MEN AND LUPUS.........

Gender Differences in Lupus
Although lupus is often called a "woman’s disease," lupus can and does occur in males of any age.

      Before puberty, approximately 1 male will develop lupus for every 3 females.
      In teens and adults, approximately 1 male will develop lupus for every 10 females.
      After age 50, approximately 1 man will develop lupus for every 8 women. The decrease in the ratio of lupus in older man and women might be related to the fact that older men develop lupus more often than younger men, or because hormones have less of an effect in older women.
      These gender differences are seen only in systemic lupus, not in cutaneous (skin) lupus.

The Clinical Course Of Lupus

      The symptoms of lupus are similar in males and females; most commonly skin rash, extreme fatigue, and joint pain.
      The overall clinical course of the disease is the same in both genders, and males and females with lupus typically will be treated with the same therapies.
      Some researchers suspect that the later manifestations of lupus may differ between the sexes:
            Several studies have found more severe kidney, nerve, and blood vessel disease in males with lupus compared to females with the disease.
            However, there is no substantial evidence to support a significant difference between the severity of lupus in males and in females.
      Studies of lupus in the aging male are in progress.
      Young men with lupus have normal levels of male hormones, and their lupus disease activity usually is much worse than seen in older men.
      Late-onset lupus in men may depend in part on lower levels of male hormone.

Drug-Induced Lupus Erythematosus

      More men than women develop drug-induced lupus erythematosus (DILE) because the most common medications to trigger DILE are used more frequently in men: isoniazid (used to treat tuberculosis), procainamide (used to control various types of heart abnormalities), and hydralazine (used to control high blood pressure).

Hormones

For years investigators have been looking at hormonal differences between males and females which might explain the higher prevalence of lupus in women. Hormones being studied include:

      estrogens (female hormones)
      androgens (male hormones)
      testosterone (a male hormone)
      prolactin (a pituitary hormone)

Estrogens

      Estrogen is present in low levels in males and higher levels in females.
      There does not appear to be an increase of estrogen in men with lupus.
      There is no significant difference in the way estrogen is metabolized (chemically changed) by men with lupus versus women with lupus.
      Some data, however, do indicate that there is a difference in the way estrogen is metabolized in normal individuals versus in individuals with lupus.

Androgens

      Androgens are present in high levels in males and lower levels in females.
      There is a difference in the way that androgens are metabolized by men with lupus and by women with lupus.
      There also are data indicating that women with lupus metabolize androgens at a faster rate than women without lupus.
      The result of this rapid metabolism appears to be a lower amount of this hormone in women with lupus.
      There are instances when a young man might not have a normal level of androgens.
            This can happen as a result of an injury or infection.
            Such men could have a poor sex drive, enlarged breasts, and lack of beard growth.
            Androgen replacement is provided to these men.
            Men with this condition usually never go on to get an autoimmune disease like lupus.
            A lupus diagnosis is very rare in a young man who has low androgens.

Testosterone

Testosterone is present in high levels in males and lower levels in females.

      There is also evidence that lower levels of testosterone (another male hormone) in both young and old men may predispose these men to autoimmune-like diseases.
      However, the levels of this hormone are normal in most young men with lupus.
      Drugs that lower testosterone levels in men are associated with rheumatic symptoms, but have not been specifically associated with the onset of SLE.

Prolactin

      Prolactin is present in low levels in males and higher levels in females.
      Recent investigations suggest that prolactin might be elevated in men who are older and have lower androgen levels.
      However this appears to be an unusual finding and is not typical of most men with lupus.

Sexual Factors

There are significant differences in the way men and women might react to the diagnosis of SLE. Men might have the misconception that lupus is a "women's disease" and therefore a man with SLE is less masculine than a man who does not have SLE. This is simply not true.
As far as sexual factors are concerned, young males with lupus are not different than those without lupus.

      Young men with lupus are fertile and have normal reproductive histories.
      Lupus should not affect their ability to be sexually active.
      If males with SLE were any different hormonally than males who do not have lupus, female characteristics would be apparent, yet this is not the case.

As mentioned above, older men with lupus can have less androgen than younger men

      As a result of this normal drop in androgen levels, a man's sex drive changes as he becomes older.
      Despite this drop in androgens with most aging men, only a very small number get the disease of lupus.

All of these things indicate that, while hormones play a role in the disease, many other factors play an important part as well.

Coping

The emotional stresses for men with SLE are the same as those experienced by women with the disease. In some ways, it may be even more difficult for men to cope with having lupus because of the cultural and societal expectations of men.

      For example, the same incapacitating feelings that a woman with SLE feels may be even more apparent in a male:
            He may no longer be able to perform or progress in his work environment
            He may not be able to continue working to support his family
            He may have difficulty in performing duties or activities that involve physical labor.
      The inability to work and earn a living, because of disability due to illness, may result in significant emotional and mental stress.
            The roles and expectations of males and females in today's society are changing, but acceptance of these changes takes a long time.
            These types of stresses, coupled with the fact that lupus is mistakenly referred to as a "woman's illness," can make it difficult for males to cope with this chronic disease.
      Although cosmetic changes are usually not as incapacitating for men as they are for women, certain symptoms associated with either the disease or the treatments are of some concern to men with lupus:
            skin rashes
            hair loss
            weight gain.
      On the other hand, men may be more concerned than women with:
            a change of job
            a loss of job
            a decrease in job performance
            a significant loss of independence
            problems with self-esteem
            false feelings about a "loss of masculinity."

Impotence and depression

Other phenomena, such as impotence and depression, often accompany a chronic illness. Unless a man has very low male hormone levels, such phenomena are likely to be psychological. Professional help will be able to assure a man of his normal hormone levels and assist him in working through the sexual problems.

      Erectile dysfunction (ED) is frequently mentioned today as occurring in men of all age groups, mostly those without a chronic disease.
      The most common cause of ED is usually psychological and often is remedied with counseling.
      In a chronic disease such as lupus, ED can be quite common.
      The good news is that this can be overcome in most men and should be brought to the doctor's attention early. The rheumatic disease specialist in consultation with a urologist can help men with ED.

Related Information
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Ask Dr. Paul
Summer 2008 issue of Lupus Now
Spring 2008 issue of Lupus Now
Summer 2007 issue of Lupus Now

If you are a man with questions about living your best life with lupus, we encourage you to write to Paul Donoghue, Ph.D., co-author of Sick and Tired of Feeling Sick and Tired and our expert on coping strategies for men with chronic illness. Send an email to lupusnow@lupus.org, with "Ask Dr. Paul" in the subject line. All questions are confidential, and if printed in Lupus Now magazine will not include name or location



AWARENESS IS NEEDED FOR BOTH SEXES!! MEN SHOULD NOT HAVE TO SUFFER WITH THIS DISEASE ALONE. NO MORE THAN A WOMAN SHOULD HAVE TO!!!!