Burning Mouth Syndrome in Men

Men, You’re Not an Exception, and You’re Not Out of Options

If you’re a man living with burning mouth syndrome, you’ve probably noticed something when you go looking for answers. Almost everything written about BMS seems to be about women: menopause, estrogen, women in their fifties and sixties. You may have been told, directly or not, that this is “a women’s condition.” You may have wondered whether what you have is even the same thing.

It is. You’re not imagining it, you’re not an oddity, and you deserve the same careful search for causes and the same hope for relief that women with BMS get.

Frequency of BMS in Men

BMS is more common in women, but men are not rare. Estimates of how common BMS is in the general population range from 0.7 to 4.6%, rising as high as 18% in postmenopausal women. In one large Italian oral medicine clinic, roughly one man was seen for every three women. So in a room of BMS patients, about one in four might be a man.

There’s also reason to think men are undercounted. Research consistently shows women are more likely to seek medical care and report symptoms than men, and the same researchers suggested that this difference in care-seeking may partly explain why BMS looks so much more common in women. Many men put up with a burning tongue for a long time before they tell anyone, and some never do.

Men and Women Have the Same BMS Condition

The best evidence we have says yes. In 2024, researchers in Naples published one of the only studies designed specifically to compare men and women with BMS. They enrolled 242 men and 242 women with BMS, matched for age, precisely because most earlier studies had too few men to say anything meaningful.

What they found should be reassuring. Men and women did not differ in their oral symptoms, how intense the pain was, how it felt, or their levels of anxiety, depression, and sleep problems. In both groups, the tongue was the most commonly affected area, involved in about half of patients, followed by the palate, gums, and lips.

In other words, the burning you feel is the same burning women describe. And the toll it takes on sleep and mood is just as real for you.

How BMS Differs in Men

While the symptoms looked the same, the rest of the health picture did not. The men in the study were more likely to drink alcohol regularly and to carry more weight, and heart disease was significantly more common among them. A prior heart attack was reported in about 8% of the men compared with under 2% of the women, while low thyroid was more common in the women.

The researchers also found that in men, depression and alcohol use were linked to how severe and unpleasant the pain felt. They noted that some people with chronic pain use alcohol to self-medicate, particularly men who drink to ease pain.

This isn’t a judgment. It’s useful information. Depression in men often doesn’t look like sadness; it can show up as irritability, withdrawal, or a couple more drinks at night. And alcohol, while it may take the edge off in the moment, is itself irritating to the tissues of the mouth. Recognizing that cycle is part of breaking it.

Hormones Matter for Men, Too

Most of the hormone conversation around BMS focuses on the drop in estrogen and progesterone at menopause. Researchers believe lower estrogen can make the pain-sensing nerve receptors in the mouth more active and easier to trigger, increasing pain sensitivity.

Here’s what often gets left out: men need estrogen too. A man’s body makes much of its estrogen by converting testosterone into estradiol. As testosterone gradually declines with age, which is sometimes called andropause, the supply of estrogen to his tissues can decline along with it. Men also produce DHEA, cortisol, and thyroid hormone, all of which influence nerve health and inflammation.

So the same hormonal pathways that make women vulnerable to BMS are present in men. They simply change more gradually, and fewer doctors think to look at them.

It’s important to be honest here: this is an area where the research has not caught up. The Naples study did not measure hormones in either men or women, and the authors specifically called for future research on hormonal changes in both sexes. That gap is exactly why men have felt left out. But a gap in the research is not the same as a dead end in your care.

BMS Evaluation for Men

BMS is a diagnosis made after other causes have been ruled out, and many contributing factors can be found and corrected. For men, a complete workup should include:

Hormones. Testosterone (total and free), estradiol, DHEA-S, cortisol patterns, and a full thyroid panel. Low thyroid is less common in men, but it isn’t rare, and it’s easily missed.
Nutrients that nerves depend on.Vitamin B12, folate, iron, zinc, and vitamin D. Men who take metformin for blood sugar or acid-reducing medications for heartburn are at particular risk of low B12, a well-known cause of oral burning and nerve pain.
Blood sugar. Diabetes and prediabetes can damage the small nerves throughout the body, including the mouth.
Medications. Some blood pressure medications, particularly ACE inhibitors, have been associated with burning mouth symptoms. Many medications for blood pressure, bladder, prostate, mood, and sleep can also cause dry mouth, which makes burning worse. Never stop a medication on your own, but do ask whether yours could be playing a role.
Reflux. Silent reflux can irritate the mouth and throat without obvious heartburn.
Your mouth itself.Dentures, clenching or grinding, tobacco use, and harsh mouthwashes or toothpastes can all irritate sensitive tissue.
Sleep and mood. Poor sleep and pain feed each other. Snoring or waking unrefreshed may point to sleep apnea, which is worth evaluating in its own right.

Treatment Obstacles for Men with BMS

Men with BMS often face a particular set of obstacles. They may be told it’s “just stress.” Their doctor or dentist may not think of BMS at all because they’ve learned it as a condition of older women. And many men are reluctant to push for more answers, or to admit how much a constant burning mouth is wearing them down.

If that sounds familiar, please hear this: needing help with chronic pain is not weakness, and a normal-looking mouth does not mean nothing is wrong. BMS is increasingly understood as a problem of the small nerve fibers that carry pain signals. The pain is real, and it has real biology behind it.

There is Hope for Men, Too

The approach that has helped so many women with BMS rests on a simple principle: look for what is out of balance and restore it, rather than just masking the pain. That principle applies to men just as much. We have seen just as much success in our treatment programs when we apply these principles to men. When hormones are evaluated and optimized, nutrient deficiencies are corrected, medications are reviewed, and blood sugar, sleep, and inflammation are addressed, many people with BMS see meaningful improvement.
Men have not been studied as much. That does not mean men respond worse. It means they have been asked fewer questions.

What You Can Do Now

• Keep a symptom log for two weeks: when the burning starts, how strong it is, and what makes it better or worse, including food, drinks, alcohol, and sleep.
• Bring a full medication list, including supplements and over-the-counter products, to your next appointment.
• Ask directly for testosterone, estradiol, thyroid, B12, and blood sugar testing if they haven’t been checked.
• Be honest about alcohol and mood. This information helps your provider help you.
• Look for a provider who treats BMS as a real, investigable condition, whether that’s an oral medicine specialist, an orofacial pain specialist, or a functional medicine physician experienced with BMS.

You belong in this conversation. The answers may take some searching, but they are worth looking for, and you don’t have to look alone.

References

Calabria E, Canfora F, Leuci S, et al. Gender differences in pain perception among burning mouth syndrome patients: a cross-sectional study of 242 men and 242 women. Sci Rep. 2024;14:3340. doi:10.1038/s41598-024-53074-4

Wu S, Zhang W, Yan J, et al. Worldwide prevalence estimates of burning mouth syndrome: a systematic review and meta-analysis. Oral Dis. 2022;28(6):1431–1440.

Seol SH, Chung G. Estrogen-dependent regulation of TRPV1 and P2X3: implication in burning mouth syndrome. J Dent Sci. 2022;17(1):8–13.