Multiple Sclerosis in Men

Multiple sclerosis (MS) is a chronic disorder of the central nervous system. In MS, messages between the brain and the rest of the body are disrupted, causing a wide array of symptoms.

In 2020, researchers estimated that 2.8 million people around the world are living with MS. Overall, women are twice as likely to have MS as men, but the ratio of women to men is as high as 4 to 1 in some countries.

Learn how MS in men differs from MS in women and why it’s important to seek a diagnosis and early treatment.

What causes MS in men?

It’s not clear exactly what causes MS. We do know it involves an abnormal immune response in which the immune system attacks myelin in the central nervous system. What prompts this process isn’t fully understood.

According to the National MS Society (NMSS), development of MS may involve a combination of risk factors such as:

  • Geography and vitamin D. MS occurs more often in areas that are farther from the equator. Research suggests that higher sun exposure is associated with a lower risk of MS. Because they may get less sun, people living farther from the equator may also get less vitamin D, which is thought to support the immune system.
  • Smoking. Smoking is associated with a higher risk of developing MS, as well as disease severity and progression.
  • Obesity. Research suggests that having childhood or adolescent obesity may be involved in MS susceptibility, and the relationship may be causal.
  • Infection. Researchers have and continue to study the potential role of various bacteria and viruses, including Epstein-Barr virus (EBV), in the development of MS.
  • Genetics. MS is not an inherited disorder. But the genetic predisposition to developing it may be. In fact, researchers have identified more than 230 genes that may contribute to MS risk.

The NMSS also cautions that some theories on the cause of MS remain unproven. These include:

  • environmental allergies
  • exposure to household pets
  • exposure to heavy metals such as mercury (including mercury amalgam tooth fillings), lead, or manganese
  • organic (chemical) solvents

What are the symptoms of multiple sclerosis in men?

MS is different for each person and the range of symptoms is broad. Some symptoms of MS are:

  • double vision, optic neuritis
  • vertigo
  • lack of strength in the limbs
  • needles and pins sensations or other strange sensations (dysesthesia)
  • muscle spasticity
  • balance, coordination, and gait issues
  • cognitive problems
  • fatigue
  • bowel and bladder problems

When symptoms re-appear, it’s called a relapse. Relapses can last from a few days to many weeks. Remissions can last from a few weeks to many years.

Men are more likely to be diagnosed with primary progressive MS

It’s not clear why, but men are more likely to be diagnosed with primary progressive MS (PPMS). This type of MS is characterized by a lack of remissions and symptoms that don’t improve.

Research suggests that men are more likely than women to experience:

  • increased disease progression
  • brain atrophy
  • cognitive impairment

Men are also more likely to have more:

  • T1 lesions
  • atrophy of gray matter
  • thinning of the retinal nerve fiber layer
  • greater loss of axons from the spinal cord
Men with MS have higher rates of hypogonadism

Research from 2014 suggests that men with MS may have higher rates of hypogonadism, which might be associated with disease progression. And research from 2015 suggests that prenatal androgens may affect MS risk in men. More research is needed to verify and understand these connections.

How is multiple sclerosis in men treated?

Treatment for MS is the same for all genders. There’s no cure, but there are treatments to control the disease, ease symptoms, and improve quality of life.

Medications for the disease

There are at least 18 medications designed to reduce disease activity. These disease-modifying therapies include:

  • oral drugs
  • injectables, such as interferon beta and glatiramer acetate
  • monoclonal antibody treatments that are infused or given by injection

Most disease-modifying drugs are approved to treat relapsing forms of MS. Treating PPMS can be challenging. Ocrelizumab (Ocrevus) is the only disease- modifying therapy specifically approved to treat PPMS.

Medications for relapses

Treatment for a relapse may reduce lasting effects and promote faster recovery. Medications may include:

  • corticosteroids
  • plasmapheresis or IV immunoglobulins (IVIG)
Medications for symptoms and complications

Symptom treatment can help improve quality of life. Your doctor may prescribe medicines to help treat:

  • muscle spasms
  • fatigue
  • dysesthesia
    • pain
  • bladder problems
  • constipation
  • sexual dysfunction
  • depression, anxiety
Complementary practices

Some nonmedicinal practices that may help improve symptoms include:

  • psychological counseling
  • physical therapy
    • yoga
  • reflexology
  • massage
  • meditation
  • acupuncture

Not everyone will respond to these therapies. Talk with your doctor for a referral to complementary services that may help your symptoms.

What’s the outlook for men with MS?

Being male suggests a worse prognosis for MS. Other factors that may worsen prognosis are:

  • progressive course of disease
  • early and frequent relapses
  • minimal recovery between relapses
  • spine or brain lesions, or brain atrophy shown on MRI
Early treatment is important

Early treatment may help slow disease progress and prevent or delay disability. Some researchers theorize that men often delay seeking help. This delay may lead to later diagnosis and treatment, potentially allowing the disease to progress and cause permanent damage.

According to the NMSS, most people with MS never become severely disabled. Although some will need a cane or other walking aid, about two-thirds remain able to walk. Life expectancy for people with MS is about 7 years lower than that of the general population.

Takeaway

Although more women get MS, men tend to have more severe symptoms. Men are also more likely to have PPMS at diagnosis.

The first symptoms of MS often feel vague and are easy to dismiss. But early diagnosis can get you started on disease-modifying therapy and can potentially slow disease progression. Treatment can also include therapy for acute relapses and symptom management. Gender doesn’t play a role in treatment for MS.

Most people with MS don’t become severely disabled and live a near-normal lifespan. If you have MS-like symptoms, see a doctor so you can find out for certain.

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