Multiple sclerosis in men: What to know

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Multiple sclerosis (MS) is an autoimmune disease in which the body’s immune system attacks the myelin sheath that coats the neurons of the central nervous system (CNS). This results in chronic inflammation and nerve damage.

Experts do not know exactly why some people develop MS and others do not, but they believe that it might be due to a combination of genetic and environmental factors.

The mechanism behind MS is the same in both males and females. However, reproductive hormones may play a role in the likelihood of a person developing MS, as well as in how the disease progresses.

The risk factors for developing MS include:

• Infections: Certain infections appear to have links with MS, particularly the Epstein-Barr virus.
• Smoking: People who smoke are twice as likely to develop MS as those who do not smoke.
• Obesity: Researchers have linked obesity in childhood, adolescence, and early adulthood with an increased risk of developing MS in later life.
• Low levels of vitamin D: Vitamin D helps support immune function and protect against immune-mediated diseases, such as MS. Low levels of vitamin D may increase a person’s risk of developing MS.
• Genetics: Having a parent or sibling with MS increases a person’s likelihood of developing the condition by 2–3%.
• Geographical location: MS is more common among people who live farther away from the equator. This may be due to sunlight exposure and vitamin D, but other factors — such as genetics among certain demographics, local infections, and other environmental differences — may also play a role.

Sex is also an important factor, as MS is more common in females than in males. The reasons for this are not entirely clear, but it seems that hormones such as estrogen influence MS. For instance, pregnancy can often reduce MS symptoms, and females are more likely to have a relapse after giving birth.

Additionally, because males are generally less likely than females to develop autoimmune diseases, scientists believe that male sex hormones may reduce the risk of conditions such as MS. More research is necessary to confirm this.

Today, females account for an increasing proportion of people with MS. Experts theorize that environmental or behavioral factors may be driving new cases. However, what these factors might be is currently unknown.

Learn more about MS in females.

The symptoms of MS can be similar in males and females. Some symptoms that may be early signs of MS include:

• vision problems
• dysesthesia, or “MS hug,” which is a squeezing sensation in the torso
• numbness or tingling

Other potential MS symptoms include:

• persistent aches or pains without a specific cause
• involuntary movements, such as twitches and spasms, or an inability to control the limbs
• difficulty with balance, mobility, or walking
• problems with bladder or bowel function, including incontinence
• fatigue that is not due to physical activity or lack of sleep
• frequent dizziness
• changes in cognition, such as “brain fog”
• anxiety and depression

There are some differences between males and females in terms of the type of MS they experience and how the disease progresses.

Symptom severity in males

Neurodegeneration is the medical term for damage to nerve cells, or neurons. Some research suggests that males tend to experience more severe neurodegeneration and cognitive symptoms than females.

This may be due to males having lower levels of estrogen than females. Although female sex hormones may play a role in the higher rates of MS among females, estrogen also appears to be neuroprotective. This means that it may help prevent some of the damage that MS can cause to the brain once a person has the disease.

Males and females who receive a diagnosis of MS after 50 years of age will experience a similar disease course. This suggests that the hormonal changes that occur during menopause reduce the effects of estrogen on MS.

However, not all differences in the presentation of MS are due to biological differences. A 2020 study notes that males are more likely than females to delay seeking medical attention for MS symptoms. By the time they receive a diagnosis of MS, they may already have sustained significant damage to their nervous system.

Types of MS in males

There are higher rates of relapsing forms of MS among females. This means that females are more likely to have MS that flares up and then remits, such as relapsing-remitting MS.

Primary progressive MS (PPMS) is a form of MS that progressively worsens without periods of improvement. Males and females experience this type of MS in roughly equal numbers. As fewer males get MS, they are more likely, proportionally, to get PPMS.

There is some debate surrounding whether males and females are naturally more likely to experience different types of MS or whether the higher likelihood of PPMS in males is a result of late diagnoses.

The treatment of MS is generally the same for males and females.

The first line of treatment is typically disease-modifying agents. These drugs suppress the immune system, slowing its attack on the CNS.

However, they may also weaken the immune system and increase the risk of infection. Therefore, it is important to talk with a doctor about the risks and benefits of these drugs, as well as any potential alternatives.

Some additional treatment options for MS include:

Rehabilitation

Rehabilitation programs can help a person improve or maintain their ability to carry out their normal functions at home and at work.

Rehabilitation therapy may include the following:

• physical therapy, which focuses on improving the following:
  • strength
  • balance
  • posture
  • walking
  • mobility
  • fatigue
  • pain
• occupational therapy, which provides tools, devices, and modifications to simplify everyday tasks in the home and the workplace
• speech and language therapy, which involves diagnosing and treating issues with speaking or swallowing
• cognitive rehabilitation, which involves treatment strategies to improve the following:
  • thinking
  • reasoning
  • concentration
  • memory

Emotional support

Depression, anxiety, and mood changes are common among people with MS. A person may benefit from emotional support in the form of psychotherapy or support groups for people living with MS.

Males may prefer to seek help from therapists with experience in treating males with chronic illnesses. They may also wish to look for support groups specifically for males, who may better understand what they are going through.

Learn more about MS support groups and where to find them.

Complementary therapies

Complementary therapies are those that a person can use alongside standard treatments to help manage their condition. The complementary therapies that may benefit people with MS include those below.

Diet

Researchers have not yet identified a particular diet that can modify the course of MS. However, most experts recommend that all people, including those with MS, follow a heart-healthy diet that is high in fiber and low in fat.

Exercise

People with MS may benefit from a combination of aerobic activities and stretching exercises.

Aerobic exercises are those that increase a person’s heart rate and respiratory rate. They may help improve the following symptoms of MS:

• strength
• bladder and bowel function
• fatigue
• mood

Stretching exercises are those that work particular muscles or tendons. These may help reduce stiffness and improve strength and mobility.

Stress management

Some people with MS report that stress worsens their condition or results in disease exacerbations, known as flares. People who notice this association may benefit from stress management techniques, such as:

• meditation
• mindfulness
• yoga
• tai chi
• talking therapy

Acupuncture

Acupuncture is an ancient Chinese medicinal practice that involves inserting fine needles into designated areas of the body to stimulate nerves beneath the skin.

According to the National Multiple Sclerosis Society, some studies suggest that acupuncture may help alleviate pain and improve gait.

MS is a chronic illness with no cure. However, in many cases, treatments may slow or even halt the progression of the disease.

The outlook is generally less positive for people who seek treatment later in the course of the disease. For this reason, it is vital to speak with a doctor as soon as possible symptoms of MS occur.

Although MS is not a terminal illness, the complications of the disease can be fatal. According to a 2015 study, the median life expectancy for people with MS is 76 years, compared with 83 years among those without the condition.

Multiple sclerosis is an autoimmune condition that involves the destruction of the myelin sheath surrounding the nerves. Although the condition is treatable, males may be more likely to delay seeking a diagnosis and treatment. Delaying treatment allows the disease to progress and cause additional damage to the nervous system.

Although reproductive hormones appear to influence the type of MS and a person’s likelihood of developing it, they are not the only risk factor. The symptoms and causes of MS can be similar in males and females, and there is no cause of MS that is unique to males.

Anyone who experiences symptoms of MS should consult a doctor as soon as possible for a diagnosis and appropriate treatment. The care plan for MS will likely consist of disease-modifying medications, alongside other treatments, such as rehabilitation therapies and complementary therapies.