By Philip Chanin, Ed.D., ABPP, CGP
Board Certified Clinical Psychologist
Assistant Clinical Professor, Department of Psychiatry
Vanderbilt University Medical Center

“Men’s willingness to downplay weakness and pain is so great that it has been named as a factor in their shorter life span.  The ten years of difference in longevity between men and women turns out to have little to do with genes.  Men die early because they do not take care of themselves.  Men wait longer to acknowledge that they are sick, take longer to get help, and once they get treatment do not comply with it as well as women do.”  (I Don’t Want to Talk about It:  Overcoming the Secret Legacy of Male Depression by Terrence Real, 1997, pp. 36-37)

“One of the ironies about men’s depression is that the very forces that help create it keep us from seeing it.  Men are not supposed to be vulnerable.  Pain is something we are to rise above…Yet I believe it is this secret pain that lies at the heart of many of the difficulties in men’s lives.  Hidden depression drives several of the problems we think of as typically male: physical illness, alcohol and drug abuse, domestic violence, failures in intimacy, self-sabotage in careers.  We tend not to recognize depression in men because the disorder itself is seen as unmanly.” (p. 22)

“’Toxic masculinity’ has become a catchall term for the words and actions of men, ranging from the profoundly destructive, like sexual assault and reckless driving, to the merely irritating: dumb pickup lines, flexing at the gym.  But when researchers first began using the term, they meant something narrower and more specific: a culturally endorsed yet harmful set of masculine behaviors characterized by rigid, traditional male traits, such as dominance, aggression and sexual promiscuity.  Men trapped in this man box, as it is sometimes called, are less likely to seek medical care and are more likely to engage in risky behaviors detrimental to their health, such as binge drinking or drug use.  They’re also more likely to get into serious road accidents, become victims of violence and have thoughts of suicide.”  (“Guy Maintenance: What Does It Take to Get Men into the Health Care System, by Helen Ouyang, New York Times Magazine, September 7, 2025)

This article explores the efforts at the Cutler Center for Men, in Cleveland, Ohio, to help men to begin to take better care of their health.  According to the article, the Center “is one of the few clinical spaces trying to tackle the stubborn problem of men’s lack of engagement with America’s health care system.”  The article states that “Right now, men in the United States, whether infants or elders, are more likely to die at younger ages than their female counterparts.  Male life expectancy at birth is currently 75.8 years—5.3 years less than it is for women…While living longer doesn’t guarantee that those extra years are healthy or meaningful, life expectancy remains a rough proxy for overall health.”

“Over the past several years, men have died at higher rates than women from 14 of the top 15 causes of death.  The only exception has been Alzheimer’s disease—and that, at least to some extent, is because more women live long enough to develop it.  Young men in particular are heavily affected by deaths of despair, like suicides and overdoses, which significantly lower overall male life expectancy.  Native American and Black men have the shortest lives; across all racial groups, men die younger than women.”

“That disparity has many causes, one of which is that men simply don’t go to the doctor as often.  The problem begins early: After pediatric care, young men largely disappear from medical settings until after serious issues arise.   Women tend to see their gynecologists regularly; men have no clear equivalent.  The Affordable Care Act covers only one preventative service specifically targeting men, while it lists 27 for women (some of which are related to pregnancy).  HPV vaccination, for example, recommended for all adolescents, still feels mostly associated with girls, when HPV-related throat cancers are now more common in men than cervical cancers are in women.”

“Men are told to have discussions with their doctors about P.S.A. testing rather than given a clear directive.  This leaves men without an obvious incentive to seek primary care.  And overworked primary-care doctors, so often constrained by having to limit appointments to 15 minutes, may not have time for such conversations anyway.”

“In the past, what reliably brought men into doctors’ offices were problems of sexual performance…Now, for-profit telehealth companies, like Hims and Ro, can provide those medications (like Viagra) in many states through an exchange of text messages, enabling men to forgo comprehensive health screenings.”

“Without meaningful change, the health care system will keep meeting mean only after they’re already sick—when treatment is harder, outcomes are worse and lives are more likely to be cut short.  And that’s the situation now, before the next public-health crisis hits, as it inevitably will.  During the pandemic, men died of Covid at a rate roughly 60 percent higher than women, and male life expectancy declined by three years.”

Derek M. Griffith is a health-policy professor at the University of Pennsylvania and is a leading expert on men’s health disparities.  He is quoted in the article as saying, “I’ve lost count of the number of men I’ve seen show up in the E.R. after having endured troubling symptoms for months or even years.  And typically it has been a wife or daughter who pushed them to finally seek care—in the E.R., oftentimes, because they don’t have their own doctor…In American households, women make roughly 80 percent of medical decisions.  They’re also almost twice as likely as men to have received a checkup in the past year.”

In Terrence Real’s second book, How Can I Get Through to You: Reconnecting Men and Women (2002), he writes about a similar phenomenon regarding who initiates marital therapy.  He writes, “Men do not bring women into therapy.  Some men may volunteer, but most are brought; they are what I call ‘wife-mandated referrals.” (p. 120).  He elaborates on this dynamic: “There is a fundamental asymmetry in their agenda for therapy.  She is there because she is unhappy with him, and he is there because she is unhappy with him.  Pretending that both partners are equally troubled, equally skilled, and equally motivated is simply a charade.” (pp. 124-125)

Dr. Griffith continues, “A common refrain I hear from men when I ask them about their medical history is, ‘I’m healthy.’  Then they add, often proudly, ‘I haven’t been to the doctor in years.’  Meanwhile, many of the diseases that men die from could be prevented, or at least managed as a chronic condition, if caught earlier, before symptoms appear.  But this would require the health care system to figure out how to get men to show up and take a more active role in their own health.”

