Do men get pregnant, too?

Photo by Jonathan Borba on Unsplash

Up to 80% of men report sensations similar to their partners during pregnancy, including morning sickness, irritability, bloating, and weight gain. Yet, it is impossible for men to produce some of the hormones that cause them. Are they sympathetic, is it psychological, or is there something else happening here? If men are actually feeling the effects, how does this happen, which hormones do it, and how do the hormones transfer from men to women? This could change how we view men as partners in pregnancy and social policies before and after the birth of his child. To understand what’s happening, first we have to…

Pee on a frog

Before you could buy pregnancy tests at the supermarket, the most reliable way to determine pregnancy was to inject urine into a frog.

In 1933, Hillel Shapiro and Harry Zwarenstein explored the human chorionic gonadotropin (hCG) hormone in pregnant women’s urine by injecting it under the skin of the African clawed frog Xenopus laevis. When exposed to hCG, the Xenopus frog spontaneously ovulates. Since women only produce hCG when pregnant, and urine carries a high concentration of hormones, the frog’s ovulation demonstrated pregnancy. A similar practice in mice and rabbits produced similar results. Due to the near 100% efficacy of frogs, it wouldn’t be until the 1970s that home pregnancy tests replaced them.

The hCG hormone is an ideal pregnancy indicator because it is almost exclusively produced by the development and presence of a placenta. High levels of hCG have been tied to morning sickness and nausea. Men, obviously, do not develop a placenta, nor do they produce hCG, so why would they develop morning sickness?

Man Flu or Pregnant Too?

Men report symptoms ranging from morning sickness to strange food cravings, constipation, abdominal pain, mood swings, weight gain, and even post-partum depression. In extreme cases, they may even experience pseudocyesis — false pregnancy. These symptoms don’t occur at random. Their timing coincides with the same feelings in their female, actually pregnant, partner. Despite the widely documented occurrence, men rarely receive treatment.

Psychologists call this Couvade Syndrome. Commonly known as “sympathy pain”, the prevailing prognosis is that the symptoms are purely psychological. The symptoms are treated as mental illness or disease. The AMIA defines a syndrome as “a recognizable complex of symptoms for which a direct cause is not necessarily understood.” That last part is telling. We wouldn’t call pregnancy a disease, but before van Leeuwenhoek saw sperm under the microscope in 1677 the direct cause of pregnancy was not understood. Now we use this terminology to describe the male condition.

Babycenter relays “with financial worries, health concerns, and good old-fashioned cold feet… you have a perfect recipe for a sympathetic pregnancy.” Scientific American emphasizes the mental condition “from jealousy about a man’s inability to carry a child to guilt over having caused this transformation in his partner to selfish attention seeking.”

Is this a fair diagnosis or a justification of ignorance?

Both society and science share a fundamental bias. Men don’t get pregnant, ergo male pregnancy symptoms must be a disorder. Worse, many cultures ridicule men who report feeling “women’s” pains. Viewed as effeminate or emasculating, men consequently under-report their experiences. In fact, most Couvade anecdotes don’t come from men but from their partners who relate their misery to a doctor.

What’s really happening? Some scientists are digging deeper, and finding remarkable results.

Separate studies have shown that couples tend to sync their hormones — cortisol during bad relationships, and testosterone during and after pregnancy.

Dr. Katherine Wynne-Edwards of the University of Calgary found in a 2000 study, “Men with more pregnancy (couvade) symptoms and men who were most affected by the infant reactivity test had higher prolactin levels and greater post-test reduction in testosterone. Hormone concentrations were correlated between partners.

How could men have correlated hormone concentrations without actually carrying a child?

Kiss me baby

Hormones are contagious. Birds and animals, including humans, “leak” hormones in small concentrations, making them externally available for detection on contact. Not only are hormones contagious, that contagion plays a role in how humans get pregnant in the first place.

Urine and feces carry high concentrations of hormones, hence the frog, but let’s, please, assume men neither ingest nor inject either. Hormones also leak through skin oil, breast milk, breath vapor, saliva, blood, and hair. Steroid hormones can be absorbed by the skin.

Saliva contains testosterone, transferred through kissing. The longer and sloppier the kiss (think French), the more testosterone exchanged. The testosterone men pass on to women through kissing tends to increase the woman’s sex drive, spurring intercourse. In exchange, women pass on estrogen, allowing a male to identify her fertility (it is believed). If kissing can exchange and influence hormones, might a pregnant couple exchanging kisses also sync hormones?

Men’s raging hormones

To find clues, we’ll need to look at the hormones produced by women’s bodies during each trimester.

