Is the 'Man Flu' for real, or do guys really get sicker than women do?

When a cold or flu hits, nothing looks better than your couch and the Netflix remote. But you may fight that urge, lest you be ridiculed as coming down with the “man flu,” a phrase coined to underscore the often-held belief that when men are sick, they just can’t handle it, and tend to overreact or exaggerate the symptoms.

Now, there might be some evidence behind the fact that colds and flu really are worse for men than women—and there may be an evolutionary basis for it, according to new research published in the Christmas issue of the scientific journal BMJ, which takes a more lighthearted and tongue-in-cheek approach to analysis, but still undergoes to same rigorous peer review process.

That’s the consensus researchers came up with, after reviewing about 30 studies on the topic, both in mice and in humans.

Some of the kickers? For one, female mice may actually have a higher immune response to flu viruses such as H1N1 and H3N2, according to researchers from Johns Hopkins, which may mean that women mount higher antibodies against the flu when they get sick. Scientists believe this could be due to hormonal differences, mainly how estrogen bolsters immune response and testosterone dampens it.

Other studies looked at human cells. In fact, one study examining cells from premenopausal women found that they had a stronger immune response to rhinovirus (the common cold) than men or post-menopausal women did. And that, of course, furthers the theory that differences in hormones may be a driving factor.

Broader population studies note the difference, too. Flu season data in Hong Kong from 2004 to 2010 and in the United States from 1997 to 2007 show men had higher rates of hospitalization and death associated with flu than women did, regardless of other factors such as heart disease, cancer, lung disease or kidney disease. Even the World Health Organization seems to acknowledge the difference, in their recommendation that “sex should be considered when evaluating influenza exposure and outcomes.”

All in all, there’s a surprising number of studies out there on the topic, and they do seem to show that men really do experience worst symptoms, says study author Kyle Sue, M.D., of Memorial University of Newfoundland in St. John’s, Newfoundland in Canada. He actually decided to analyze the information after coming down with the flu himself the week before he had a presentation on the topic.

Sue wasn’t surprised by the news that hormones play a role in immunity, but the link he saw to higher testosterone was interesting. According to the studies, testosterone is immunosuppressive, which means it can reduce the effectiveness of your immune system.

“Traditionally, we think of the manly men—or those with more testosterone—as the winners,” he says. But this data suggests, when it comes to immunity at least, that they may actually be the weakest.

Several scientists have pointed to the “live hard, die young” mentality, and the fact that males across many different species, not just humans, are more likely to die from trauma than infection. As a result, their immune systems may be less developed, since they wouldn’t have had the opportunity to fight off as many bugs.

Still, we need more studies to examine the link further. In his article, Sue jokingly suggests a further avenue of study might be to look at how men with the flu react when they have caregivers to help them recover versus when they’re left to fend for themselves. But the real science should delve more deeply into other factors that really can affect the outcome, like the fact that men tend drink and smoke more often than women do, which could contribute to worse and longer-lasting cold and flu symptoms. The studies also need to include more people and look beyond mice models or cells in a test tube.

Until then, well, if you come down with a cold or flu, don’t fight the rest and recuperation you need just to challenge the “man flu” stereotype. To feel better, consider taking zinc tablets, which can cut cold symptoms by three days, and avoid these nine foods, which can just make you feel worse.