Despite driving a pickup and owning steel-toed boots, I’m not a “man’s man.” I don’t look or sound tough, and I feel awkward at Home Depot. I own a gun, but it’s for caulking bathrooms. My life is a dichotomy in that I’ve spent years in Taekwondo, love football and rodeos, but have an affinity for frozen yogurt and watching Netflix with merlot and soy vanilla candles next to my cats, Thelma & Louise. I attribute my temperament to genes and California hippy tap water.

The origins of personal traits, to include anxiety, can be biological, environmental, or inadvertently “seed-planted” by anxious parents. Male anxiety (aka, “manxiety”) is clinically contagious if you’re around it long enough. My dad, a manly victim of indecisiveness, often had me second-guessing my own life choices, or not making one at all. To this day, I’m often paralyzed by an Applebee’s lunch menu or yellow traffic light.

Men are stalwarts of resolve with an uncanny ability to chug beer, char meat, and kill one another.

We recognize that our cars and lawn mowers need tune-ups and diagnostic tests, but we rarely wash our feet in the shower, let alone visit a physician for our own check-ups – especially for anything regarding the brain. And when we don’t prioritize our own wellbeing, neither do others. If you’re a man with anxiety, however, the norms become skewed and irrational.

I grew-up a hypochondriac certain that every pain, rash, bump, or twitch was something malignant or terminal. I visit the hospital countless times per year while spending the equivalent of a Range Rover of backup dancers on annual copays. What I thought was testicular cancer was an inguinal hernia from doing deadlifts. What I was certain was genital herpes was an ingrown hair. What I feared was Lyme Disease was an allergic reaction to grass. And what I accepted as a heart attack turned out to be … anxiety.

Only twice did I not go to a hospital when I should have. The first was at 18 while suffering intense chest pains and labored breathing because I had unknowingly collapsed a lung. In my defense, I thought it was heartburn. The second was when I intermittently pee’d blood over a 10-month stint. A rational man would interpret hematuria as the ultimate motivation for a hospital visit. But the only thing worse than my fear of potential hospice, was the anxiety of a pending cystoscopy.

Consequently, I settled on platinum level denial until I landed in surgery and chemo. Ignorance is a prickly muse. With chronic male anxiety, it’s torturous to determine what warrants an ER visit versus antacids. And when it came to my mental health, I handled it like most men: denial, distraction, and drugs. In that order.

Most men with anxiety have no idea what’s wrong with them – like Bill Bixby in “The Hulk,” they just feel “off.”

Denial and distraction are why so many men walk around as functioning alcoholics or addicts. In the absence of knowing any better or a willingness to seek help regarding male anxiety, we plug the holes however we can. But if you treated any other disorder by ignoring or avoiding it, the outcome would be similarly grim. You can ignore asthma and diabetes for a while too. But every disorder has its dues.

Since anxiety, depression, and all disorders of the mind are still largely stigmatized among men, my first coping tactic was denial; lest I appear weak and vulnerable among my peers. “While some may consider this a stereotype – that men do not seek help for mental health issues – it is statistically correct… men are much more stigmatized by any admission of a psychiatric illness and are much less likely to seek treatment,” cites Sammie LaMont Moss, MD, a psychiatrist at Kaiser Permanente in Denver.

This is particularly troublesome as depression and anxiety in men are more likely to manifest in substance abuse and suicidal behavior. “We often see in the clinical setting that an attempt to address anxiety can manifest in different ways. For example, men will turn to substances like alcohol or cannabis for some immediate relief, which can cause long-term, harmful effects,” says Moss.

How anxiety presents in men:

I’m an exceptionally kind and empathetic guy, but anxiety makes me irritable and angry. If I’m forced to socially interact or deal with a rude stranger, I become a Chupacabra with a flashpoint of Aqua Net. I expend great effort trying to determine when I’m feeling anxious before it defaults to a felony persona. But distinguishing between anxiety and petulance requires Maharajah level introspection.

“Due to the social pressure that men experience based on the unwritten rule that men are to be strong and in control at all times, anxiety is not easily identifiable in men, even if that man’s anxiety has reached overwhelming levels” says San Diego psychologist and singer/songwriter, Dr. Bruce Thiessen.  “Many of the symptoms may express somatically, in the form of medical problems or conditions, such as ulcers, back pain, hypertension and the like,” he says.

Chicago-based clinical psychologist and founder of the LEAP Center for Anxiety, Dr. Dustin Siegel, agrees. “A lot of men have been told their whole lives to ’man up’ or ‘be tough.’ It’s hard for many men to talk to someone else about their vulnerabilities, and one of the paradoxical truths about mental health is that the more a person – male or female – tries to bottle-up their feelings, the more likely they are to develop a problem.”

