Lupus symptoms in men and other people assigned male at birth are sometimes different from those commonly experienced by those assigned female at birth.
While nearly 90% of people with lupus are assigned female at birth, men can get lupus and should know the symptoms to look for. People transitioning from one sex to another may see a change in their risk of lupus, as well.
This article looks at the symptoms of lupus in males, why they have lupus less often, lupus risk during sex transition, emotional challenges faced by males with lupus, and sex-based differences in diagnosis and disease outcome.
Lupus Symptoms in Men
Males can get any of the common lupus symptoms, but evidence suggests certain lupus symptoms are more common in those assigned male at birth than in other people with the disease.
Lupus symptoms that appear to be more common in men include:
- Renal (kidney) disease
- Lupus anticoagulant (can promote abnormal blood clotting)
- Seizures
- Heart problems
- Inflammation in the lining of the heart (pericarditis), lungs (pleurisy), and abdomen (peritonitis)
- Swelling of the glands (adenopathy)
- Enlarged spleen (splenomegaly)
- Hemolytic anemia (from the destruction of red blood cells)
- Lymphopenia (low white blood cell count)
- Thrombocytopenia (low platelet count)
- Fever
- Unintended weight loss
Older research suggests a type of lupus called discoid lupus is more common in males. Discoid lupus causes reddish, scaly skin.
Lupus nephritis, which affects the kidneys, may be more severe in those assigned male at birth.
Common Lupus Symptoms
Some common lupus symptoms may accompany those that are more common in males. They include:
- Severe fatigue
- Painful, swollen joints
- Butterfly-shaped rash across the cheeks and nose (malar rash)
- Other rashes, especially after sun exposure
- Hair loss (temporary)
- Sun or light sensitivity
- Mouth sores
- Memory problems
- Swelling in the face, hands, and feet
- Headaches
Why Is Lupus Less Common in Men?
More questions than answers exist when it comes to discussing lupus and sex-based differences, including why it’s so much less common in males. However, researchers have some ideas about what could be causing the differences.
Lupus and Male Fertility
Lupus doesn’t appear to affect male fertility. However, some lupus medications may damage sperm-producing cells. Cytoxan (cyclophosphamide) and glucocorticoids may affect your reproductive abilities. If you’re intending to cause a pregnancy, talk to your healthcare provider about protecting your fertility and safeguarding the health of your child.
A potential answer might be the role of sex hormones:
- Estrogen and progesterone, the “female” hormones
- Testosterone, the main “male” hormone
People of all sexes have both female and male hormones, just in different amounts.
Females with lupus have abnormally high estrogen and low progesterone levels. Males with lupus may have high estrogen and lower testosterone levels than is considered normal for their age.
Researchers also suspect sex-based differences in immune function and genetics play a role in who gets lupus more often. Pregnancy changes the body in ways that may increase the likelihood of autoimmune disease, as well.
Lupus in Transgender or Non-Binary People
Research on lupus in transgender or non-binary people is in its earliest stages. However, the role of sex hormones in people who are transitioning has gained some attention.
A 2022 review looked at case studies involving autoimmune and autoinflammatory rheumatic diseases in trans people on hormone therapy. Conditions included:
- Lupus
- Rheumatoid arthritis
- Systemic sclerosis
- Ankylosing spondylitis
- Anti-synthetase syndrome
Most of the cases were in trans women and occurred after they started estrogen therapy. In some cases, stopping hormone therapy helped alleviate symptoms and disease activity. This all seems to bolster the theory that sex hormones play a major role in these diseases.
One trans man who had lupus before transitioning had a marked improvement in symptoms after starting testosterone therapy.
Again, research is just beginning, and there’s much to learn about the medical effects of hormone therapy for transition.
Emotional Challenges
All chronic disease can cause emotional difficulties, such as depression. Males with lupus may wrestle with extra problems because of societal expectations.
Being unable to perform physical labor and perhaps being unable to hold a job are all harder, socially, for people who present as men. Having a “women’s disease” can add to that burden.
If you’re struggling to cope with your illness, talk to your healthcare provider and look for support groups that include or are exclusively for males with lupus, autoimmunity, or chronic pain. Online groups may give you a better chance of finding groups with other males.
Differences in Diagnosis and Outcome
Because lupus is sometimes thought of as a “women’s disease,” healthcare providers may not consider that diagnosis when you go in with symptoms. This is especially true if your symptoms don’t match what they’re used to seeing with lupus.
The average age for diagnosis in people assigned female at birth is 30. For those assigned male at birth, it’s 40. It’s not yet clear how much of that gap is accounted for by delayed diagnosis.
An early lupus diagnosis can lead to a better outcome, so it’s in your best interest to push for diagnostic tests if you think you could have lupus. If your provider is reluctant to test or isn’t comfortable diagnosing you, consider getting a second opinion.
Lupus is rarely a simple, straightforward diagnosis. It can take a few rounds of testing to know for sure whether you have it. Expect it to take a while and try not to get discouraged. Each test brings you closer to knowing what’s wrong and how to treat it.
Summary
Males get lupus less often than females and may have different symptoms, as well. For example, males with lupus might be more likely to have a discoid rash or kidney problems.
The reasons for the sex-based disparity is thought to be sex hormones, differences in the immune system, and genetics. People transitioning from one sex to another with hormone therapy may change their susceptibility to lupus.
Males with lupus may face an added stigma over having a debilitating illness in general and also for having a “women’s disease.” Finding support from other males like you may help.
If you suspect you have lupus, ask your healthcare provider to test you. Early diagnosis leads to better outcomes, but some providers fail to think of lupus as a possibility when their patient is male.
Frequently Asked Questions
- What age does lupus start in men?
- Lupus can occur in anyone at any age but is most often diagnosed between the ages of 15 and 50. Some data has shown that males tend to be diagnosed around the age of 40, which is about 10 years later than when most females with lupus get diagnosed.
- Learn More:
- Lupus Causes and Risk Factors
- How do men get tested for lupus?
- Testing for anyone with suspected lupus usually involves a combination of blood and urine tests and a conversation with a provider about symptoms.However, it’s can be harder for men to get a diagnosis of lupus because healthcare providers may not consider the diagnosis a likely possibility, at least initially.
- Learn More:
- How Lupus Is Diagnosed
- What foods trigger lupus flare-ups?
- Some research has suggested that compounds in garlic and alfalfa sprouts could trigger a flare of lupus symptoms. That’s because they boost the immune system, which is a bad thing in people with autoimmune diseases.
- Learn More:
- Is There a Lupus Diet?
Lupus can occur in anyone at any age but is most often diagnosed between the ages of 15 and 50. Some data has shown that males tend to be diagnosed around the age of 40, which is about 10 years later than when most females with lupus get diagnosed.
Testing for anyone with suspected lupus usually involves a combination of blood and urine tests and a conversation with a provider about symptoms.
Some research has suggested that compounds in garlic and alfalfa sprouts could trigger a flare of lupus symptoms. That’s because they boost the immune system, which is a bad thing in people with autoimmune diseases.
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By Jeri Jewett-Tennant, MPH
Jeri Jewett-Tennant, MPH, is a medical writer and program development manager at the Center for Reducing Health Disparities.
