Fibromyalgia in Men

Men with fibromyalgia are definitely outnumbered - with

women making up about 90% of cases - but that doesn't mean
the diagnosis shouldn't be considered in men. After all,
according to National Fibromyalgia Association estimates, that
10% could mean one million men are living with illness.
Because of the gender disparity, however, we know a lot more
about how fibromyalgia affects women. Many studies are done
with exclusively female participants, and most doctors have a
lot more practical experience with female fibromyalgia
patients.
A lot of people and even some doctors erroneously think that
men don't get fibromyalgia. This can cause special problems for
men who are living with it, both in getting a diagnosis and in
finding support. Societal expectations and stereotypes of men
pose their own problems as well.
A 2012 study suggested that fibromyalgia is underdiagnosed in
general, and even more underdiagnosed in men. It was a
relatively small study and it didn't examine the reasons behind
the underdiagnoses, but now that the issue has gotten this kind
of attention, it's possible that we'll learn more about it in the
coming years.

Gender & Symptoms
This is an area that needs more research, but some research is
beginning to suggest that men's symptoms may be quite
different than women's. study showed several differences in
pain symptoms.
In that study, men tended to have:
Lower reported pain intensity
Lower tender-point count
Lower depression rates
Longer duration of symptoms when making the first
complaint to a doctor
Higher overall disability due to symptoms
Also, ongoing pain in men was especially linked to pressure-
triggered hyperalgesia (amplified pain) in the neck.
Future research will need to determine why men have different
symptom profile, but some of the physiological differences
discussed below may be involved.
Hormonal Differences
The most obvious difference between fibromyalgia in men
versus women is hormonal. In women, flares are often tied to
the menstrual cycle, and hormonal events such as menopause
or hysterectomy may trigger symptoms.
Certainly, men don't have such obvious hormonal events to
focus on. So far, studies examining male hormonal fluctuations
or abnormalities in fibromyalgia simply haven't been done, so
we don't know what role, if any, these hormones play.
Generally speaking, though, we do have evidence that male
hormones impact pain in certain ways.
Testosterone, the primary male hormone, is thought to play a
beneficial role when it comes to pain in general. Research
suggests that it may help prevent muscle fatigue and, in
combination with a certain protein, may help repair muscles
after exercise. Male hormones may also modulate other
biological processes related to fatigue and pain.
We also know of gender-based differences in the stress
hormone cortisol, which research suggests is low in
fibromyalgia. One study published in Health Psychology in 2008
showed that cortisol levels were different in happily married
women than in their unhappily married counterparts, while
men didn't exhibit any differences based on marital happiness.
Researchers speculated that this could explain why conditions
involving low cortisol are more likely in women.
Brain Chemistry
The brains of men and women are not identical. One difference
that may influence what fibromyalgia is like for each gender is
the neurotransmitter (chemical messenger) serotonin.
Serotonin is believed to play a key role in fibromyalgia. Its areas
of influence include pain, sleep, anxiety and depression. Some
research suggests that the serotonin system works differently
in men than in women.
A 2008 study published in Neuroimaging showed that men
have fewer serotonin receptors (brain cells that respond to it)
than women. However, the process of reuptake - which is
essentially "recycling" so the neurotransmitter can be used
again - may be more efficient in men.
Drugs that slow reuptake are commonly prescribed for
fibromyalgia. They're called SSRIs (selective serotonin reuptake
inhibitors) or SNRIs (serotonin norepinephrine reuptake
inhibitors. Two of the three drugs approved for this condition
are SNRIs: Cymbalta (duloxetine) and Saville (milnacipran).
Because of the gender differences in the serotonin system,
some doctors have suggested that these drugs be tested on
men and women separately. This hasn't happened yet, but we
do have anecdotal evidence that men and women respond
differently to these drugs.
A separate study published in Biological Psychiatry in 2007
showed that lowering the body's serotonin levels doesn't affect
men and women in the same way. In women, it caused
worsening mood and increased cautious behavior. Men didn't
have mood changes at all but became more impulsive, the
researchers say.
These kinds of differences, which we don't fully understand,
could make fibromyalgia harder to spot for doctors accustomed
to seeing mood problems in their female patients.


Is Sleep More Important in Men?
A study published in 2012 in Psicothema looked at gender
differences in the major fibromyalgia symptoms, including pain,
sleep, fatigue, psychological disorders, emotional distress, and
function.
Researchers found that sleep quality was the best predictor of
pain in men but not in women.
Fibromyalgia is known to involve sleep abnormalities and often
overlaps with one or more sleep disorders. This research
suggests that identifying and treating sleep problems may be
more important for men.
Psychological & Social Impact
Our society has certain expectations of men and specific ideas
about what it is to be masculine. Even in a two-income
household, the man is often thought of as the primary
breadwinner. Men are supposed to be hard-working, tough,
and oblivious to pain.
Everyone with fibromyalgia faces the misconception that we're
crazy, lazy or both. When a man has a debilitating pain
condition, people may also view him as weak and think
especially badly of him if he doesn't have a job. He may view
himself this way as well.
Men with fibromyalgia report feeling like they've failed as a
husband, father, and provider. It's a huge blow to the ego to be
knocked down with what's sometimes considered a "women's
condition."
It's important to remember that illness is not weakness.
Instead, the ability to keep functioning at any level when you're
sick shows tremendous strength.
Also remember that it's not weakness to need mental-health
counseling to deal with these issues. It may help you overcome
mental and emotional barriers to getting better.

