MG and its treatments can affect aspects of being a man or woman. We thank neurologist David Randall, DO, from Northshore Neurological Institute in Glenview, Illinois, for shedding light on these issues. He spoke at the Conquer MG Fall Patient Meeting in October, 2017.

What follows are highlights from Dr. Randall’s talk. If you’d like to see a short video clip or his full presentation, visit our YouTube channel.

MG Incidence in Men and Women

When considering how myasthenia gravis affects men compared to women,

• Women are over represented; they make up over 60% of MG patients.
• Women are more often affected at a younger age.
• The highest incidence for women is in the 20s and 30s.
• Genetic studies correlate early-onset myasthenia gravis, which affects women of childbearing age, and the HLA-DR3 and B8 gene-alleles. Other genes also affect susceptibility to autoimmune disorders.
• Men are more often affected after age 50; this incidence appears to be rising.

MG and Women

Periods of exacerbation – when MG symptoms get significantly worse – can be triggered in both men and women. Triggers include infection, anesthesia, thyroid changes, medications, emotional stress, and physical stress (such as illness, trauma, or surgery).       

MG symptoms in women also can be affected by menses, pregnancy, and postpartum changes in hormones.

Menses

• Small studies and case reports have demonstrated a frequent exacerbation of myasthenia gravis during the menstrual period.
• In one study, 42 premenopausal women with generalized disease were evaluated. Twenty eight (67%) of the patients reported exacerbation of their myasthenic symptoms two to three days prior to the menstrual period.
• This exacerbation persisted in 22 study participants to the third day of the menstrual period. In nine of the women this clinical worsening necessitated an increased intake of medications during the days prior to menstruation.
• Menstrual exacerbations occur in both seronegative and seropositive patients. These exacerbations may frequently necessitate therapeutic changes.
• Anecdotal benefits of long acting birth control pills have been reported.
• Improvement of these exacerbations tends to occur after menopause.

Pregnancy, Labor and Delivery, Postpartum Issues

If you’re a woman with MG, it’s important to discuss your pregnancy plans in advance with your neurologist whenever possible, so you can work as a team for the best outcomes. You’ll want to discuss how pregnancy can affect your MG, and how MG can affect your pregnancy. Together you can discuss if pregnancy is an option, medications that need to be changed, and risks to the fetus and newborn. You’ll want any pregnancies to be closely monitored.

Visit our YouTube channel for Dr. Randall’s detailed discussion about how MG impacts pregnancy, labor and delivery, breastfeeding, and the postpartum period. He also discusses MG’s effect on the fetus and newborn,

MG and Men

For men, MG generally is not a direct cause of infertility, erectile dysfunction, or loss of libido. However, low testosterone may be correlated with myasthenia gravis in terms of MG medications and with factors not associated with medications.

Low testosterone is known to cause the following:

• Loss of muscle mass and strength
• Fat distribution
• Bone density
• Hair Loss
• Mood
• Fatigue
• Decreased sex drive
• Erectile dysfunction

Other factors related to a chronic illness like myasthenia can play a part in male sexual dysfunction. Individuals who have MG are at higher risk for general fatigue, depression, thyroid disease and diabetes. These other symptoms and diseases and their treatments may cause male sexual dysfunction.

If you have these issues, discuss them with your neurologist. Your medications should be reviewed, and other underlying causes such as depression or diabetes should be considered and treated. Your doctor can check hormone levels, and treat low testosterone.

MG Medications

Medications used to treat MG can produce side effects for men and women. For example:

• Prednisone can cause:
  • Emotional changeability (men and women)
  • Depression (men and women)
  • Hair loss (men and women)
  • Low serum testosterone (men)
  • Decreased libido (men and women)
  • Weight gain (men and women)
  • Bone demineralization (men and women)
• Mycophenolate can cause:
  • Emotional changeability (men and women)
  • Erectile dysfunction (men)
• Azathioprine can cause:
  • Hair loss (men and women)
• Mestinon can cause:
  • Emotional changeability (men and women)
• No specific side effects related to men or women have been reported for:
  • Rituximab
  • Plasma exchange
  • IVIG