Does masculinity shorten lifespans? This study suggests ‘manly’ men at higher risk of heart problems

CHICAGO — Men who strongly conform to traditionally masculine behaviors are significantly less likely to receive crucial diagnoses and treatment for serious cardiovascular conditions, according to new research. The study suggests that societal pressure on men to appear tough and self-reliant may be literally putting their hearts at risk.

Researchers from the University of Chicago say this pattern begins as early as adolescence and continues into adulthood, potentially putting these men at greater risk for future cardiovascular problems. Their study, published in JAMA Network Open, followed over 4,000 American men from their teenage years through early adulthood, examining how their degree of “male gender expressivity” (MGE) – essentially, how closely they conform to typical male behavioral patterns – affected their likelihood of being diagnosed with and treated for conditions like high blood pressure and diabetes.

The research team found that men who displayed higher levels of masculine behavior were significantly less likely to receive diagnoses for these conditions, even when medical tests showed they had them. For instance, among men with elevated blood pressure, those with higher MGE scores were 4% less likely to receive a hypertension diagnosis. The effect was even more dramatic for diabetes, where men with higher adolescent MGE scores were 15% less likely to receive a diagnosis when their blood sugar levels indicated they had the condition.

“When we talk about gender expression, we’re not looking at anything physiologic that could be affected by the Y chromosome,” explains Nathaniel Glasser, MD, a general internist and pediatrician at UChicago Medicine and lead author on the paper, in a media release. “We’re purely focused on self-reported behaviors, preferences and beliefs, and how closely these reported behaviors and attitudes resemble those of same-gendered peers.”

Perhaps most troubling, even when these men did receive diagnoses, they were less likely to follow through with treatment. Among men who had already received a hypertension diagnosis, those who displayed more masculine behaviors in adolescence were 11% less likely to take prescribed blood pressure medications. Similarly, men showing higher masculine traits in young adulthood were 7% less likely to take blood pressure medications and 10% less likely to take diabetes medications when diagnosed with these conditions.

“Our hypothesis is that social pressures are leading to behavioral differences that impact cardiovascular risk mitigation efforts, which is concerning because it could be leading to worse long-term health outcomes,” Glasser adds.

The study participants, who had an average age of 38 by the end of the research period, were predominantly White (64%) and privately insured (80%). The sample included Asian American and Pacific Islander (7%), Hispanic (12%), and non-Hispanic Black (16%) participants, making it broadly representative of the U.S. male population.

The findings suggest that societal pressures on men to appear strong and self-reliant may be inadvertently encouraging them to avoid seeking medical help or acknowledging health problems. This behavior pattern could have serious consequences, as early detection and treatment of cardiovascular risk factors is crucial for preventing heart disease later in life.

“We’re seeing how pressures to convey identity — whether it’s rooted in gender, race, sexuality or something else — impact health behaviors,” Glasser concludes. “Fitting in and achieving belonging is a complicated task, and we feel strongly that increased societal sympathy, empathy and patience for others undertaking that task would be good for people’s health.”