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Sex Matters In Multiple Sclerosis - Understanding Multiple Sclerosis And The Sexuality Spectrum

Multiple sclerosis (MS) is more common in women than in males, and sex variations in disease course show that sex matters in multiple sclerosis. MS is a central nervous system inflammatory and neurodegenerative disease. MS usually has a relapsing-remitting or progressive illness pattern.

Dr. Cooney Blades
Mar 06, 20235 Shares292 Views
Multiple sclerosis(MS) is more common in women than in males, and sex variations in disease course show that sex matters in multiple sclerosis.
MS is a central nervous system inflammatory and neurodegenerative disease. MS usually has a relapsing-remitting or progressive illness pattern.
Women had a more benign course, predominantly sensory complaints and fewer inflammatory relapses.
Men have more significant motor symptoms, cognitive impairment, and a slower course.

Multiple Sclerosis Shows Clinical And Radiological Sexual Dimorphism

MS is affected by biological sex in all facets of the illness.
Women have a two to four times greater chance of acquiring MS than males.
The study of gender variations in MS prevalence, clinical outcomes, and radiological measurements is explored.
Many natural historystudies on MS indicate that the male sex is related to a poorer clinical prognosis.
Men suffer more than women in relapse-free study periods, and clinical relapses do not affect their sustained Disability Status Scale (EDSS) progress over time.
Men have more cortical lesions than women in all MS phenotypes, and they lose more cortical thickness with age than women.
Using diffusion tension imaging (DTI), males had more diffuse and localized damage, particularly in the thalamus.
Male and female Relapsing-remitting MS (RRMS) patients have varied sex hormone-related disease activity patterns, as evaluated by Gd-enhancing lesions and T1 and T2 lesions.
These hormones may provide synergistic immunological responses, with low estradiol to progesterone ratio protecting against MS disease activity.

Multiple Sclerosis And The Biology Of Sex Differences

Sexual dimorphism may also exist in internal organs and various biological processes, including immune function.
Male MS patients had a greater incidence of cortical GM lesions than females.
Women have somewhat more significant remyelination than males in MS patients.
Male MS patients had much more significant losses in nerve fiber density when compared to females.
Sex dimorphism in the CNS most likely affects lesion development, and hence disparities in disease occurrence and course.
MS pathophysiology involves axonal degeneration and localized inflammatory demyelination.
RRMS is characterized early in the illness course by frequent provocative assaults in the CNS.
Progesterone, estrogen, and androgen signaling pathways may constitute an endogenous anti-inflammatory coping strategy.

Sex Hormones And Multiple Sclerosis

There is substantial evidence that sex hormones are critical in developing the immune system's sex bias and immunological-mediated illnesses such as MS.
Sex hormones, including estrogen, progesterone, prolactin, and testosterone, significantly impact the immunological and neurological systems.
The majority of sex disparities in MS may be shown as a direct result of their behaviors.
A man and woman in white shirts are hugging each other
A man and woman in white shirts are hugging each other


Puberty, a period of lifeaccompanied by increased sex steroids, is a watershed moment for MS and sexual dimorphism.
Overall, puberty in females is linked to an increased chance of developing MS.
Puberty in boys often occurs later (around the ages of 30–40) and correlates with a fall in testosterone levels.
Testosterone is an anti-inflammatory hormone that inhibits both humoral and cellular immune responses.
In MS patients, low testosterone levels are associated with severe disability and cognitive impairment.
Testosterone treatment reduced disability, cognitive decline, inflammation, and demyelination clinical ratings.

Estrogens And Progesterone

Pregnancy improves the short-term course of MS.
Pregnancy's short-term protective impact on MS is most likely due to an immune change during pregnancy.
Estrogen levels, including estradiol, estriol, and estrone, control cells, and pathways in the innate and adaptive immune systems.
Preclinical MS research indicated that estrogen therapyhad anti-inflammatory characteristics.
Estradiol was shown to lessen the severity and frequency of two disease models, EAE and Theiler's virus-induced demyelinating illness (TMEV-IDD).
Estriol treatment protects EAE mice from disease activity.
Hormone replacement treatment might be utilized to prevent MS disease progression and neurodegeneration.
Another female hormone, progesterone, has receptors on immune cells as well.
In postmenopausal women with MS, treatment with systemic estrogen with or without progestin was linked with a higher quality of life.


Prolactin, a pituitary gland hormone or luteotropin, is called luteotropic hormone or luteotropin.
Prolactin is involved in various other processes, including immunological regulation, which promotes B cell maturation and autoreactivity, and cell proliferation, which promotes remyelination.
For example, in the EAE model, a modest prolactin dosage did not aggravate the illness, whether provided prophylactically or therapeutically, but a significant amount did.
Overall, it seems to have a dual impact on MS and cannot be recommended as a treatment drug for the disease.

Latest clinical trials and updates on the relationship between sex hormones and MS

People Also Ask

Is MS A Sex-Linked Disease?

Multiple sclerosis (MS) is a chronic autoimmune disease with a significant hereditary component.
A straightforward but unexplained female gender bias exists, as it makes a maternal parent-of-origin impact.

What Is The Main Sex Difference In Multiple Sclerosis?

Women are roughly three times as likely as males to get multiple sclerosis (MS).
On the other hand, being male is a risk factor for poorer impairment development.
Susceptibility has been connected to inflammatory genes, whereas neurodegeneration is at the root of disability progression.

Can Men With Multiple Sclerosis Have Sex?

Many persons are suffering from multiple sclerosis experience a decrease in sexual desire.
With symptoms like weariness, muscular spasms, and bladder control issues, it may be challenging to consider sex.
Despite MS, you may take actions to enhance sexual function and intimacy.


Multiple Sclerosis (MS) has an evident sexual dimorphism in both illness susceptibility and progression, and it is more frequent in women, while males have a more severe disease course.
Males have a more active immune system, as shown by more significant numbers and increased proliferative ability to circulate T-cells.
Females' higher peripheral immune responses may explain why women with MS have a more inflammatory phenotype.
Male MS patients exhibit quantitatively more significant levels of CNS inflammation than their female counterparts, offering a causative explanation for the inferior clinical outcome reported in men.
This trend clearly shows that sex matters in multiple sclerosis.
Female and male microglial cells have distinct structural, functional, transcriptomic, and proteomic characteristics and responses to CNS damage.
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