"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, all its
sufferers can find relief. Several medications are now approved for the
treatment of fibromyalgia in both men and women.