And why do men have worse infections?
By Austin Perlmutter, MD
KEY POINTS
Women are more likely to experience immune issues including autoimmunity and inflammation
Men are more likely to experience worse infections and their complications
Hormones, chromosomes and stress all may play a role in differences between risk for conditions
Smoking and drinking damage immune health and may help explain mens' predisposition to worse infections
Metabolic dysfunction is an often hidden contributor to immune issues
You probably know that inflammation is a huge problem for overall and brain health. But did you know that women vs men have different risks for inflammatory problems and other immune issues? One important issue is autoimmunity, which may impact up to 4x more women. This is concerning for brain health in particular due to brain-autoimmune issues like lupus and multiple sclerosis
Beyond this however, is the idea that women may be predisposed to additional issues with immunity, while men may be more susceptible to other problems. One of the most notable differences is that women may have more issues with inflammation while men may be more at risk of issues with infections (E.g., worse outcomes during COVID-19. Here are some reasons why this may be the case:
1. Hormonal and chromosomal differences Men and women have different chromosomes (XX vs XY). It's notable that the "X" chromosome contains more genes and data related to immunity, and though any individual cell should only express one X chromosome, women experience a diversity of the gene products of these chromosomes throughout the body due to something called "mosaicism". In addition, there are differences in hormones like estrogen and testosterone which impact immunity including inflammation and response to infection. 2. Women experience higher levels of psychological stress compared to men It's well established that chronic stress may promote inflammation. This is why it's notable that women tend to report higher levels of chronic stress and anxiety compared to men. There are likely a number of reasons for this statistic, but in the context of inflammation, it's worth a careful consideration. Also, it's important to know that chronic stress is rampant in both sexes around the world, so billions of people are likely experiencing problems in immunity due to this link. 3. Men may be more likely to drink and smoke Both excess alcohol consumption and smoking at any level are known to negatively impact overall, brain and immune health and may predispose to easier infection. This is why it's notable that men are more likely to engage in unhealthy levels of these behaviors. 4. Men and women may experience different forms of metabolic dysfunction Metabolic dysfunction is rampant, with most people experiencing some aspect of poor metabolic health (e.g., high triglycerides, high blood sugar). Worse metabolic health is strongly linked to worse immune health (and brain health, for that matter). So while on the whole, women may experience more obesity (linked to inflammation), men have higher rates of diabetes (linked with inflammation but also with issues fighting off infections).