She Got Pregnant. His Body Changed Too.

Couvade syndrome, in which men get pregnancy symptoms, remains a medical mystery. But the condition reveals how transformative fatherhood is—and how society misunderstands that.

A man's belly growing over time
Adam Maida / The Atlantic

When Kevin Gruenberg’s wife was pregnant, he was anxious, irritable, and preoccupied with the thought that his stomach was growing. He kept thinking of a family story, from when his mother was pregnant with him, and his father gained weight in parallel. In 2014, three decades later, Gruenberg was having a similar experience, though it went beyond overeating. And although he is a psychologist in Los Angeles, he didn’t know where to turn for help.

Gruenberg, who today leads an organization that runs support programs for fathers called Love, Dad, felt brushed off by his friends. Discouraged and alone, he began to research couvade syndrome, in which men experience pregnancy symptoms. It was, he said, something that he “definitely felt psychologically and physiologically.”

The term couvade first appeared in a book by a British anthropologist, Edward Burnett Tylor, in 1865. It comes from the French word couver, to brood or hatch. In its earliest documentation in the scientific literature, male pregnancy symptoms were seen as purely psychosomatic. Today, the syndrome’s loose definition means its prevalence is hard to track. But couvade, as it is commonly referred to, has appeared in the United States, China, Thailand, and other countries, according to Arthur Brennan, a British labor-and-delivery nurse turned lecturer at Kingston University, in the United Kingdom.

Brennan first became interested in couvade when he was completing his master’s degree. He had heard anecdotal reports from dads about “phantom pregnancy” and read a paper about the topic, then decided to research it. In 2007, he published a small study of 14 men at a teaching hospital in London. The fathers-to-be experienced a variety of ailments, including stomach problems, appetite issues, and various aches. Many of them reported their symptoms happening in conjunction with a partner’s.

“I was throwing up and retching a lot and couldn’t keep anything down,” one man reported. “I was constantly hungry all the time and had an unstoppable craving for chicken kormas and poppadams. Even in the early hours of the morning, I would get up and prepare myself one,” another subject said. In this paper and in subsequent research, the symptom list has seemed to include almost everything: diarrhea, constipation, leg cramps, a sore throat, depression, insomnia, weight gain, weight loss, tiredness, toothaches, sore gums.

The symptoms also seemed to follow a pattern similar to a physical pregnancy: peaking during the first and third trimesters, and in many cases disappearing after the birth of the child. Some symptoms didn’t appear at all in the beginning; some continued postpartum. Regardless of when couvade arrived, it seemed to carry a stigma. “In the U.K., it appears that the syndrome arouses little interest and men who display its symptoms are usually ignored, ridiculed or remain undiagnosed,” Brennan wrote.

Yet the symptoms keep appearing. In 2019, during his wife’s second pregnancy, an NBA player for the Washington Wizards, Bradley Beal, went public about how food cravings and weight gain left him drained and ashamed when his partner was pregnant. “I was up at 3, 4 o’clock in the morning eating ice cream when I shouldn’t have been eating ice cream,” Beal told NBC. “That’s all because momma was pregnant and I had the exact same symptoms.” Men also post similar experiences on Reddit’s r/predaddit forum. “There are days that I wake up violently ill and I can’t keep anything down all morning,” one poster wrote. “I don’t feel sick otherwise, just the vomiting. So much vomiting … Maybe it’s all in my head.” In 2016, Karlos Williams, an NFL player for the Buffalo Bills at the time, said he had been slowed down by extra weight gain after the birth of his fourth child. He attributed his poor in-game performance to “the injury of pregnancy.”

A lot of fringe theories have been put forward to explain couvade. There’s the Freudian one: pregnancy envy. And the psychosocial explanation: the marginalized father clamoring for attention. But these men know that they are not really pregnant. The enduring mystery of their symptoms reveals something deeper: Becoming a father changes a man’s identity, emotions, even hormones. Our society misunderstands that transformation.

Consider the moment a child is born and how far hospital norms have changed from fathers staying outside the delivery room. “For so much of human history, men were basically barred,” says Darby Saxbe, a psychology professor at the University of Southern California who studies families. Now fathers are there for delivery; they have skin-to-skin contact with the newly born baby to bond.

But some outdated gender assumptions persist in society. “We celebrate a vision of men as high-testosterone and aggressive and manly, and that’s inconsistent with the parenting role,” Saxbe told me. Men don’t always think to tell their doctors that they have become fathers, and medical forms don’t always ask. Male experiences with postpartum depression (an under-explored condition in men that has no clear definition) might be brushed off as the normal anxieties of a new dad.

Fatherhood is physiologically transformative too. Research by Saxbe shows that becoming a dad is associated with declines in men’s levels of testosterone, and those declines are linked with greater paternal investment. Hormonal changes could explain fathers’ weight gain as well as their pre- and postnatal depression. (Still, whether hormones create these effects or vice versa is unclear; the research is in its early stages.)

