By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist
Men's mental health has become a bigger topic of conversation, but stigma and misunderstanding still surround it. The figures that make the case most starkly are about suicide. In England and Wales in 2024 the suicide rate for males was 17.6 deaths per 100,000 people, against 5.7 for females (Office for National Statistics, 2025). Males have accounted for around three quarters of suicide deaths in England and Wales since the mid 1990s (Office for National Statistics, 2024). Behind those figures sits a question about how the way many men are brought up to be men shapes how they carry distress, and whether they ask for help.
From a young age many boys are told to 'man up', 'don't cry' or 'be strong'. Some of what that teaches can serve a man well. Some of it leaves little room for fear, sadness or asking for support. This piece looks at what the research says about masculinity and mental health, what men commonly bring to therapy, and how therapy can help. It is written from the point of view of a London psychotherapist who works with men, and it is not a substitute for urgent help.
Article Summary
In England and Wales men account for around three quarters of suicide deaths, and the rate for males was 17.6 per 100,000 in 2024.
A review of 37 studies found that conformity to traditional masculine norms affects how men experience depression, how they view help seeking, and how they manage symptoms.
A large meta analysis found that stronger conformity to masculine norms was modestly linked with poorer mental health and moderately linked with less psychological help seeking, and that some norms mattered more than others.
Stigma is one of the barriers, and men were among the groups most deterred by it in a systematic review.
Therapy can help, and several approaches have evidence. Finding the words for how you feel is often the first step.
What the research shows
The figures above tell us how serious the problem is. They do not tell us why. A growing body of research has looked at the role of masculine norms, and the findings are more nuanced than the slogans.
A systematic review of 37 studies looked at the role of masculinity in men's help seeking for depression. It concluded that conformity to traditional masculine norms has a threefold effect on men experiencing depression. It affects their symptoms and how those symptoms are expressed, their attitudes to and actual help seeking behaviour, and how they manage their symptoms. The authors suggest that tailoring and targeting clinical interventions may increase men's service uptake and the effectiveness of treatment (Seidler et al., 2016).
A meta analysis of 78 samples and 19,453 participants looked at conformity to masculine norms and mental health related outcomes. Conformity was modestly and unfavourably associated with mental health, and moderately and unfavourably associated with psychological help seeking. It was more strongly related to negative social functioning than to psychological indicators of poor mental health. Conformity to the specific norms of self reliance, power over women and playboy was robustly and consistently related to poorer outcomes, while conformity to the norm of primacy of work was not significantly related to any mental health outcome (Wong et al., 2017). I read that as saying that masculinity is not one thing. Some parts of it seem to matter more than others, and the associations are modest, so they describe tendencies across large groups and not what is true of any one man.
Stigma is part of the picture. A systematic review of 144 studies with 90,189 participants found a small to moderate negative association between stigma and help seeking, with internalised stigma and treatment stigma most often linked with reduced help seeking. Ethnic minorities, young people, men and people in military and health professions were disproportionately deterred by stigma (Clement et al., 2015). That review was about stigma in general and not about masculinity as such, and I mention it because men were among the groups it named.
There is also research on health behaviour. A study of 140 men aged 18 to 78 found that masculinity and men's perceptions of how normal other men's health behaviours were predicted their own self reported behaviours, including alcohol use, physical fighting, use of social support, exercise, diet and medical check ups, beyond what education and income explained (Mahalik et al., 2007). Courtenay (2000) proposed a theory in which health related beliefs and behaviours are a way of demonstrating masculinities, and in which some of the practices that undermine men's health are signifiers of masculinity and tools in negotiating power and status (Courtenay, 2000). That is a theoretical paper, and the other studies are correlational, so none of them proves that masculine norms cause poorer mental health.
Most of this research does not report in detail on sexual orientation, ethnicity or gender identity, so I would be careful about applying it to every man. In my experience gay and bisexual men, trans men and men from different cultural backgrounds meet their own versions of these pressures, and I describe that as a clinical observation and not a finding.