If I simply ignored my feelings of angst, I could pretend anxiety didn’t exist for me. But denial wasn’t designed nor intended to work long-term. And when denying anxiety exacerbated problems, I turned to distraction. People’s secrets were always safe with me because I was never listening. Distraction is an effective but equally short-term, non-curative technique in countering stress or discomfort, in that it avoids addressing the core issue.

How does chronic anxiety for men differ in anxiety for women? 

“The most obvious signs of male anxiety are the physical ones,” says Psychiatrist and Chief Medical Officer at Success TMS, Dr. Lindsay Israel.  “Men might find themselves going to the emergency room or their primary care provider with complaints of chest pain, fearful they are having a heart attack,” adds Israel. As men, we need to save our hearts for red meat and breakups.

Though anxiety is an equal opportunist, Israel shares that “women are twice as likely to develop an anxiety disorder as compared to men, and women are more likely to seek help for their anxiety symptoms. Therefore, men are more likely to develop severe symptoms of anxiety and possibly develop an additional depressive disorder due to the lack of treatment intervention.”

Dr. Thiessen confirms this assertion adding that, “men are also more likely to become aggressive, and to develop problems in their relationships, due to dysfunctional ways of expressing their anxiety. Many men turn to drugs alcohol, gambling, and personally-destructive sexual addictions to relieve chronic stress through escape,” says Thiessen.

In my case, I wielded distraction like artillery over my physical wellbeing. I over trained in the gym, over ran the trails, and over swam in the lap pool. But I also over imbibed alcohol. Drinking to distract is a futile endeavor. I would later harm-reduce to cannabis edibles, tinctures, and vapes. And on a few occasions, I casually overdid those too. Overdosing on sativa edibles leads to a nauseous, frenzied panic that is ruefully memorable with a hangover that rivals kerosene.

So, what to do with all this male anxiety?

Men are fixers. We often try to fix things and people that aren’t broke. It’s important to note that acute anxiety that prompts us to do our taxes or flee a K-pop mob is healthy. Once it becomes long term or chronic, however, it’s detrimental to one’s physical and mental health.

“One of the best ways for men to become comfortable with accepting that he has a mental health issue is to speak to other people,” says Moss. “Quite often a man will be surprised to learn how many other people are suffering similar difficulties. Finding out that you are not alone can go long way to help normalize what you’re experiencing,” adds Moss. Anxiety doesn’t always love company, but it loves perspective.

Thiessen upholds this tenant. “Men need to feel accepted, and not judged, for showing both strength and weakness. Society might judge them, mental health providers will not,” he says. In almost every instance where I’ve revealed my anxiety struggles to another man, he has replied in commiseration with his own. It’s not that I only talk with guys at wine bars or waiting outside Zara stores at malls. Rather it’s indicative of the ratio and cross section of men silently suffering from anxiety.

You don’t need a panic room; you need a panic plan.

There are simple and clinically effective things men can do to lower their anxiety:

• Talk to your primary care provider who could potentially prescribe medication or refer you to other specialists who can help. “This is also an area where group therapy, segregated by gender, may help – particularly for men who are stigmatized and think they’re being seen as weak or as a victim. Learning what other men experience can help break that stigma,” highlights Moss.
• There are phone apps for anything from interpreting your cat’s meows, to fermenting mead in your man-shed, to treating your anxiety while preserving your privacy. Moss encourages his patients to leverage smart phone apps like Calm, myStrength, and Headspace. Digital therapeutics are a thing now.
• Biofeedback, medications such as SSRIs, SNRIs, and in more recent years, neuromodulation such as TMS (transcranial magnetic stimulation) are all effective options of treatment for anxiety disorders. “Typically, it is not any one modality that targets these symptoms for a person, it is more often a combination of various modalities that gives the most optimal results,” says Israel.
• Physical exercise is an exceptional way to relieve anxiety. “Exercise prevents an excessive buildup of cortisol in the body, while increasing levels of epinephrine and norepinephrine, neurotransmitters that modulate of anxiety, and regulate mood and emotion, yielding a sense of peace of mind,” cites Thiessen. Hakuna Masquata, fellow men. Moss suggests also integrating healthy lifestyle choices, nutritious eating, and limiting harmful substances like alcohol and cannabis.

More than just the ‘greatest hits’ to contest male anxiety, this is my own triage to maintaining a career, relationships, and a life largely unfettered by the cerebral minesweeper of anxiety.

Because there’s no place like “om.”