Ignored: Lupus and the Man

Although lupus is primarily a women’s disease, men get this chronic autoimmune disease as well. In this article I talk about what lupus does to men mentally and physically.

Approximately 10% of the lupus population is male. Lupus is known as a “female disease” as a result, there is a misconception that men with lupus are less masculine than other men. There needn’t be-just like females, males with lupus look perfectly normal. They have normal male characteristics and have normal sex drive, performance and fertility. Homosexuality is not any higher in men with lupus than without. While their numbers are fewer, lupus tends to hit men harder physically and emotionally.

There are several differences between men and women with SLE although the low number of male participants in research studies makes it hard to conclude. Dr. Michelle Petri of John Hopkins University conducted a recent study with 545 females and 41 males and found that men had an increased frequency of seizures, immune related anemia and thrombosis (blood clots) that leads to more strokes and blood vessel blockage. Men also suffer from drug induced lupus more often than women possibly because men suffer from heart attacks more often than women and the *drugs procainamide, a drug used for heart abnormalities and hydralazine, a drug used to control high blood pressure are known to cause drug induced lupus. The numbers are also higher for discoid lupus, renal disease and neurological disease.

The role of sex hormones in lupus appears to be a complicated and valid one. There are two types of sex hormones, estrogen (female hormones) and androgens (male hormones). While both sexes produce these hormones, the estrogens, along with the role in the development of secondary sex characteristics (facial hair/breast development) may encourage autoimmune disorders. Some data indicates that there is a difference in the way estrogen is metabolized in normal people versus those with lupus. While there is no significant difference in the way estrogen is metabolized by men and women with lupus, there is a difference in the way androgens are metabolized by male and female lupus patients. Although there does not appear to be any 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. On the other hand, androgens are thought to play a protective role. Evidence suggest that lower testosterone levels in both young and older men may predispose these men to autoimmune diseases. Drugs that lower testosterone are associated with rheumatic symptoms. Because the introduction of androgen can improve mouse lupus and the introduction of estrogen can make it worse, researchers believe that birth control pills can trigger the start of lupus and women with lupus are discouraged from taking them. While some doctors treat female patients with DHEA for hormone therapy, it does not appear to have the same results with men.

The fact that men are misdiagnosed just as often if not more than women and are more hesitant to seek a physicians care than women hampers treatment. Very little information is available regarding men and lupus and their numbers are almost non-existent in support groups. Those that do attend find themselves feeling out of place and ostracized in female dominated support groups. Societal expectations dictate that men are the breadwinners, physically strong and capable of leaping tall buildings in a single bound. Unfortunately, It is not uncommon for a person with lupus to be unable to work and be forced to accept assistance or change careers. It is incredibly frustrating to go from being attractive, active and career driven to fatigued, bloated and unable to run with the guys let alone provide for your family. Men, more than women wrap their self worth behind what they do for a living. No one likes to feel as if they have no control and knowing that you are chronically ill, not knowing why or how, will produce an incredible amount of emotional issues including self-esteem and loss of masculinity. Nonetheless, it is important that men, just like women seek a physician’s care and get rest, support and maintain physical and emotional health. Life does not end with a chronic disease; sometimes it can be the beginning.

Glossary

DHEA- Generic – dehydroepiandrosterone (DHEA)

Designated use: Treatment of Systemic lupus erythematosus (SLE) and the reduction in the use of steroids in steroid-dependent SLE patients.

Hydralazine- a thiazide diuretic used to treat high blood pressure. A common side effect is hypokalemia

Klinefelter’s syndrome-Also known now as “XXY males.” In 1942, Dr. Harry Klinefelter and his coworkers at the Massachusetts General Hospital in Boston published a report about nine men who had enlarged breasts, sparse facial and body hair, small testes, and an inability to produce sperm. The XXY chromosome arrangement appears to be one of the most common genetic abnormalities known, occurring as frequently as 1 in 500 to 1 in 1,000 male births. Although the syndrome’s cause, an extra sex chromosome, is widespread, the syndrome itself-the set of symptoms and characteristics that may result from having the extra chromosome-is uncommon. Many men live out their lives without ever even suspecting that they have an additional chromosome.

Procainamide-Otherwise known as Procan SR, Procanbid, Pronestyl, Pronestyl-SR. It is used to treat seriously irregular heartbeat patterns.

Thrombosis-The tendency to clot is called antiphosphilid antibody syndrome and it can indicate the presence of SLE in men by falsely testing positive for syphilis, is a characteristic of the syndrome.

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