How Multiple Sclerosis Affects Men

Although men and women experience many of the same symptoms of multiple sclerosis (MS), research suggests that the course of the disease differs between the sexes.¹

Biological and social differences may contribute to the variation in disease course. There is data that suggests reproductive hormones may be a factor in the likelihood of a patient developing MS, as well as in how the disease progresses. For example, more women than men are diagnosed with MS, MS typically presents in young adulthood, (between menarche and menopause in women), and women with MS who are pregnant seem to be relatively protected from MS during their pregnancy.

On the other hand, while men may be less likely to be diagnosed with MS, data tell us that men with MS show poorer recovery from MS relapses, higher rates of brain volume loss, more cognitive impairment, greater disability development, and higher rates of transitioning to secondary progressive MS.^2,3

Testosterone may play role in MS risk and lower levels of testosterone in men with MS is correlated with worse physical and cognitive disability.⁴ However, there isn’t definitive evidence that MS impacts hormone levels or that MS is impacted by hormone levels. Low testosterone is likely underdiagnosed, and the symptoms of low testosterone can include fatigue and cognitive impairment making it difficult to ascertain if these symptoms are due to MS or a hormonal issue.

Not all differences in the presentation and progression of MS are because of biological differences. The impact of underdiagnosis and delayed diagnosis and treatment initiation in men contributes to worse prognosis. We have observed that men take significantly longer than women to report symptoms or get evaluated for MS.⁵

One possible explanation for this is that men may not seek evaluation as quickly as women for fear of being seen as vulnerable, weak or lacking independence. By the time men receive a diagnosis of MS, they may already have accumulated significant disability and damage to their nervous system. But this delay in diagnosis for men may not always be because they are slower to seek medical attention. There could be a delay in health care professionals recognizing MS in men due to the emphasis on MS being a woman’s disease. It is important that we shift away from talking about MS as a disease that primarily affects women and instead focus on improving early diagnosis by educating the general public and healthcare professionals on recognizing the neurological symptoms of MS like dizziness, numbness, vision loss, trouble with balance, and weakness, regardless of gender or sex.

Once a man has been diagnosed with MS, effective management of the disease requires more than addressing physical wellness. It is critical that we manage stress, mood disturbances and promote building and nurturing relationships. Societal attitudes often view these as female issues, and they don’t traditionally include men. But opening the door for men living with MS to pay attention to their emotional health, develop support networks and ask for help may offset pre-existing gender stereotypes and lead to better disease management and health outcomes.

Anxiety and depression are present in more than half of individuals living with MS and it's often underappreciated and under addressed, especially in men. In patients newly diagnosed with MS, men show increased anxiety and depression scores and poorer attention compared with women.⁶ This may be because of a reluctance among men to talk about their feelings or discomfort among health care providers in broaching this subject. We need to be vigilant in looking for symptoms of depression or anxiety, which may present as fatigue, disturbance of sleep, low energy, decreased sex drive and decreased appetite.

Early diagnosis and treatment with disease modifying therapy makes a significant difference on outcomes. We believe that recognizing and diagnosing MS in men earlier and initiating an effective therapy will make a tremendous impact on their prognosis and quality of life. What is true in stroke management is also true in MS, time is brain!

REFERENCES
1. Coyle PK. What Can We Learn from Sex Differences in MS?. J Pers Med. 2021;11(10):1006. Published 2021 Oct 7. doi:10.3390/jpm11101006
2. Golden LC, Voskuhl R. The importance of studying sex differences in disease: The example of multiple sclerosis. J Neurosci Res. 2017;95(1-2):633-643. doi:10.1002/jnr.23955
3. Safi N.V., Krieger S. Men with Multiple Sclerosis. Pract. Neurol. 2021;February:37–40.
4. Chitnis T. The role of testosterone in MS risk and course. Mult Scler. 2018;24(1):36-41. doi:10.1177/1352458517737395
5. Safadi AL, Barry BD, Shin RK. A Cross-Sectional Study of Delayed Diagnosis Associated with Gender and Racial Identity in Multiple Sclerosis. J Racial Ethn Health Disparities. Published online September 5, 2025. doi:10.1007/s40615-025-02611-6
6. Prokopova B, Hlavacova N, Vlcek M, et al. Early cognitive impairment along with decreased stress-induced BDNF in male and female patients with newly diagnosed multiple sclerosis. J Neuroimmunol. 2017;302:34-40. doi:10.1016/j.jneuroim.2016.11.007