Multiple academics I spoke with seemed skeptical about some of the more extreme symptoms of couvade—the ones that are more frequently caricatured in pop culture—such as a large swollen belly and labor pains. But they felt that certain symptoms could be explained by hormone studies, for a simple reason: Our hormones generally sync up with other people in our environment. “Research on couvade has not been well substantiated,” Saxbe said. “I haven’t seen a ton of evidence of sympathetic pregnancy. What I do see are patterns of linkage [between partners’ psychological and physiological states],” she said.

Brennan thinks hormonal study could be the most fruitful research area for trying to explain couvade. It stands to reason that if men’s testosterone levels drop, changes will occur in their body. “The hormonal components of the syndrome over the three trimesters of pregnancy for men would definitely benefit from further study,” he told me via email.

Another psychologist, Daniel Singley, who runs a therapy practice called the Center for Men’s Excellence that focuses specifically on men and couples, thinks that many couvade symptoms could also be explained by society’s approach to men’s mental health. “As a society, we punish men and boys for having depression or anxiety or really any sort of mental-health issues,” he told me. “Some men will somaticize and turn depression into ‘I just feel like there’s a heaviness on me or gastrointestinal problems. My stomach’s upset. I get migraines. I have muscle tension.’” After the birth of his own child, Singley experienced unwanted intrusive thoughts, which can be a hallmark of postpartum depression in women. Like many I spoke with, he then shifted his attention to helping other dads.

For their part, the men I spoke with who experienced couvade symptoms did not believe they were actually on the verge of bearing a child. Instead, they described being at sea from their own body and mind, with no one to turn to. Gruenberg, the psychologist, didn’t think there was any professional that could help him, and so he started his own support groups. Another man I spoke with in the U.K., Scott Mair, had difficulties in the run-up to the births of his seven children. During his wife’s pregnancies and postpartum, he experienced stomach pain as well as back, shoulder, and neck fatigue. He was tired and lost his appetite. He was sent to the hospital, and increased his pain-medication intake. Mair said he was seeing an excellent doctor, but the physician did not link these symptoms to his fatherhood experience. Only after the especially traumatic birth of his seventh child did he end up seeking help and finding someone who ran a workshop on postpartum depression for fathers.

Years ago, a friend’s husband told me that, at the hospital when his wife was delivering, there were no resources for him: no food, no place for him to sleep, nobody speaking with him. I thought he was being selfish, seemingly upset that the woman’s pregnancy wasn’t all about him. But looking back, I think he was lamenting something real: that society was telling him that he had no place in the family.

As the research on couvade has developed, however, the syndrome is being reframed. Brennan thinks the stigma around it is changing in tandem with the role of fathers. “In recent years, there has been increasing interest in the syndrome and the importance of men taking a more active role in their partner’s pregnancy and preparation for it,” he said. “Indeed, those who exhibit the syndrome are now commonly perceived as being empathic towards their pregnant partners.”

Some researchers are now hypothesizing that the more involved in child-rearing a father is, the more his mind and body might change. Lee Gettler, an anthropologist at the University of Notre Dame, has studied fathers across the world. He told me he suspects that changes in men’s testosterone levels as they become dads depend in part on cultural norms of fatherhood. Robin Edelstein, a psychologist at the University of Michigan who has studied hormones and fatherhood, has also wondered whether these hormonal changes occur in a feedback loop. In her research, the fathers who were most involved with child care had the lowest testosterone levels, and she theorized to me that the more time dads spend participating in child care, the lower their testosterone levels might go.

Speaking with researchers, I was struck by the expanded attention to and awareness of postpartum depression in men. Although Brennan told me that symptoms cross into the postnatal period, he is wary of lumping them together with couvade, but almost everyone else I spoke with saw the transition to fatherhood more holistically. In some ways this attitude shift seems to mirror what is happening in mothers’ health care, albeit with a long way to go: a gradually growing consideration for not just the pregnancy, but the postnatal period.

If society sees parenting only as the domain of women, the act is undervalued as both a responsibility and a rite of passage for men too. “Increasing the dialogue around men’s experience and how transformative the experience is directly bears on women’s access to support,” Saxbe said. Saxbe has a paper under review about how women whose partners are allowed more parental leave have less stress and depressive symptoms.

Regardless of their symptoms, no man today is truly pregnant, with all the physical and psychological change that carrying a child entails. But, often seen throughout history as bystanders at best, and incompetent at worst, dads face higher expectations today. Viewed this way, a phantom pregnancy is neither empathy pain for a partner nor a subconscious attempt to hog the familial spotlight, but a physical surfacing of the dissonance between what a modern dad experiences and what society expects of him. Perhaps society will one day look back on the diagnosis of couvade, with its amorphous symptoms and psychosomatic roots, the way people retrospectively think of how doctors diagnosed women with hysteria. As society changes, our medical frameworks should too.