
Although at the cellular level biological mechanisms that determine the connection between sex hormones and immunity do exist, it is premature to draw a conclusion on this basis that men suffer ARVI more severely. Most of these experiments were carried out in vitro, that is, in a test tube, and the reliability of such data is not very high, notes Canadian physician and researcher Kyle Sue in an article for the British Medical Journal. Moreover, he rightly notes that such studies mainly studied influenza, and colds can be caused by dozens of different viruses. How the immune systems of men and women react to them remains to be seen.
Some scientists have turned to statistics in search of an answer. Thus, researchers from Hong Kong in 2015 calculated, patients of which gender are more often hospitalized with severe influenza. The difference was only statistically significant among children—boys were actually hospitalized more often than girls. At the same time, the distribution among adults turned out to be almost uniform. In 2022, a similar study held American scientists - however, they were not interested in the fact of hospitalization, but in the variety and severity of symptoms. In their study, women were the leaders in the severity of the disease. Spanish scientists in 2020 researched gender distribution of cases and deaths from COVID-19. Although both sexes were infected almost equally in the sample (51% vs. 49%), the mortality rate was higher in men (4.4% vs. 2.5%). The researchers suggested that it was not a matter of gender-related differences in immunity, but that among men there were more smokers, so their respiratory diseases were more severe. Journalists of The Wall Street Journal in the same 2020 analyzed similar American statistics and noticed that men face a higher risk of infection and death from coronavirus than women. At the same time, the publication notes, men generally lead a less healthy lifestyle, more often have concomitant health problems, tend to neglect prevention and put off visiting a doctor until the last minute. These assumptions are confirmed by a study by Scottish scientists - they found outthat women are much more likely than men to go to doctors with mild symptoms of ARVI.
Other researchers have relied on subjective patient reports. In 2019, Swedish scientists published The results of a 30-year observation of almost 15,000 people - volunteers were asked what symptoms of illness they had experienced over the past three months. In general, women more often complained of feeling unwell and named almost all symptoms (with the exception of problems with urination and hearing problems). However, it is premature to register women as malingerers. In 1993 in Glasgow held An experiment in which men and women were asked to rate the severity of their illness with a respiratory infection, but their answers were compared with an independent assessment of specialists. It turned out that women more often assessed their condition objectively, and men were inclined to believe that they were suffering from ARVI more severely than they actually were. In 2022, Austrian researchers studiedhow men and women suffer from rhinosinusitis, and received completely different data. In their experiment, it was women who, shortly after infection, subjectively assessed themselves as sicker than men (but also recovered faster - according to the same subjective assessment).
Dr. Charles Garven for the Cleveland Clinic summarizes: There is currently no evidence that the severity of ARVI is related to the gender of the patient. There are scattered studies on the role of sex hormones in the immune response, and there are conflicting statistics, but all this is not enough to say that men tolerate colds worse than women. Firstly, the expert explains, the severity of symptoms is a rather subjective factor, and secondly, the severity of the disease will always be influenced by many details: lifestyle, nutrition, weight, physical activity, concomitant diseases, etc. Finally, in addition to the biological, there is also a social context. In many societies, it is believed that a man should usually be stronger and more resilient, so illness gives him a kind of indulgence, allowing him to relax and allow those around him to look after him. English even has expression “man flu” - it is used in a situation where the disease does not pose any danger, but the patient (usually male) takes it unreasonably seriously.
All the studies conducted to date can hardly be called sufficient to draw unambiguous conclusions about the connection between the severity of ARVI and the gender of the patient - each of them ignores one aspect or another. Kyle Sue in an article for the British Medical Journal writesthat the ideal would be an experiment that excludes the social context. For example, men infected with the virus are randomly assigned to two groups, with the first cared for by caregivers, volunteers in the second left to their own devices, and scientists compare the severity of symptoms.
Garven sums it up: although there is no evidence of the existence of “man flu” yet, this is not a reason to ignore the malaise and not a reason for ridicule from others. The doctor recommends that men with a cold be guided by their own feelings and the advice of doctors, and not by cultural stereotypes.
Thus, sex hormones do play a role in the functioning of the immune system, with testosterone suppressing the immune response, and estrogen stimulating it. However, these findings were based on experiments with cell cultures, and not with living people, which means it cannot be said that men suffer respiratory diseases worse than women. Statistical data is very contradictory, and many existing studies ignore the social context and do not take into account the lifestyle of the participants in the experiments. Based on the available scientific evidence, the idea of a “male cold” is driven more by cultural stereotypes than by biological differences.
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