Lupus in Men
Although SLE is about ten times more common in women than in men, it is important not to forget the men with lupus and the effects of the disease on their health and life. In particular, the development of a chronic disease may necessitate life style changes that can alter their traditional role within the family.
Clinical Disease in Men
Although lupus is uncommon in males, it does not differ clinically in major ways from lupus in females. Some have suggested that lupus is more severe in males but most studies have not found this to be so. The difference may be explained by a delay in diagnosing or treating lupus in males, as the disease is less often looked for in men, and because men may be more reluctant to seek medical advice than women.
Some studies have reported increases in males in skin rashes, pleurisy, neurological disease affecting the nerves in the arms and legs (peripheral neuropathy), kidney disease, vasculitis and Raynaud's phenomenon. Other studies didn't find these increases! Impotence has been reported in some patients with abnormal hormones, particularly low androgen levels. More men develop drug-induced lupus than women mainly because medications that produce drug-induced lupus are more frequently used in men.
To TopLifestyle Considerations
Men may react differently from women when the diagnosis of lupus is given. This may be because of the misconception that lupus is a woman's disease giving rise to the idea that a man with lupus is less masculine than his colleagues without lupus. This is not true. As far as sex hormones and sexual function are concerned, most men with lupus are no different from those without lupus. Men with lupus are usually sexually active, potent and have normal reproductive histories. There may be some interruption in this when the disease is very active or with the use of certain drugs, especially cyclophosphamide which can affect fertility.
Many of the day-to-day stresses in life are emotionally equal for men and women with lupus. However, in some ways it may be more difficult for men to cope with having lupus because of the pressures created by what they think their family, friends and society expect of them. They may not be able to work or follow hobbies in the environment previously expected of them (e.g., in the cold due to Raynaud's phenomenon). There may be difficulties in performing activities that require physical strength and a change of role in the workplace may be necessary but not available. Historically it has been the male who is the provider for the family. If a man with lupus has to stop working or change job this may result in significant financial and emotional stress. However, with earlier diagnosis and better treatment, many patients can remain in work, although some will have to change job, modify duties, or reduce their hours compared with their colleagues. Combined advice from an occupational health physician at the workplace and the lupus physician may be required to establish what is appropriate work for an individual with lupus. Similarly, lupus patients may have to discuss with their family and consultant how to adjust their leisure activities and hobbies, as it is essential that they get enough rest and remain as physically and emotionally fit as possible.
Another aspect of the disease that men (and women) have to cope with is the change in physical appearance. Rashes, unexpected hair loss and weight loss or gain may not be appreciated as being as important to men as to women. However, they may result in further loss of self esteem and the feeling of loss of masculinity, particularly in young men. More serious problems such as disability are even harder to cope with and may cause profound depression that needs active treatment as well as physical rehabilitation by physiotherapists.
Often men find it difficult to talk about health matters or seek support from self-help groups. They can appreciate one-to-one informal chats more than taking part in predominantly female meetings. The above stresses, coupled with the fact that lupus is commonly referred to as a "woman's illness," only makes it more difficult for males to cope with this chronic disease.
To TopConclusion
Men, like women, will need to discuss their lupus disease and its likely effects on their health and lifestyle with their consultant. Every case is different but certain generalisations will be possible based on the clinical picture (the parts of the body affected) and the results of blood tests and other investigations. There is no definite evidence that the disease is more severe in men than women, or that men with lupus have more female hormones or less male hormones than those without lupus. Fertility is not usually affected but active disease and certain drugs may affect sexual function and this needs to be discussed openly by the patient and his physician.
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