‘Toxic masculinity’: the problem with men

Worldwide, men’s attitude towards their own health is often one of denial – partly because the act of admitting to a health problem is perceived by some men as degrading to their self-image as an ‘invulnerable male’.

Cultural expectations and peer pressure can compound the problem by encouraging men to do ‘blokey’ things, including overindulgence in unhealthy foods, excessive alcohol consumption and smoking. Furthermore, risk-taking behaviour puts younger men in the way of ill health from violence and trauma, misuse of drugs, and sexually transmitted diseases, including HIV/AIDS.

In medical care the term ‘toxic masculinity’ is particularly apt, as it helps encapsulate a variety of factors that have meant men’s health outcomes, despite significant improvements over the past 40 years, remain far poorer than they could be.

What initiatives do you think could be taken to persuade men in general to better look after themselves, present earlier when symptoms develop and, consequently, live happy, healthier and longer lives? In other words what is the antidote to toxic masculinity? All suggestions welcome.

You can read the editorial on this topic by clicking here.

You can also read the article on this topic, which includes four relevant case studies, by clicking here.  

Comments (7) Add yours ↓
  1. Patricia GP

    Thank you for your article on ‘toxic masculinity’, which I really enjoyed reading. I think first steps would be 1.) Wide-spread education. For example via social media, in public places (e.g. gyms, ? pubs, supermarkets) and via GPs when patients attend; 2.) researching/exploration of barriers to seek help (e.g. time pressure, stigma, cultural expectations, peer pressures) and of behaviour patterns (e.g.risky behaviours, maladaptive coping strategies); 3) Addressing these (e.g. help available online via Apps/online consultations to address time pressures/stigma; risk behaviour reduction interventions…). Interesting and important topic, which warrants further discussions and action plans.

    September 20, 2019 Reply
  2. Christina Brown Urologist

    Interesting article and one that resonated with me. In my urological practice I am seeing a split, particularly in young men, whereby some are gym going, kale smoothy drinking, non smoking (and often non drinking) really healthy individuals and others the complete opposite. I fear that if good healthy behaviour is extreme it won’t last and we really need to educate all about taking the middle ground as it’s much more sustainable. As we all know long term heath is about what your do over years and years not weeks and weeks. If we could stop everyone smoking and junk food on the train home we would have achieved something massive!

    October 1, 2019 Reply
  3. Hannah Warren Urology Registrar

    From early childhood boys in our society are rewarded for displaying strength and bravery, and teased or humiliated for showing vulnerability or sensitivity. Typical ‘boys toys’ include guns, swords and action figures while little girls are given dolls to care for and cuddle. With this kind of gender conditioning from infancy are we surprised as adults that they behave any other way? If you want a man to feel comfortable coming forwards to talk about the painless blood he had in his urine, or a mole that doesn’t look quite right we need to permit them from childhood to talk about their feelings and fears rather than expecting them to bottle everything up and hope the problem just goes away.

    October 4, 2019 Reply
  4. Brian Dye Patient

    Good blog. I’m a bit dubious that attaching the label of “male toxicity” to an alcoholic, a sex addict and a nicotine addict, or to a man too embarrassed to discuss a bowel problem, is a helpful approach; the language in which we discuss this matters. I am not going to discuss the embarrassment issue, because I think it raises different considerations, but let’s look at the other three cases. The three men who are addicts have plainly failed in basic self-care – in the most fundamental aspects of their health, and have been compulsively self-harming. Yet, it is precisely for this reason that public health messages also fail to bring them into the surgery: public health messages operate in a health space, which is the very space which these men have already abandoned. In such cases, we can be pretty sure that warnings that doing X, Y or Z will damage health will fall on deaf ears; the behaviour of these men already demonstrates that they are not motivated by such failure, or by the possibility of failure, in their health. At least, until extremis.

    To change the behaviour of such men, I submit, something different has to happen. Their motivation to change cannot come from pointing out how to rectify failure; it can only come from the men finding that the task is worthwhile. That is something quite different. The message to these men cannot, I say, succeed if it simply describes how to implement a choice as to how to behave according to some set of practical health norms. For these men to avoid or escape their current failure, their motivation needs to become their wanting to do something “right”. This can, I say, only be done by holding up a vision of self-value to them of who, in truth, these men are, or what they could be; a vision that provides the answer to “why health?”, over and above the technocratic question of: “what health” or “how health?” It’s the “vision thing” that counts.