Getting a Diagnosis
If you suspect you have fibromyalgia, bring it up to your doctor,
as he or she may not consider it because they're so accustomed
to seeing it in women.
If your doctor dismisses the idea based on your gender, you
may need to be persistent about it or see another doctor.

Finding Support
Local support groups and online forums for fibromyalgia have
always been dominated by women, which can make it hard for
men to feel included and really understood. Several websites
now offer information and support specifically for men,
including Men With Fibro. You may also be able to find male-
focused groups or pages on social networking sites.
However, you do share experiences, not to mention dozens of
symptoms, with the other 90% of people with fibromyalgia. You
can learn a lot from them and teach them a lot, too.

How Many Men Have Fibromyalgia?
Recent research suggests that 1 in 8 fibromyalgia patients is
male. However, it is difficult to know if this number is truly an
accurate reflection of the real number of male sufferers of the
disorder. Because it is so often thought of as a woman's illness,
many men suffering from fibromyalgia actually don't get
diagnosed with the syndrome. As a result, a large number of
male sufferers may go unreported. It is thought that the
number of men suffering from fibromyalgia could in fact, be
closer to 30%.

Differences in Male Fibromyalgia Sufferers
Though many men do suffer from fibromyalgia syndrome, the
experience of men with the illness is very different from that of
its female sufferers. There are actually a number of differences
in male fibromyalgia symptoms, treatment, and testing.
Fibromyalgia Rarer Among Men

It's uncertain what causes fibromyalgia or why so few men
suffer from it. Certain types of viral infections, traumas such as
car accidents, and emotional stress can trigger it. In some cases,
though, it strikes without warning.
Whatever the cause, there are certain biological markers that
those with the disorder frequently have in common. According
to Muhammad B. Yunus, MD, a professor of medicine at the
University of Illinois College of Medicine, fibromyalgia is
characterized by an imbalance of chemicals in the brain.
"It is a neurochemical disease," says Yunus, who points out that
people with fibromyalgia show a higher than average amount
of substance P, a neurotransmitter that signals pain, and a
lower than average amount of serotonin, a neurotransmitter
that inhibits pain.
Genetics and hormones, says Yunus, also appear to play a role,
both in causing the disease and in the gender discrepancy
associated with it.
"There are genes that make people more susceptible to pain,
and some are related to gender," he says. "And women are
more susceptible to pain because estrogen reduces the pain
threshold."
That heightened sensitivity to pain may give women higher
odds of getting a diagnosis of fibromyalgia.
A common test that doctors perform is to apply a fixed amount
of pressure to what are called "tender points": 18 specific
points on the body, designated by the American College of
Rheumatology, where even a light touch can cause pain.
At least 11 of those spots must produce a significant pain
response in order to merit a diagnosis. But because men have a
higher threshold for pain, they often don't meet the criteria.

How Fibromyalgia Affects Men

Chronic pain may be its chief symptom, but fibromyalgia
sometimes comes with additional complications. Chronic
fatigue and difficulty sleeping are common complaints, as
are headaches, irritable bowel syndrome, and restless legs
syndrome. Memory problems and difficulty concentrating often
come with the territory as well.
In general, Yunus says, men have fewer symptoms than
women. They tend to have less from fatigue and they have pain
in fewer places. "It's much less common for men to hurt all
over," Yunus says. "But in many ways, men are more affected,
more bothered by fibromyalgia."
The reason for that may be more sociological than biological.
Undiagnosed Cases
"Men don't come to the doctor nearly as much as women,"
says Michael J. Pellegrino, MD, a fibromyalgia expert at Ohio
Pain and Rehab Specialists and an expert on WebMD's
Fibromyalgia Exchange. "Why? Gender stereotypes."
"Men tell themselves, I'm not supposed to go to the doctor,
I'm not supposed to complain.' So a lot of the men I see, their
wives make them come," says Pellegrino, who estimates that
up to 20% of men with the disorder are undiagnosed.
The longer men put off seeing the doctor, the more they put
themselves at risk of developing complications that can affect
their work, their hobbies, their relationships. Pellegrino, who
has fibromyalgia himself, says that depression is not
uncommon among men who have delayed getting a diagnosis.
"Men [with fibromyalgia] often feel broken, even suicidal," says
Gavin Levy, an Austin, Texas-based writer who was diagnosed
with fibromyalgia four years ago, at age 33. "We've all been
there. It feels like your masculinity has been taken away to a
degree. You are a provider and protector, then suddenly that
role is reversed."
The most important thing a man with fibromyalgia can do,
Pellegrino emphasizes, is to get diagnosed. The sooner that
happens, the sooner he can start treatment.

Living with Fibromyalgia
There is no cure for fibromyalgia, but there
are medications that can help curb its symptoms. Equally
important, though, are lifestyle changes. Exercising and eating
well are essential, says Yunus.
"There is a clear relationship between overweight and pain and
fatigue. Overweight is a risk factor for fibromyalgia," Yunus
says. Are cent linked obesity and a greater chance of having
fibromyalgia. That does not mean that everyone with
fibromyalgia is overweight, or that extra pounds, by
themselves, cause fibromyalgia.
World hits the treadmill for at least 10 to 15 minutes a day. He
also does some light weightlifting to keep his strength up and
his own weight down. He even gets out on the golf course once
in a while, knowing that it will wear him out.
"When I'm done, it makes me feel better," he says. "It reminds
me that a little of my old life is still there."