Men and women experience fibromyalgia symptoms differently — here’s why.
By Jan Sheehan
Medically Reviewed by Ed Zimney, MD
Fibromyalgia predominantly affects women — as many as 90 percent of cases are diagnosed in females, according to U.S. government statistics. Men get the disorder too, but they experience it very differently. Males tend to get fewer and milder symptoms than women. Their discomfort also lasts for shorter periods of time and occurs less often.
“While women typically experience tenderness or pain in at least 11 of 18 tender points, men may have only six places in the body that are tender, and they aren’t as painful as those in women patients,” says Tarvez Tucker, M.D., a fibromyalgia expert and associate professor of neurology at the University of Kentucky in Lexington. The reasons for these gender differences aren’t completely understood, but there are several theories why women suffer more than men.
Fibromyalgia: The Estrogen Connection
Because fibromyalgia peaks in women during the reproductive years, female hormones are believed to play a role in the higher incidence and severity of the disorder. Many women complain that fibromyalgia pain is worse just before and during their periods. This may be due to hormone fluctuations — estrogen plummets right before menstruation and begins to rise again after a woman’s period is over.
“Estrogen is believed to be protective against pain,” says Dr. Tucker. “It’s very high during pregnancy, probably to protect women from the pain of childbirth.” But in menstruating women, estrogen levels fluctuate during the month, which can worsen fibromyalgia symptoms as levels dip.
It’s also thought that men more effectively release endorphins, natural substances in the brain that activate its pain-killing receptors. Research suggests that women, in general, have lower thresholds to pain than men, which may relate to these endorphin and hormonal differences.
Fibromyalgia: Role of Testosterone
Men have a small amount of estrogen, but it doesn’t fluctuate throughout the month the way it does in menstruating women. “It’s the changes in estrogen levels that seem to trigger a higher sensitivity to pain,” says Dr. Tucker. Additionally, the male hormone testosterone may be protective against pain. “Clinical experience has shown that men with [the] highest levels of testosterone are the least prone to fibromyalgia,” says Patrick Wood, M.D., a fibromyalgia researcher and chief medical advisor for the National Fibromyalgia Association. Women have this hormone too, but only in a small amount compared to men. Some researchers theorize that testosterone may protect men from experiencing as much fibromyalgia discomfort, as well as fewer migraines or other pain conditions that are more common in women.
Fibromyalgia: A Hidden Disorder in Men?
Though fibromyalgia symptoms are less intense in men, many still suffer from the disorder. Moreover, some experts believe that the incidence in men may be higher than the numbers indicate. Because fibromyalgia is typically considered a woman’s syndrome, male sufferers may be overlooked. “There’s a notion among physicians that fibromyalgia is only a female problem, so it’s not a diagnosis that’s often considered in male patients,” says Dr. Wood.
Additionally, men tend to see doctors less often than women, especially for generalized pain complaints “Many men believe that going to a doctor for vague, hurt-all-over pain is being a little bit of a wimp,” notes Dr. Tucker. Rather than being seen as less manly, they don’t seek diagnosis and treatment.
Fortunately, awareness of fibromyalgia is increasing both in the public eye and in medical circles, so it’s becoming increasingly common for doctors to pick up on fibromyalgia symptoms in male patients. Properly diagnosed, most of its sufferers can find at least some relief. Several medications are now approved for the treatment of fibromyalgia in both men and women.