“The tragedy is than many of the diseases most likely to kill men are also the ones medicine already knows how to avert…Just one year after quitting smoking, the risk of heart disease—America’s leading killer—is almost halved.  And men may have more at stake: Heart disease kills them at a substantially higher rate than women…Half of the adult men in the United States have hypertension, yet they are more likely than women to leave it untreated, even when they are given recommendations to take medication.  Bringing blood pressure down by just 10 points lowers the risk of major cardiovascular events by 20 percent.”

“Diabetes, which is afflicting substantially more people in recent years but is currently more common in men, is yet another condition that fuels cardiovascular damage when left unchecked; it can also lead to kidney failure, blindness and amputations.  Controlling blood sugar, though, can cut the risk of heart attacks by more than 15 percent and greatly reduce those other complications.  The gains multiply when people with diabetes combine glucose control with comprehensive care, which might involve smoking cessation and the managing of blood pressure and cholesterol, giving them as much as eight extra years of life, according to one long-term study.”

Dr. Griffith states, ‘We treat the health system as almost transactional—men in particular wait until they feel sick, rather than regarding their doctor as a partner in staying health—but in an ideal world, you want your doctor’s office to be one of the first places you go for information.’

It’s supposed to be a trusted relationship, after all…common screening questions for depression like the PHQ-9 ask about symptoms typically experienced by women…even though men die of suicide at nearly four times the rate women do and are less likely to be diagnosed with depression.”

“Healthy People 2030, the national health objectives of the U.S. Department of Health and Human Services, has four goals specifically targeting men; there are 30 for women.  Today there are at least six federal offices for women’s health, while none exist for men.  Representative Donald Payne Jr. of New Jersey recently introduced multiple bills to establish one for men’s health; before any of them could pass, he died of a heart attack.”

“Even seemingly positive attributes associated with traditional masculinity, such as providing for one’s family—which 86 percent of American men see as the top definition of being a man, according to a 2025 report by Equimundo—can have negative health consequences.  They may put work ahead of addressing medical concerns, especially in poorer households where steady employment may be scarce.  Or they may take on dangerous jobs or work extreme hours.”

“But why do some men hold so tightly to these cultural notions about masculinity that lead them toward worse health?  The answer may be traced to how fragile manhood itself can feel.  To capture this concept, two psychology professors, Jennifer Bosson and Joseph Vandello, popularized the term ‘precarious manhood’ in 2008.  Building on ideas from David Gilmore’s seminal 1990 book, Manhood in the Making, they set out to better understand how insecurity around manhood shapes male behaviors, particularly those that can be unhealthy.  People view manhood as a social status that must be earned and that can be lost, they found, while womanhood is seen as a permanent biological transition; there’s no female equivalent, for instance, for ‘man up’ or ‘be a man.’”  Bosson says, “Men get their manhood challenged in ways that women don’t.’”

“Around the world, in countries where precarious manhood is felt more strongly, men tend to have higher rates of risky health behaviors and lower life expectancy…The United States ranks higher in precarious manhood beliefs than its peers like Spain, Germany, and Finland; correspondingly, American men die younger…the more strongly a country endorses precarious manhood, the more likely its men are to die from high-risk causes—drownings, accidents, homicides—and moderate risk causes like lung cancer from smoking.”

“’The U.S., compared to other countries, has more rigid norms for manhood,’ Griffith says.  ‘It’s part of our national ethos’…Researchers at New York University found that men with stronger precarious manhood psychology were more likely to support Trump and other Republicans.  Some men on the political far right are ‘comically insecure in their own manhood,’ Vandello says…’The need to prove that you’re a real man, I don’t know that it’s changing in the West right now,’ Bosson says.  She points to the so-called manosphere—the constellation of male influencers promoting a narrow, traditional vision of masculinity—and she says, ‘It might actually be getting worse.’”

At the Cutler Center referenced above, the author of this article states, “The men I met all seemed to be searching for some sort of male company, which one attendee in his 60’s, dressed in a polo shirt patterned with palm trees and sailboats, put to me explicitly: ‘You women have all these things you go to.  Men have nothing, and when we do go somewhere, we just stare out, bored.’”

“American men aren’t the only ones dying younger; the life-expectancy gap between men and women exists everywhere in the world.  But what is different is that other countries have done much more on a national level to try to make progress in improving men’s health.  A handful, including Ireland, Australia, and Brazil, have developed national men’s health policies.  Since Ireland introduced its strategy in 2008—the world’s first—it has made considerable strides in male life expectancy, outpacing most European nations.  One advance the country has made is at workplaces, getting employers in male-dominated industries, like farming and construction, on board with prioritizing men’s health.”

“Australia’s national government has invested heavily in men’s sheds, which are community spaces intended specifically to reduce male loneliness, where men of all ages come together and do activities like woodworking.  Men’s sheds have been found to have significant health benefits.  But without comparable government backing, similar initiatives falter in the United States, says Mark Winston, chair of the U.S. Men’s Shed Association.  ‘Nobody in the U.S. is truly investing in this,’ he says.”

I will try to end this article on a positive note: In the first four decades of my psychotherapy practice, I rarely saw men until they were in their mid-30’s or older.  In the past 10 years, I have begun to see many more men in their 20’s and early 30’s, who have been reaching out for psychological assistance.  Perhaps this is a sign that younger men are becoming more interested in addressing their overall health.  We should hope so.