In the first trimester, the body starts producing more progesterone and estrogen. Once established, the placenta is the main source of progesterone. Progesterone causes constipation by relaxing the digestive tract. It is also responsible for mood swings. Estrogen swells the blood stream, causing a stuffy nose and frequent urination.

In the second trimester, relaxin ushers in aches and pains, especially in the back and hips. Cortisol increases, responsible for stress and increased blood pressure. The hormone human placental lactogen (HPL) stimulates insulin resistance. It is believed insulin resistance can result in weight gain. In a pregnant woman, that gain is manifested in the formation of the fetus. In men, not growing a baby, it may simply result in tummy fat. Progesterone may also play a role in this weight gain.

In the third trimester, estrogen and progesterone are at their highest and may cause swelling in the hands and feet. Prolactin levels skyrocket. In rare cases in men, high levels of prolactin may even cause breast growth and galactorrhea (a milky nipple discharge), decreased libido, decreased testosterone, and decreased sperm production. In men, this is known as hyperprolactinemia.

With the release of the placenta at birth, all those hormones go with it. The resulting hormone crash, the low levels of estrogen and progesterone, in conjunction with wailing induced, sleep-deprived heightened cortisol levels, can induce post-partum depression. Interestingly, a common symptom of low levels of estrogen and progesterone in men is also depression.

While doctors study these hormones in women during pregnancy, they remain largely unstudied in men. “The precise therapeutic manipulation of progesterone actions in the male requires completely new endocrine-pharmacological approaches,” says Dr. Michael Oettel.

So if these hormones cause pregnancy symptoms in women, and men sync hormones with their partners, might we find the same hormones cause symptoms in their partners as well, and at the same times? Might it even be her hormones?

Blindness

We’re left with the pieces of a puzzle. Pregnant women’s bodies release pregnancy specific hormone levels. Some hormones can influence biological behavior even across species. Males experience symptoms similar to their pregnant partners. Hormones transfer between humans, especially by kissing, an activity any good husband with a pregnant wife knows to initiate. But the connection between hormone transfer and Couvade syndrome has not yet been made. Why?

In one word: sex, both in act and gender. The very idea that a man may experience pregnancy defies most culture’s core binary beliefs. Societal taboos surrounding sexual discussions and masculine traits make it difficult to study, or even conceive of studies, which might tie men and women together hormonally. It is unlikely a scientist studying pregnancy symptoms in men would also ask about the frequency and methods of kissing, sex, or cunnilingus. It is equally unlikely that men in hyper-masculine cultures could answer without bravado or modesty. The notion that we’re influenced by hormones produced in someone else’s body challenges the very perceptions of self-control and free will that form the cornerstone of our societies.

In other words, we don’t know. Yet. But we’re starting to ask the right questions.

There may be an easy way to test this: pregnancy tests for men (not frogs). Test for hCG in men during their partner’s pregnancy. Home pregnancy tests are sensitive enough to detect the presence of hCG up to six days before a missed menstruation, so they may detect it in men at the height of their partner’s hCG production, toward the end of the first trimester. High levels of hCG in men, who are unable to produce it, would prove hormone transfer and, by extension, show the symptoms of Couvade as not an aberration but a perfectly normal human condition.

Maybe some day men will take time off with their partners, three months before the birth and three months after at a minimum, as we learn how important hormone transfer is to both parents and their baby. Until then, keep kissing your partner and sync up.

We need pioneering research in what could be an earth shattering human discovery. If we can prove hormone transfer, it may explain a multitude of other human behaviors.

Rage: When two men argue, you can observe them move their faces closer and closer together. Perhaps this is to better detect the cortisol and testosterone levels in each other’s breath, allowing the least testosterone fueled of the two to back down?

Riots: Perhaps what we know as “mob mentality” is actually a self-reinforcing feedback loop of cortisol and testosterone in densely packed humans. If so, police employing rubber bullets and pepper spray, employing fear, only make the situation worse. Perhaps they could instead spray an estrogen mist?

Isolation: Perhaps the pandemic practice of wearing masks and avoiding touch hindered hormone transfer, reinforcing a sense of isolation even when in the proximity of others.

If you’re a careful reader, following the links to my source material, you may have noticed that the hormone in “breath” linked to hormones measured in whale blow holes. That’s a good indicator of the problem scientists have. We understand hormone detection in animals better than in humans. We resist seeing humans as little more than animals, much less controlled by our bodies in immutable ways.

That’s the point of this series “Out of Control”. I’m highlighting the scant research done on humans in order to show that not everything about us is psychological. Sometimes we do what we do because we have no choice. Our behavior, our actions, are literally Out of Control. Look for more on this series soon.

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