Multiple sclerosis (MS) is an autoimmune disorder in which inflammation causes damage to the nervous system. This can result in a variety of MS symptoms in patients, including muscle spasms and weakness, fatigue, depression, unusual sensations, and problems controlling the bladder and bowels.
While the disease affects everyone differently, certain factors are associated with the risk of developing MS and trends in disease course. Among other factors, there are some general differences in how MS tends to affect men compared with women.
Of note, biological sex and gender identity are separate concepts that each exist on a spectrum of experiences. For purposes of simplicity, in this article, the term “man” is used to refer to people assigned male at birth, who have one X chromosome, one Y chromosome, and a hormone profile characterized by high levels of testosterone.
MS can develop at any age, but the most common age of onset is between 20 and 50.
In general, men are less likely to develop MS than women. This difference also depends on the type of MS.
Most patients are initially diagnosed with relapsing-remitting MS (RRMS), which is characterized by periods of less severe symptoms (remission) interspersed with bouts of worsening symptoms (relapses). Relapsing MS is about three times more common in women than in men.
This difference is thought to be driven mainly by differences in sex hormones (testosterone in men, estrogen in women) that occur after puberty. Prior to the onset of puberty, rates of MS are similar regardless of sex. Rates of MS also are similar among older people later in life, when sex hormone levels decrease.
Primary progressive MS (PPMS), a rarer form of MS in which symptoms gradually worsen from disease onset, affects men and women at roughly equal rates.
Each person with MS will develop a unique set of symptoms, based on the specific pattern of inflammatory nervous system damage in that individual and the affected part of the body. There are no MS symptoms that are exclusively found in men and not women, but some signs of MS are generally more common for men or women.
Men with MS are more likely to experience:
In contrast, vision problems are more common in women with MS.
Men are more likely than women to initially develop PPMS. Additionally, among people with RRMS, men are independently associated with a shorter amount of time to onset of secondary progressive MS (SPMS). Rates of brain atrophy are generally higher in men.
Among relapsing MS patients, men tend to have worse recovery after relapses — that is, more symptoms continue to persist even in times of relative remission. In large part because of this reduced recovery, disabling symptoms tend to accumulate more quickly in men with MS, resulting in a faster progression of the disease. In PPMS, rates of disability accumulation are similar regardless of sex.
The manifestations of MS are unique for each individual, and being a man with MS can pose unique social and psychological challenges. The disease also can complicate a person’s sex life — most men with MS will experience erectile dysfunction at some point. Bladder problems also are common in MS patients.
Some research has shown that disabling MS symptoms have a larger impact on the quality of life and functional ability in men than in women with MS. In other words, men with MS tend to view their own physical, psychological, and social welfare more unfavorably than women with MS who have similar scores on measures of disability.
One factor that likely contributes to these differences is that living with a chronic, disabling condition like MS can challenge men’s perception of their own identity, as the dominant cultural concept around masculinity places men in the role of “protector and provider.”
Research also suggests that men generally are less likely to seek healthcare services or mental health resources such as counseling or support groups. Nonetheless, care and support can improve clinical outcomes and make day-to-day life more enjoyable. It’s important to keep in mind that needing help is not a sign of weakness but an integral part of the human condition.
In MS, damage to the nervous system can interfere with the body systems that normally control the physiological processes associated with sexual arousal. As many as 9 in 10 men with MS experience some form of sexual dysfunction.
In addition to the direct effects of MS, some MS symptoms may require adjustments or accommodations during sexual intimacy. For example, a tremor may make it difficult to put on a condom without assistance, while fatigue and emotional changes can cause strain in sexual and emotional relationships.
Men with MS are advised to talk about their desires and the challenges they are experiencing with both their sexual partners and their healthcare team.
The formal guidelines for diagnosing MS, called the McDonald criteria, state that a diagnosis may be made if there is evidence of MS-like inflammatory damage affecting more than one part of the central nervous system at more than one point in time. There are no differences in MS diagnostic criteria or tests for men and women.
Multiple sclerosis itself is not fatal, but it can raise the risk of health complications such as pneumonia, which may be life-limiting. Life expectancy for people with MS is about five to 10 years shorter than the general population on average, though this gap is closing over time as care for MS patients continues to improve.
The average lifespan in the general population is shorter for men than women, and this also is generally true in MS. A 2017 analysis that assessed data for more than 1,000 MS patients across 60 years in Norway found that the median lifespan was 72.2 years for men with MS, and 78.9 years for those without the disease. In women, the median lifespan was 77.2 years for those with MS and 84.6 years in the general population.
Rates of disability worsening in MS vary substantially from person to person and are influenced by MS treatments as well as the type of disease. Progressive forms of MS generally lead to a faster accumulation of disabling symptoms.
A 2015 study assessed disability progression in 15,826 MS patients across 25 countries. Among patients with relapsing disease, the average time from the onset of MS to the development of moderate disability was about eight years for men and 10 years for women. The average time from disease onset to requiring an aid to walk was 32 years in men with relapsing MS.
In the same study, rates of disability accumulation were similar for men and women with PPMS. These patients developed moderate disability within about two to three years of symptom onset on average and required an aid to walk within roughly 15 years of disease onset.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Multiple sclerosis (MS) affects everyone differently, and its exact impact on daily life will depend on the unique situation of each patient, as well as their specific set of symptoms. MS in men tends to have a poorer prognosis than in women. In general, men with the disease usually have a worse recovery from relapses, have higher rates of cognitive impairment, and are more likely to develop progressive forms of MS, which are associated with greater disability. MS symptoms may make it harder to do certain day-to-day tasks, and as the disease progresses, patients may require assistance or specific accommodations. Proper care and support can improve clinical outcomes and make daily life more enjoyable.
Men with MS are no more likely to experience hair loss than individuals without the disease, though some MS therapies may cause hair loss as a side effect. Patients who experience unexpected hair loss are advised to talk to their healthcare providers.
Erectile dysfunction affects roughly three-quarters of all men with MS at some point. MS also can cause reduced libido, diminished genital sensation, and difficulty achieving orgasm.
MS may alter a person’s sex drive or libido. Most commonly, the disease is associated with decreased libido, but there have been a few case reports of hypersexuality (abnormally increased sex drive) occurring in men with MS.
Viagra (sildenafil) is a medication used to manage erectile dysfunction that works by increasing blood flow to the penis. Studies have shown that the medication is generally effective to help induce an erection in men with MS. Patients are advised to talk to their healthcare team about the potential benefits of Viagra in their particular case.
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