Coeliac Disease
in Men

Coeliac disease occurs less frequently in men than women, with a diagnosis ratio of approximately 1 man for every 2-2.5 women.1

A study that evaluated a Dutch cohort showed that men tend to be diagnosed with coeliac disease at an older age than women.2

In the same Dutch study, compared with women, men were less likely to present with classical symptoms such as diarrhoea, abdominal pain, fatigue and/or weight loss,2 which could lead to misdiagnosis. The study also revealed that dermatitis herpetiformis is more likely to occur in men than women.3

Men with coeliac disease may experience health-related stigma, particularly in social settings.4

Coeliac disease and male reproductive system dysfunction

Men with untreated coeliac disease may experience disruption of reproductive functions:5,6

Altered sperm morphology and motility5,6

  • The inflammatory response to eating gluten creates an adverse environment for reproductive tissues
  • Anti-sperm antibodies associated with coeliac disease autoimmune response and compromised nutritional status may cause reduced sperm morphology and motility

Gonadal dysfunction5,6

  • The gut influences hormone metabolism
  • Low levels of testosterone can cause hormone imbalances, leading to hypogonadism

A gluten-free diet has been shown to improve sperm morphology, normalise hormone levels and restore fertility in men with coeliac disease.5,6

 

Man shopping in supermarket, reading product information

Dermatitis herpetiformis

Dermatitis herpetiformis, a cutaneous manifestation of coeliac disease, is up to twice as likely to occur in men than in women.3 Dermatitis herpetiformis presents as an intensely itchy blistering rash. It can be treated with a strict gluten-free diet.7

Stigma and mental health in men with coeliac disease

Men with coeliac disease experience health-related stigma, irrespective of age or how long they have been diagnosed. In a study of 20 adult males in the UK diagnosed with coeliac disease, men described social exclusion and isolation resulting from their coeliac disease and gluten-free diets. Recognising gender-based assumptions may influence diagnosis, support and gluten-free diet management in men with coeliac disease.4

  1. Galli G, Amici G et al. Sex-gender differences in adult coeliac disease at diagnosis and gluten-free-diet follow-up. Nutrients 2022;14:3192
  2. Tan I L, Withoff S et al. Non-classical clinical presentation at diagnosis by male celiac disease patients of older age. Eur J Intern Med 2021;83:28-33
  3. Antiga E, Maglie R et al. Dermatitis herpetiformis: novel perspectives. Front Immunol 2019;10:1290
  4. Pitt A, Lerigo F, Satherley R M. Health-related stigma and challenges faced by men living with celiac disease: a qualitative analysis. J Acad Nutr Diet 2024;124:674-685
  5. Freeman H J. Reproductive changes associated with celiac disease. World J Gastroenterol 2010;16:5810-5814
  6.  Vanderhout S M, Rastegar Panah M et al. Nutrition, genetic variation and male fertility. Transl Androl Urol 2021;10:1410-1431
  7. Salmi T T. Dermatitis herpetiformis. Clin Exp Dermatol 2019;44:728-731