Fibromyalgia in men: beyond invisibility-a biopsychosocial and clinical perspective in rheumatology

Fibromyalgia is a chronic pain syndrome traditionally perceived as a predominantly female condition, although growing evidence suggests that this view may partly reflect diagnostic and sociocultural biases rather than true epidemiological differences. This perspective critically examines fibromyalgia in men as an underrecognized and understudied clinical entity. The authors propose an integrative conceptual framework in which the invisibility of men with fibromyalgia emerges from the interaction between sociocultural barriers to healthcare-seeking, clinician-related diagnostic bias, and heterogeneous symptom expression influenced by biological and psychosocial factors. Men may delay seeking medical care due to cultural expectations of masculinity and frequently encounter skepticism regarding symptoms such as diffuse pain, fatigue, and psychological distress. Although core symptoms are shared across sexes, men may differ in coping strategies, illness perception, and healthcare interaction. Emerging evidence also suggests possible neurophysiological and functional alterations, including small fiber pathology, reduced muscular strength, gait impairments, and psychological comorbidities. However, current evidence remains limited by small samples and methodological heterogeneity. The article argues that understanding fibromyalgia in men is essential not to establish rigid sex-specific phenotypes, but to improve diagnostic sensitivity, promote biopsychosocial and gender-sensitive care, and expand the understanding of heterogeneity within chronic pain disorders.