Varicose Veins in Men

Many times we underestimate the presence of venous disease in males paying more attention to venous insufficiency in women, either because they consult more often for varicose veins or because this pathology in females has been studied more as a result of the effects of hormones in the female vascular system and the one that causes varicose veins on the appearance of varicose veins.

The higher rates seen in women may be related to a greater tendency to consult than men, especially since the appearance of less severe varicose veins.

– I can’t say if women are better than men. However, I can say without hesitation that they are not worse. Golda Meir.

It is easy to see that female venous insufficiency has been given more visibility, when looking at the literature, most of the studies that exist have included many more women than men, however there are already studies in some populations that show a practically equal prevalence of varicose veins between both sexes.

Many authors agree that the fact that there was a higher prevalence of varicose veins in women has been a reflection of a greater register of symptoms in the female sex since they seek medical help for varicose veins more often than men.

There is an almost equal prevalence of varicose veins between men and women.

Over time, clinical studies have improved in patient recruitment. When reviewing those that included a sufficient number of men, it was found that the prevalence of varicose veins varies widely in different countries, up to 56% in men and 60% in women, which is very similar.

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In general, women are believed to be more affected by varicose veins than men. According to the Framingham study, the annual appearance of varicose veins is 2.6% in women and 1.9% in men. However, the difference in the proportion of both sexes decreases with increasing age. For example, a study in Israel found that in the age group 20–34 years the sex ratio was 6 women: 1 man, but in people aged 65 to 74 this ratio fell to 3 women for every 2 men. There are studies where the rate of those affected between both sexes is very similar, despite the fact that most of the women included were nulliparous, a factor that must be considered.

The Edinburgh Vein Study found a significantly higher prevalence of varicose veins in men compared to women, a study in Switzerland where there was no significant difference between the prevalence of varicose veins in men and women, and a study in New Zealand where, although the prevalence of mild and moderate varicose veins was higher in women, macroscopic varicose veins were equally prevalent in men.

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What causes varicose veins in men?

In both sexes, the main trigger for venous insufficiency is venous hypertension that acts on a genetically fertile substrate such as the connective tissue of the veins of the lower limbs, both in men and women.

Both the force of gravity, acting on the blood within the leg veins, and the absence of an active venous return mechanism (there is no second heart that pumps blood from the feet to the head) carry the components of the venous wall and its supporting tissue to be subject to intense biomechanical forces that can condition or aggravate its functional failure.

Effect of hormones on varicose veins

Modulating factors such as hormones, obesity, type of work, etc. they are known to be involved in the course of the disease.

Thus, the structural and functional compensation of the vein wall in the legs will delicately depend on various conditioning factors to maintain or damage themselves, among them are hormones. However, to this day, the way in which the molecular changes that lead to vein disturbances occur and how hormones are involved has not been determined.

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Estrogen and progesterone receptors have been shown to be more expressed in varicose veins of both men and women (an increase proportional to the amount each sex has and which is greater in women) – Estrogen and progesterone receptors show important changes in its localization expressing itself in the three tunics that cover these varicose veins at twice as high levels compared to veins from healthy patients of both sexes (progesterone receptor genes are expressed three times in women). Although androgen receptors increase in the varicose vein neo-symptom, the expression of its gene falls significantly in this type of vein. Some studies show that inhibition of androgen receptors can occur in the presence of high levels of progesterone.

Overexpression of estrogen and progesterone receptors and redistribution of androgen receptors in the wall of varicose veins reinforce the hypothesis that hormones are involved in the pathophysiology of varicose veins.

Increased receptors could stimulate the proliferation of vascular cells responsible for morphological changes, such as increased diameter, thickness, and tortuous characteristics of varicose veins.

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Symptoms of varicose veins in men

There are studies that have shown that the development of pain syndrome is less frequently reported by men (45.7 versus 65.2% for women), which is why venous insufficiency is often an ignored problem. The cramps are similar in both sexes, it has been seen in some cases that it is more related to the time that the person spends standing and their work than to the sex of the person who refers them.

Perhaps it is due to the less frequency with which men consult the fact that it seems to some doctors that when they come to have a venous ultrasound they usually arrive in more advanced or complex conditions than women. It has been shown in some populations that men go to endovascular surgery at a more advanced stage of venous disease than women.

Recommendations for varicose veins in men

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The recommendations of phlebologists on the use of compression, pharmacotherapy and surgical methods are not very different in men and women. However, women are more frequently prescribed phlebosclerosis.

Varicocele is a venous problem in the genital area that, if left untreated, can lead to male infertility.

Treatment of varicose veins in males

This does not differ much from what I have explained in other articles, and is based on:

General measures

Destined to improve or avoid the disease: they are those related to avoiding modifiable risk factors through a healthy lifestyle through weight control, exercise, a high-fiber diet to facilitate evacuation, avoiding tobacco, etc.

Graduated compression stockings

In both sexes it is an important pillar of the treatment and prevention of venous insufficiency.

flujo venoso normal

Conrad Jobst

Precisely, the one who invented the decreasing graduated compression stockings was a man with a complex case of venous insufficiency: Conrad Jobst, who noticed how his condition improved with decreasing external compression.

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Graduated compression stockings for men come in numerous models and colors, they can be so comfortable that I know several women who wear them.

Venotonic treatment

They are medicines that seek to increase the tone of the vein wall so that the valves inside it get a little closer and can co-fit better. I have been able to see this effect work through Doppler ultrasound.

Invasive treatment

It should be considered only when necessary and indicated by your vascular disease specialist who will individualize your case. It is based on: conventional surgery to remove as far as possible abnormal venous tracts or endovascular procedures (laser, radiofrequency) and sclerosis of the veins, in these last two cases the aim is to obliterate the interior of the vein on which it is applied.


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Bibliographic References

Evans, C.J., Fowkes, F.G., Ruckley, C.V., Lee, A.J., 1999. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 53, 149–153. https://doi.org/10.1136/jech.53.3.149

García-Honduvilla, N., Asúnsolo, Á., Ortega, M.A., Sainz, F., Leal, J., Lopez-Hervas, P., Pascual, G., Buján, J., 2018. Increase and Redistribution of Sex Hormone Receptors in Premenopausal Women Are Associated with Varicose Vein Remodelling [WWW Document]. Oxidative Medicine and Cellular Longevity. https://doi.org/10.1155/2018/3974026

Kavousi, Y., Al Adas, Z., Karamanos, E., Kennedy, N., Kabbani, L.S., Lin, J.C., 2018. Men present with higher clinical class of chronic venous disease before endovenous catheter ablation. Journal of Vascular Surgery: Venous and Lymphatic Disorders 6, 702–706. https://doi.org/10.1016/j.jvsv.2018.05.024

Kirienko, A.I., Zolotukhin, I.A., Iumin, S.M., Seliverstov, E.I., 2012. [Lower limb varicose disease in men and women: findings of prospective study SPECTRUM]. Angiol Sosud Khir 18, 64–68.

Schneider, M., Glaus, L., Widmer, L.K., Leu, H.J., 1973. [Have people with varicose veins venous disease? Examinations of 3641 men and 781 women of the Basel study. II]. Dtsch. Med. Wochenschr. 98, 343–346. https://doi.org/10.1055/s-0028-1106810

Shingler, S., Robertson, L., Boghossian, S., Stewart, M., 2013. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008819.pub3

Simpson, S., Roderick, P., n.d. 11 Varicose Veins and Venous Ulcers 90.

Models of compression stockings for men

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