The higher occurrence of the disease in women might depend partially on the age at which it occurs. Before puberty, approximately one young male is affected for every three females, whereas in the adult years, approximately 10 females are affected for every male. After the menopause (that is, after the mean age of 55), there are approximately 8 female for every male affected. These differences in sexual prevalence apply only to systemic lupus erythematosus and not to discoid lupus, which is lupus of the skin. Discoid lupus affects more men than does SLE.
More men than women develop drug-induced lupus, because most of the medications that produce drug-induced lupus are used more frequently in men than in women. The two most common drugs that produce drug-induced lupus are procainamide, which is used to treat various types of heart abnormalities; and hydralazine, which is used to control high blood pressure. Since more males than females suffer heart attacks which may result in irregular heartbeats afterward, procainamide is used more often by males. Similarly, hydralazine is used more often by men than by women, for reasons that are not clear.
The symptoms of SLE are identical in men and women at the time of initial presentation of the disease. However, some researchers suspect that the later manifestations of SLE may differ between the sexes. Several studies conclude that there is more severe renal, neurologic and vascular disease in men with SLE than in women. Such findings, however, have not been confirmed and more research is needed in this area. At this time, there is no substantial evidence to document a significant difference between the severity of SLE in men and women. The clinical course of the disease is the same in both sexes.
For years investigators had been looking at hormonal differences between males and females which might explain the higher prevalence of lupus in women. Studies have considered estrogens (female hormones) and androgens (male hormones). Some data indicates that there is a difference in the way estrogen is metabolized by men and women with lupus, there is a difference in the way that androgens are metabolized male and female lupus patients. Therefore, while that does not appear to be a significant increase in estrogen in men with lupus, there is a suggestion that women with lupus metabolize androgens at a faster rate than women without lupus.
There is also evidence that lower testosterone levels (a male hormone) in both young and old men may predispose these men to autoimmune-like diseases. Drugs which lower testosterone levels in men are associated with rheumatic symptoms but have not been specifically associated with the onset of SLE.
There are significant differences in the way men might react to the diagnosis of SLE. They might have the misconception that lupus is a “women’s disease” and that a man with SLE is less masculine than a man who does not have SLE. This is simply not true. Men with lupus are fertile, sexually active and potent, and have normal reproductive histories. Many are also very hirsute (hairy). None of these characteristics would be apparent if males with SLE were any different hormonally than males who do not have lupus. Thus, as far as sexual factors are concerned, males with lupus are different than males without lupus.
The emotional stresses for men with lupus are the same as those experienced by women with SLE. 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 incapacitation feelings that women with SLE feel may be more apparent in males because they may no longer be able to perform or progress in their work environment, or they may not be able to continue to work in order to support a family. They may have difficulty in performing duties which 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 for the male. This may not be the case in all instances for the female with lupus. The roles and expectations of males and females in society are changing, but these changes take a long time. The above stresses, coupled with the fact that lupus is commonly referred to as a “women’s illness,” only makes it more difficult for males to cope with this chronic disease.
There are cosmetic changes that are of some concern to men with lupus. Symptoms such as rashes, hair loss, and weight gain are usually not as incapacitation for men as they are for women. On the other hand, men may be more concerned than women with a change or loss of job a decrease in job performance, a significant loss of independence and problems with self esteem, and false feelings about a “loss of masculinity.”
There is a significant lack of written and published material geared to men with lupus, or men who suffer from and chronic disease, for that mater. In addition, lupus support groups are comprised mostly of women, and as a result, men with lupus feel ostracized or deprived of what few normal counseling mechanisms exist. The Lupus Foundation of America is attempting to change this approach in its support groups.