    The health message, I say, cannot succeed with these men if it is simply self-referencing; it can only be successful if health is a step to a greater vision of their identity for the men themselves. The reason these men have let their health fail is that they have in effect engaged in a form of self-abuse; they can only stop such self-abuse if they embrace a new vision of themselves, and their self-worth, which has an external connection beyond health itself. So, we cannot hope to succeed if we stigmatise them as “toxic”; we have to see though toxicity in order to communicate to them their innate and internal worth, and we have to have a message of hope and optimism for them.

    And this is why, I feel, with great respect to him, Christian Brown’s “middle way” is not actually be reflected in the types of men that he says he meets. In good humour, he says that his practice has generally two sets of patients: very healthy types who, he says, even drink “kale smoothies”, and very unhealthy types. My view is that a middle way recommendation suits neither type: not eating junk food on the train doesn’t provide the “vision thing” to the unhealthy ones; and the healthy ones are not eating junk food anyway, so they don’t need that type of message.

    I think that there are several messages from doctors that do make sense for these men. I’ll put them in non-medical terms, if I may: (1) “We can make recommendations that will add years to your life, and life to your years – evaluate this in this way: what would someone pay for a greater number of more healthy years?” (2) “We can make recommendations that will make you a (much) stronger man, stronger than your unhearing peers.” (3) “Let me educate you about the metabolic syndrome.” (4) “We can make you a more attractive man.” (5) “There are things that we/you can do which will reduce the need for visits to the doctor in future.” (6) What would you really like to do with your life and how can we help you to achieve it?

    In short, the key initial step is to present an unhealthy man with a vision of self-worth in how things could change for him, that is fun, hopeful, and optimistic, during an initial visit that he finds enjoyable, which he does not perceive as critical or humiliating, and which the man wants to repeat! This, I submit, is the way to address the good point made by Mr Brown, who asks: will any change stick? My answer is “Yes”. The reason is that once you’ve helped the man himself to change the values that he embraces, I say that you’ve changed that man.

    October 6, 2019 Reply
  5. Michael Kirby Professor

    I like your 6 points Brian.
    The JBS3 CVD risk calculator has proved very useful in that respect.
    Rather than telling men about their calculated premature death, it looks at life years gained by addressing risk factors.
    For example, how would you like 6 extra years to spend with your grandchildren??
    Motivation is the key, and each of the points you mention may well motivate.
    Addiction you are right is another issue and often it is a serious, frightening health event that will make the man focus on the harm that he is doing to himself. That is a teachable moment!!

    October 7, 2019 Reply
  6. Roger Kirby Professor of Urology

    From Churchill to Putin, masculine traits have long been perceived as evidence of competent leadership; we like our politicians to be strong, assertive and unwavering in the face of discord and conflict. It is a cultural norm that pervades not only those in power, but which also infiltrates the psyche of our society, most notably among men.
    The harmful ways in which the patriarchy constrains men is thought to be a dominant factor behind a rise in male suicides. During 2018, the number of people who died by suicide in the UK rose by almost 12 per cent, with men three times more likely to die by suicide than women.
    The gendered expectations which promote emotional repression and stigma are nowhere more visible than in our current prime minister’s misogynistic language and behaviours. Boris Johnson unashamedly referred to a peer as a “girly swot” recently, though not for the first time. Not only do his words highlight his sexist views, they also amplify the competitive alpha dominance and the social expectation on men to assert aggression as often as possible. Considered in this light the whole Brexit debacle can be seen as an expression of “masculine toxicity”!

    October 14, 2019 Reply
  7. Ruth Eardley GP

    Writing as a ‘girly swot’, may I thank the Professors Kirby for the brilliant editorial and article on toxic masculinity.
    Traditional masculine attributes certainly have their negative side but especially when combined with ‘anything goes’ post- modernism. Previous generations may have had the inclination but they did not have the money or opportunity for the high-risk behaviours of so many of our young men. The restrictions imposed by a strong family and work ethic and the lack of opportunity for hedonism seem, for many men,
    to have cultivated remarkable emotional intelligence, which, as you say, includes not only empathy but self- control.
    As a GP, I have seen many examples of stoical uncomplaining men who have devotedly nursed their womenfolk through disability, psychosis and terminal illness. Speaking to one elderly gentleman, the main carer for his partner who was suffering the ravages of advanced dementia, I placed my hand on his arm as he left the surgery. ‘You’re doing a great job,’ I said. His eyes filled with tears. ‘She’s my wife,’ he said simply.

    November 7, 2019 Reply

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