The weight of norms
Traditional masculinity is often associated with stoicism, competitiveness and self reliance. These expectations are deeply embedded in cultural messages. They are not inherently harmful. They become a problem when they leave little room for vulnerability, fear or sadness.
For many men, showing emotion other than anger or confidence can feel like a threat to identity. In my experience this leads many men to turn distress inwards and not seek support. It creates a double bind. On one side, men may struggle silently with anxiety, depression or trauma. On the other, they fear judgement if they show their pain. The review above found that conformity to masculine norms affects both how depression shows up and whether men seek help (Seidler et al., 2016), which fits what I see.
Emotional language
Another challenge is the lack of early emotional education. In many families and schools, I have noticed, boys are not taught to identify, name or regulate their emotions in the way girls often are. That is my observation from clinical work, and I am not citing a study. Without the language to describe how they feel, men may default to shutting down or externalising their distress. Examples I commonly see include these.
Stress may appear as irritability or anger and not as anxiety.
Sadness may look like withdrawal and not crying or talking.
Fear or vulnerability may be masked by overconfidence or avoidance.
This gap can affect relationships. Many men tell me they feel pressure to be the protector or the problem solver, with little space for their own needs. Over time that can lead to loneliness, conflict and a sense of emptiness even when life looks successful from the outside. If loneliness is part of it, I have written about feeling lonely in a relationship, and if a partner is struggling to reach you, stonewalling and emotional shutdowns.
Without the language to articulate how they feel, men may default to shutting down or externalising their distress
What men bring to therapy
When men do seek therapy, they often arrive with concerns that look practical or situational but are tied to emotional experience. These are the topics I see most often. They come from my practice and not from a study.
Work and identity pressure. Men often link self worth to productivity and career success. Stress, burnout or job loss can trigger feelings of inadequacy or shame. If work has taken over, I have written about work addiction.
Relationship struggles. Difficulties with communication, intimacy or trust are frequent reasons men seek help. Many say they want to be a better partner and are unsure how to express emotions or handle conflict.
Loneliness and disconnection. Men may have social circles but lack deep, emotionally supportive friendships.
Parenting and family. Fathers often grapple with balancing the provider role with wanting to be emotionally present for their children.
Depression and anxiety. Men may report fatigue, irritability or sleep problems and not low mood or worry. The review above found that masculine norms can shape how depression is expressed (Seidler et al., 2016). I have written about sadness and depression and anxiety and the nervous system.
Anger and emotional regulation. Some men struggle with outbursts or suppressed rage that are often tied to unprocessed pain. A review of 106 meta analyses found strong support for cognitive behavioural therapy in anger control problems, anxiety disorders and general stress (Hofmann et al., 2012), and I write about the approach in the benefits and limitations of CBT. That review was not specific to men.
Identity and self esteem. Questions about masculinity, sexuality or self worth can arise at midlife or after major change.
Trauma and grief. Many men carry unresolved trauma from childhood, military service or relationship loss, and feel unable to share it elsewhere. If a relationship ending is part of it, I have written about life after separation.
By the time many men enter therapy, they have often been holding these struggles for years without support.
How therapy can help
Therapy offers a confidential, non judgemental space where men can look at the weight of expectations they carry and rethink what strength and vulnerability mean. I describe below how I see it help. These are my clinical views, supported only where I say so.
Normalising emotions. Therapy helps men see emotions as natural human responses and not signs of weakness. Identifying and expressing them can reduce internal pressure and isolation.
Building emotional literacy. Through reflection and conversation, men develop a wider emotional vocabulary, which helps them communicate better and understand their own needs. If finding the words is the hard part, the free Telling someone something difficult guide is a private way to work out what you want to say and how to say it, before you say it to anyone.
Challenging limiting beliefs. Many men hold rigid beliefs such as 'I must handle everything on my own' or 'I am failing if I feel sad'. Therapy can gently challenge them. The research on the self reliance norm, which was robustly linked with poorer outcomes (Wong et al., 2017), suggests this belief is one worth looking at.
