# Man flu

Man flu is a colloquial term referring to the perception that men experience more severe symptoms when afflicted with the common cold or flu-like illnesses. Primarily British, it is frequently used in a self-deprecating manner. This term has sparked both public interest and scientific inquiry into potential sex differences in the experience of respiratory illnesses.

## Origins and cultural impact

The term 'man flu' is believed to have originated in the 1990s, with the earliest known use found in a message posted on the Usenet newsgroup misc.health.diabetes in 1999, as documented by the Oxford English Dictionary. Since then, the term gained recognition in popular culture and became the subject of discussions surrounding the perceived severity of symptoms experienced by men during respiratory illnesses.
An open-access poll featured in Nuts magazine in 2006 brought attention to this notion, although it was widely criticized as unscientific. The poll reported that men reported longer recovery times from flu-like illnesses compared to women, with men taking an average of three days to recover, while women recovered in 1.5 days. A poll conducted for a painkiller manufacturer in 2008 suggested that such exaggeration is just as prevalent in women.
The concept of 'man flu' has sparked controversy, notably in a Boots advertisement featuring the tagline "when he’s ill and you don’t have time to be – get cold and flu products for just 99p at Boots." This ad ignited debate about gender stereotypes and perceptions of illness in popular culture.

## Scientific inquiry

While initially dismissed as a cultural trope, the notion of 'man flu' has prompted scientific investigation into potential physiological differences between men and women in their response to viral infections.
One study, published in 2009, investigated the effects of the bacterium Listeria monocytogenes on genetically modified mice. While the study did not pertain to cold or flu viruses, but rather to a bacterial disease, it gained widespread attention and was misinterpreted by various media outlets, including The Daily Telegraph, as supporting the existence of 'man flu' in humans.
Subsequent research has yielded more nuanced insights into the interplay between sex, hormones, and immune responses. According to researchers at the University of Cambridge, evolutionary factors may have led women to develop more rigorous immune systems than men due to differing reproductive strategies. In addition, a 2011 study conducted at the University of Queensland suggests that female hormones, such as oestrogens, aid pre-menopausal women in fighting infections, but the protection is lost after menopause.
The scientific community continues to research the validity and significance of perceived sex differences in symptom severity and immune response to viral illnesses.

### 2017 BMJ medical review

In the Christmas 2017 edition of The BMJ, a review of existing research highlighted significant differences in immune response and outcomes of influenza between men and women. Epidemiological data indicated that men may have a higher risk of hospital admission and mortality from influenza compared to women. Specifically, data from 2004 to 2010 for seasonal influenza in Hong Kong showed a higher risk of hospital admission among adult men, and a US observational study from 1997 to 2007 reported higher rates of influenza-associated deaths among men, even when accounting for factors such as heart disease, cancer, chronic respiratory system disease, and renal disease.
Research on influenza vaccination suggested that women may be more responsive to vaccination than men, experiencing more local (skin) and systemic (bodywide) reactions, and exhibiting a better antibody response. Testosterone levels in men were found to potentially play a role in their response to influenza vaccination, with men having the highest levels tending to show a lower antibody response. This lower response may contribute to the possibility that vaccinated men experience more severe symptoms compared to women, as they may not respond to vaccination as effectively.
Furthermore, test tube studies of nasal cells infected with influenza revealed intriguing findings regarding the role of the female hormone estradiol. Exposure to estradiol reduced the immune response in cells from women but not in cells from men. Treatment with antiestrogen drugs counteracted this effect. Since flu symptoms are largely attributed to the body's immune reaction, a lessened immune response in women may translate to milder symptoms.
Despite addressing significant scientific findings, the BMJ article maintained a light-hearted tone in keeping with the traditions of its Christmas edition, and as such, is not directly intended to infer the existence of man flu.

## Implications for healthcare

The concept of 'man flu' has significant implications for healthcare, particularly in ensuring equitable access to medical treatment and dispelling misconceptions surrounding illness. Research indicates that men are less inclined to seek medical attention when unwell and may underreport symptoms when they do. Understanding the interplay between gender, biology, and societal perceptions is essential in shaping our comprehension of illness. By promoting public awareness and engaging in evidence-based dialogue, society can encourage healthier attitudes and healthcare-seeking behaviors for both genders. It's crucial to adopt evidence-based, gender-sensitive approaches to medicine to enhance diagnostics and treatment. Stereotypical portrayals of men as weak or exaggerating patients may deter them from seeking medical help, thus perpetuating toxic masculinity. The notion of 'man flu' should be critically examined; further research is warranted in this area.