What Is ‘Man Flu’?

The phrase “man flu” is a slang term, not a medical diagnosis. It’s a stereotype that men exaggerate their symptoms (and helplessness) when they get sick. Some assume men play up their symptoms to get attention or to get others to take on more caregiving responsibilities. Others think it’s a sign that men are weaker than women in some way.

Depending on who you ask, the term is either:

• A harmless joke
• Offensive
• Reflective of how our culture is set up, real differences between the sexes, or both

Who’s right? That’s up for debate.

Some research suggests men aren’t overstating their illnesses and that they do, in fact, have more severe cold and flu symptoms than women. Is it really possible that man flu reflects a biological reality? We asked family medicine doctor Charles Garven, MD, to break down the research.

Do men really have worse symptoms?

We don’t have anywhere near enough scientific evidence to say that men get sicker than women when they have infectious diseases, like colds and flu. So, why are some news outlets reporting it like it’s a proven fact?

Most of those stories were inspired by a (tongue-in-cheek) review paper that the British Medical Journal published in 2017. It was part of their traditional “goofy” Christmas issue, which the editors themselves describe as “a pile of strangeness.”

The study obviously wasn’t as serious as you’d expect from a stodgy academic article. But it wasn’t all fun and games either.

The author supported the theory that man flu is real with a collection of laboratory studies, historical research and epidemiological data. He also cited studies that suggest there’s a hormone-based immunity gap between men and women.

None of that is hard to believe. Global life expectancy data consistently shows that, on average, women live longer than men. And — from the early days of the COVID-19 pandemic to the Spanish flu of 1918 — there’s lots of evidence that when infectious diseases sweep an area, they take out more men than women. In 2009, a researcher went so far as to say, “There is no contest about the identity of the sicker sex — it is males, almost every time.”

But does any of that mean that men feel worse than women whenever they’re sick? Even with minor illnesses like the common cold?

Flaws in the research

Dr. Garven says we’d need to do a lot more research to prove that. He also points out that interpreting the data we do have is seriously complicated because:

• Most of the science involves self-reported symptoms. The phrase “man flu” is all about assuming men overstate the severity of their illness. So, studies that draw conclusions by asking men to describe how they’re feeling are flawed from the jump.
• Immune response and symptom severity aren’t the same thing. The runny nose, nagging cough and obnoxious headache are miserable. But they’re also a sign that your immune system is kicking into high gear. That means you can’t assume feeling crummy means you’ve got a weak immune system. So, the theory that men have weaker immune systems and, therefore, get sicker is shaky, at best.
• Most of the research focuses on vaccines. “There are many studies that involve measuring the antibody response to a vaccine,” Dr. Garven explains. “But a lot of the illnesses we associate with man flu don’t have vaccines. And linking a person’s antibody levels after vaccination to the severity of the symptoms they get in the future requires lots of painstaking research.”
• Everybody (and every body) is different. Sex may play a role in symptom severity. But so will other factors, like your age, the medications you take, whether you’re pregnant and more. And you can only control for so many variables when you analyze data.

But some of the science contradicts the theory that men get sicker than women. For example, a 2022 study of people with sinus infections found that women reported more severe symptoms than men, even though they recovered faster. Another 2022 study found that women had more (and more severe) flu symptoms. They also had worse overall outcomes.

Sex differences in immune function

When we look at all the evidence together, there’s still a lot more maybes than answers. We can confidently say that hormones impact the way our immune systems function. But using those studies to claim men get sicker than women is too big a leap.

“We know a good bit about how hormone levels impact our overall health,” Dr. Garven says. “But the story continues to evolve as more research occurs. And you can’t make assumptions about symptom severity using the studies we have today.”

That doesn’t mean Dr. Garven is ruling out the possibility that men and women experience respiratory viruses differently.

“We know about lots of medical conditions that impact the sexes differently, like osteoporosis, heart disease and autoimmune conditions,” he notes. “So, it’s not foolish to think that infectious diseases could have similar patterns.”

Why might colds and flus feel worse for men?

Man flu may or may not be a biological phenomenon. But biology isn’t the only factor that determines how we feel when we’re sick.

“Cultural norms surrounding health and masculinity also cause sex disparities in medical conditions,” Dr. Garven explains.

In other words, even if men aren’t sicker than women, social expectations may cause them to:

• Feel sicker
• Respond differently to illness
• Hide (or in the case of man flu, emphasize) certain symptoms

Many societies expect men to be more resilient than women — both physically and emotionally. It’s part of the reason men tend to see the doctor less often than women (more on that in a bit). Could men in those communities be using sickness, consciously or subconsciously, as an opportunity to drop the stoic act and ask for help?

One thing’s for sure: The man flu stereotype definitely impacts the way men seek and receive healthcare. One scientist whose research showed men overrate their symptoms also found that the healthcare providers who evaluated them believed women were more likely to get sick. That assumption could have led them to underrate their male patient’s symptoms.

That’s right: Even studies of man flu are influenced by stereotypes about men’s health!

All the different generalizations about how and why men get sick may also impact how they communicate their needs, all the way down to micro-expressions. Some researchers found that men and women express physical discomfort differently, with men being more inclined to take deep breaths and sigh.

There are many possible cultural explanations for the man flu stereotype. And they’ll change depending on where you live and how your community perceives illness. All we know for sure is that we can’t discuss man flu in a vacuum. Science and culture are always intertwined.

Final thoughts

Is “man flu” a joke, an insult or a stone-cold biological reality? The jury’s still out. But even if we had a verdict, it wouldn’t tell us much.

“Variability among the sexes occurs in many medical conditions. But what that means for individual people isn’t clear,” Dr. Garven says. He recommends that you rely on healthcare professionals (not generalizations) to assess your personal health risks.

“Staying connected with a good primary care provider is a fantastic way to ensure your health questions — about man flu or anything else — are answered,” he stresses. “They can also walk you through the basics of preventive care.”

As far as Dr. Garven’s concerned, that’s the big takeaway from all these statistics and theories: prevention matters. We may not know if men get sicker than women, but we do know that, in the U.S., only about 50% of men access preventive care. That’s a recipe for undiagnosed medical conditions. And those conditions could make everyday illnesses harder to get past.

Whether man flu exists or not, this much is true: Mocking or dismissing people when they don’t feel well isn’t going to make them feel better faster. But it could make them less likely to see their provider when they need to.

So, instead of focusing on the role sex differences do or don’t play in the severity of our crud, let’s focus on encouraging men to get said crud evaluated by a medical professional. It might make all the difference.