Developing coping skills. Therapy offers tools for managing anxiety, depression and stress without relying on avoidance or unhealthy coping.
Improving relationships. As men become more attuned to their emotions, they often connect better with partners, friends and family.
Exploring identity safely. Therapy can be a space to reflect on identity, whether around gender, sexuality, career or purpose, without external pressure.
Healing trauma. For men who have experienced trauma, therapy provides a structured space to process difficult memories and reduce their impact on the present.
On the question of what works, the research suggests it is worth choosing therapy that fits you. A meta analysis of 35 studies found that clients matched to their preferred therapy conditions were less likely to drop out and showed greater improvement (Swift et al., 2011), and a large review concluded that the psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment (Norcross & Lambert, 2018). If you are wondering whether therapy is for you, I have written about whether therapy is right for you, eight reasons people think therapy isn't for them and what to do when therapy hasn't worked yet.
Over time, in my view, therapy can help a man see that vulnerability is not the opposite of strength. It is part of being whole.
Redefining masculinity for better mental health
Therapy helps at an individual level, and wider change matters too. Broadening masculinity to include emotional openness, compassion and self awareness can reduce stigma and make support easier to reach. Men benefit from role models who show that strength includes asking for help, expressing emotion and building supportive relationships. Communities, schools and workplaces can help by encouraging emotional education and normalising conversations about mental health from a young age. That is my view and not a research finding.
In my experience, healthier forms of masculinity benefit men and also the people around them. When men are free to express their full humanity, they tend to feel closer to others and more purposeful. If you are a woman reading this about a man in your life, I have written a companion piece on women's mental health.
Taking the first step
If you are a man struggling with your mental health, you are not alone. Reaching out is not a sign of weakness. It is a step towards taking control of your life in a more honest way. Therapy can help you untangle the pressures of masculinity, understand your emotions and build a more balanced life. If it would help to gather your thoughts first, the free Preparing for your consultation workbook for individuals is private and optional, and it is a good place to write down what has brought you to therapy now.
If you are ever in crisis, or thinking about harming yourself, please do not wait. Contact your GP, call NHS 111 and choose the mental health option if you are in England, or call Samaritans free on 116 123 at any time. You can also text SHOUT to 85258. In an emergency, call 999.
Asking for support is one of the bravest decisions you can make.
About the Author
Mark Ryan is a London-based psychotherapist and the founder of Rise and Grow Therapy. He specializes in helping men navigate emotional challenges, relationship dynamics, and identity concerns. As a member of the British Association for Counselling and Psychotherapy (BACP), Mark is passionate about creating safe, non-judgmental spaces where clients can explore their inner worlds and build more fulfilling lives.
References
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015). What is the impact of mental health related stigma on help seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11 to 27.
Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well being: A theory of gender and health. Social Science & Medicine, 50(10), 1385 to 1401.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta analyses. Cognitive Therapy and Research, 36(5), 427 to 440.
Mahalik, J. R., Burns, S. M., & Syzdek, M. (2007). Masculinity and perceived normative health behaviors as predictors of men's health behaviors. Social Science & Medicine, 64(11), 2201 to 2209.
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303 to 315.
Office for National Statistics. (2024, August 29). Suicides in England and Wales: 2023 registrations. Retrieved 6 October 2026.
Office for National Statistics. (2025). Suicides in England and Wales: 2024 registrations. Retrieved 6 October 2026.
Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men's help seeking for depression: A systematic review. Clinical Psychology Review, 49, 106 to 118.
Swift, J. K., Callahan, J. L., & Vollmer, B. M. (2011). Preferences. Journal of Clinical Psychology, 67(2), 155 to 165.
Wong, Y. J., Ho, M. H. R., Wang, S. Y., & Miller, I. S. K. (2017). Meta analyses of the relationship between conformity to masculine norms and mental health related outcomes. Journal of Counseling Psychology, 64(1), 80 to 93.
