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 showers. My life is a dichotomy in that I’ve spent years in Taekwondo and I love football and rodeos, but I also have an affinity for frozen yogurt and watching HBO with pinot noir and nutmeg candles next to my cats, Thelma and Louise. I attribute my temperament to genes and California hippy tap water.
Male anxiety – hereby called “manxiety” – can be 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 paralyzed by an Applebee’s menu or a yellow traffic light.
Men are stalwarts of resolve with an uncanny ability to chug beer, char meat, and kill one another. Men recognize that our cars and lawnmowers need tune-ups and diagnostic tests, but we rarely wash our feet in the shower, let alone visit a physician for check-ups—especially for anything regarding the brain. And when we don’t prioritize our own well-being, 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 visited the hospital countless times a year while spending an enormous amount on annual copays. What I thought was testicular cancer was an inguinal hernia from doing deadlifts. 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 pain and labored breathing because I had unknowingly collapsed a lung. In my defense, I thought it was heartburn. The second was when I intermittently peed 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.
So 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 angry. 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 for 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 other disorders of the mind are still largely stigmatized among men, our first coping tactic is typically denial, lest we appear weak and vulnerable among our peers. “Denial is a common coping strategy among men,” says Tom McDonagh, a California-based clinical psychologist. “Often when working with male clients, I’ll ask them about their physical ailments first, such as exhaustion or muscle tension, as an entry point to discuss emotions. I’ve found that if I ask about their emotions first I’ll receive a denial-type answer, such as ‘fine’ even though they are in a therapy session!” There’s no “I” in denial.
There’s an unwritten rule that men must be strong and in control at all times. This makes anxiety difficult to identify in men, even at high levels. This is troublesome as depression and anxiety in men are more likely to manifest in substance abuse and suicidal behavior. “What compounds the issue of denial in men is how they choose to cope when denial stops working. It’s not unusual for alcohol or drug use to be the next step. Research shows that \men are more likely than women to engage in illicit drug use,” McDonagh says.
How Anxiety Presents in Men
I’m a kind and empathetic guy, but anxiety makes me exceptionally irritable. If I’m forced to socially interact or deal with a rude stranger, I become a Chupacabra with the 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.
“For some men, anxiety will present as chest pain or general discomfort. So they will see their general practitioner or cardiologist first. When they’re told the symptoms are a result of anxiety it can be embarrassing. There is a societal message that these types of mental health symptoms indicate weakness and incapability,” McDonagh says. “It’s not unusual for a male client to tell me ‘Look, I know I’m supposed to say it’s OK to feel this way. But I really don’t feel or believe that.'”
Men are conditioned to “man up” and be tough. It’s hard for men to discuss their vulnerabilities with anyone else. If guys simply ignore their feelings of angst, they could pretend anxiety doesn’t exist. But denial wasn’t designed to, nor intended to, work long-term. Distraction is an effective but equally short-term, noncurative technique for countering stress or discomfort, in that it avoids addressing the core issue.
In my case, I wielded distraction like artillery over my physical well-being. 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 overdid those too. Overdosing on sativa edibles leads to a nauseous, frenzied panic that is ruefully memorable.
How Chronic Anxiety Differs for Men
Although anxiety is an equal opportunist, the triggers for men and women appear to be different. A study examining fraternal twins showed that women are more affected by interpersonal relationships, while men were more sensitive to external factors, such as their careers.1
“In my clinical experience, women tend to have more acceptance around their anxiety. This often makes the treatment portion more successful. With some men, half the battle is working through the perception they have of themselves. For men to acknowledge they’re not always able to handle everything can be a shock to the ego,” McDonagh says. Male egos and bananas bruise easily.
Men Don’t Need a Panic Room. They Need a Panic Plan.
Men are fixers. We often try to fix things and people that aren’t broke. There are simple and clinically effective things men can do to lower their anxiety and avoid all of the preceding:
- Find a licensed professional with whom you can connect. This is the most helpful tactic. You can start by asking your primary care provider for a reference. “A professional can help with the three building blocks of anxiety treatment: education, skill building, and implementation. Once these blocks are established, male clients are much better equipped to handle anxiety,” McDonagh says. But many men will still draw up plans, build a ship, and invade Tripoli before calling a therapist.
- Focus on healthy, routine sleep. Wake up at the same time every day (including weekends), only go to bed when you are tired, keep the bedroom cool at night, and read/meditate/journal an hour before bed instead of watching TV or looking at your phone. Lack of sleep contributes to bad things like dementia and midnight pizza rolls.
- Reduce alcohol use (and other substances like marijuana). While these often feel great in the moment, in the long term, ingesting a chemical to reduce anxiety will either perpetuate the issue or make it worse,” McDonagh says.
- Biofeedback, medications such as SSRIs and SNRIs, and, in more recent years, neuromodulation such as TMS (transcranial magnetic stimulation) can be effective treatment options for anxiety disorders. Keep in mind that it’s often a combination of treatments that provides the best results. “Add to cart” and swiping right are not approved treatments. (Refer to “distractions” above.)
- Physical exercise is an exceptional way to relieve anxiety. Exercise is an effective modulator of cortisol levels while increasing neurotransmitters in the body that regulate anxiety and moods. Hakuna Masquata, fellow men.
More than the “greatest hits” to contest male anxiety, this is my own triage for maintaining a life largely unfettered by the cerebral minesweeper of manxiety.
And because hearing people say, “dude, just chill and be happy” is forever useless.
Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015 Jul;40(4):219-21. doi: 10.1503/jpn.150205. PMID: 26107348; PMCID: PMC4478054.