This week, Dr Kyle Sue published a feature in the BMJ about ‘man flu’, showing some of the science behind the phenomenon. Of course, the media took hold of it and gave it a very simplified angle, and then Twitter reduced it down even more to ‘feminism vs men’s rights’ (why does it always come down to this?). So, I took a look at the actual article, the explanations from Dr Sue, and the gender roles that he didn’t include.

It’s all about the hormones, baby

The most convincing science is the stuff that looks at hormones. If you get past Sue’s addition of the odd pun (I am not going to talk about sniffing out evidence like he did, I’m just not), the evidence does suggest that testosterone causes immune system cells to not respond in as strong a manner to the flu virus, compared with those with the hormone from the other side of the binary – oestrogen.

A large part of the research with whole animals comes from research with mice, I imagine both due to practical and ethical issues (I’ve written an ethics proposal before, I think you’d struggle to get ‘give them testosterone to see if they moan more about the flu I’m also going to give them’ approved). And don’t forget that human hormonal chemistry is generally within its own happy normal, and the side effects of altering that chemistry may cloud your results. I don’t know if mice immune systems are simpler and so avoid that, but that affects how valid the results are to humans.

Talking human cells, immune system cells from those on either side of the sex binary do react in different ways, with those from healthy females that are presumably loaded in oestrogen showing a stronger immune response. The hormone theory is supported by the fact that this disappears in postmenopausal females when compared with males of the same age.

All dichotomies are false dichotomies

I’m sure we’ve said, once or twice, that both sex and gender are spectrums – not strict binaries. You can get extremes on either end, but a lot of people cluster in the middle. See, the problem with ‘man flu’ being based on testosterone is that there is more variation in testosterone levels within sex than there is between sexes. Some females can have super high levels of testosterone, some males can be depleted. Before we even go into sex and gender not being the same thing – you should more accurately call it ‘testosterone flu’, but I don’t imagine anyone is going to join me in that – sex also doesn’t mean that your hormones are strictly either-or.

We’ve identified one contributing factor, but it’s not a hard and fast rule suggesting that all dudes should grab a Lemsip and tell women off for saying they moan too much. Of course, it’s exciting for the scientists, and the science nerds, but nobody is getting a trending topic out of ‘testosterone might be involved in doing this!’

Trending trends

There’s still another full page of the article left, so I’ll press on. Sue moves into talking about trends, and here’s where we can’t extricate the biology from the psychology, or assume any kind of causal relationship (wow, where have I heard that one before?). Statistically, men are more likely to be admitted to the hospital, from 1997 to 2007 they were more likely to die from the flu, and women are more responsive to their flu jabs – more local and systemic reactions are self reported by women than men in questionnaires.

Of course, there is likely a part of these trends that is due to the testosterone effect – it does seem to be doing something to suppress the immune systems of those who have high levels – but come join me in identifying other explanations of the results that Sue hasn’t mentioned, never mind taken into account.

‘Man up’

See, moaning is something that women do. They’re the soft ones, men just get on with things and don’t complain – until they have the flu, apparently. But are we looking at men compared with women, or are we looking at how much they’re moaning now compared to how much we’re expecting of them? You know that thing where men think that women talk more when they only talk 30% of the time? Well, do we think men are moaning more if they moan 30% of the time, because the patriarchal values we’ve all been socialised with says that they shouldn’t be moaning at all? Especially not in front of the women they’re there to protect.

Women in real life and particularly on social media (wow, was I not happy when looking through the #manflu trending topic) contribute to this – patriarchy runs deep! I’ve even been guilty of this kind of behaviour in the past, and I can’t guarantee that in the future I won’t slip up and say something akin to ‘man up’ again (although, I support redefining ‘man up’ to mean to take the advice of one of our own men on mental health). I am going to be aware of it, and try my hardest to contradict this when I see it, because there’s nothing ‘girly’ about moaning because you’re sick, and there’s also nothing wrong with it either.

‘I don’t need a doctor’

The stats regarding hospitalisation and deaths from flu, and even other respiratory infections, are fairly scary – men fare worse in pretty much all measures across a few different studies that Sue has referenced. These effects remain even if you control for other variables like heart disease, cancer and even chronic issues affecting the respiratory system.  Men also are more likely to smoke; but more importantly, they’re less likely to seek care when they’re ill – and that’s where the gender roles are kicking in again. Sue mentions but then seems to gloss over this point as a criticism of the above research he’s been talking about – dedicating more room to a lovely sexist quote about how we need the men to get better so that the shelves can be put up and someone can go to the football, than to a legitimate question of if gender roles could be another huge factor in these studies!

If your role is to be provider, protector and tough guy, you’re more likely to ignore the fact that you’re sick. In our divided patriarchal society, it’s okay for women to be sick, and to seek treatment from someone more knowledgeable than them when they are (their GP). Although a lot of GPs are women, the stereotype for men as doctors can be found in any small child who thinks women can only be nurses. Patriarchy’s man doesn’t want to go admit to another man that there’s something wrong with him, so if he just leaves it he gets to the stage of hospitalisation and death.

Nature vs. nurture

It’s the age old debate: is it biological or psychological? Testosterone needs to be taking some of the blame, it seems, but you can’t ignore the gender role impact both on how we view men with the flu, and how men view themselves with the flu and therefore how likely they are to seek help. The two are so tightly wound up that you’d need some serious hard science and a logistic regression (don’t ask me to go any further on that, it’s the one bit of uni stats I could never quite put my finger on) to see exactly how much can be attributed to each.

But that doesn’t grab the headlines.

Image by Davide Taviani

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