Primary biliary cholangitis (PBC) is traditionally thought of as a “women’s disease.”
Indeed, the majority of those affected by PBC are middle-aged women, but research shows that an increasing number of men are being diagnosed. What’s more, men may also experience different and more severe disease, a higher risk of complications and increased risk of death.
The differences between men and women with PBC
Older research reported that the female-to-male ratio of PBC was 10:1. However, more recent research has found the ratio ranges from 4:1 to 6:1 — a smaller gap than previously thought.
While men are less frequently diagnosed with PBC than women, they tend to be diagnosed at a later stage and have poorer outcomes.
When left untreated, PBC can lead to cholestasis, or reduced or stopped bile flow, and cirrhosis, which can be fatal. Research has found men with PBC have a higher risk of liver complications, are more likely to need a liver transplant and have lower survival rates compared to women with the condition.
Read more about PBC prognosis
Why men have poorer outcomes with PBC
In women, PBC typically means symptoms like fatigue, intense itching and dry eyes or dry mouth. Men largely experience the same symptoms but are less likely to experience them earlier on, particularly itching. This may mean they are less likely to seek medical care until after the disease has significantly progressed, leading to delayed diagnosis.
Clinicians may be less likely to recognize PBC in men due to the myth that it’s a “women’s disease” and extremely rare in men. This could also lead to delays in diagnosis and treatment.
Research has shown that men tend to have poorer response to ursodeoxycholic acid (UDCA), the first-line treatment for PBC. This may also explain why men have a higher rate of liver complications.
Furthermore, men with cirrhosis have a greater risk of hepatocellular carcinoma (HCC), or liver cell cancer, compared to women, which likely contributes to lower survival rates among men.
More awareness of PBC in men is needed
Most of the research done on PBC has examined the disease in women. More studies are needed to better understand how PBC and its treatments affect men.
Researchers are calling for more studies and education to raise awareness so that PBC is suspected and diagnosed at earlier stages in male patients.
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