Why Men Struggle in Silence - And How Therapy Helps Men's Mental Health

Men’s mental health looks different than women’s - from irritability to disconnection. This post explores cultural pressures that keep men silent, and how therapy creates space for vulnerability.

The Cultural Shift: Men’s Mental Health

Over the past year, I’ve noticed a cultural shift: men’s mental health is receiving more attention. Articles continue to highlight the struggles men face - but why is this happening?

About 33% of my caseload are men, which is higher than many of my peers. Some therapists either don’t work with men or rarely attract them. Personally, I’ve always found working with male clients deeply rewarding.

Because I practice from a psychodynamic framework, men often push against my less-direct style… but somehow, it works.

Why Men Seek Female Therapists

Research shows both men and women prefer female therapists. At first, this surprised me: why wouldn’t a man choose another man?

In practice, I’ve seen that many men feel nurtured by a woman, safe enough to soften without performing an internalized role. They know they won’t always get advice, but they will be contained. Many have said some version of: “I don’t do this with anyone else.”

For many of my male clients, therapy is the one space where vulnerability feels safe. At the same time, sessions with men often include humor, teasing, or pushback - dynamics that require the therapist to stay steady while encouraging openness.

How Culture Shapes Men’s Mental Health

Mental health issues often present differently across genders:

• ADHD: Girls may show inattention; boys struggle to sit still.

• Depression: Women may isolate or overeat; men often show irritability, frustration, or hopelessness.

  
  

These differences reflect cultural expectations about what emotions are “appropriate” for men to display.

Cultural messaging also weighs heavily. As highlighted in a 2025 New York Times article by Miller, the concept of “toxic masculinity” is often internalized in harmful ways. Phrases like “I hate men” have become normalized in some spaces, leaving men to arrive in therapy already feeling degraded. While men do have work to do in relationships and politics, I avoid reinforcing blanket generalizations.

Loneliness, Infertility, and Silent Struggles

Gen-Z and Western men are some of the loneliest in the country. A 2025 Gallup poll found that 1 in 4 U.S. men under 35 report feeling lonely. In his New York Times article, Graham-Felsen describes how men often connect through activities - sports, electronics, even competition - but rarely ask each other, “How are you doing?”

This echoes what I see in therapy: men frequently use me as their sole container for vulnerability. Too often, the answer to “Who else are they going to talk to?” is no one.

So why is loneliness on the rise? Many men describe anxiety more easily than sadness. Yet depression often shows up in day-to-day functioning - trouble exercising, cleaning, or motivating. It is more socially acceptable for men to be “angry” than “lonely.” Women tend to outlive men, but men’s longevity increases with a partner.

Another rarely discussed issue affecting men’s health and relationships is male infertility. Like loneliness, it carries stigma and often goes unspoken. For many, it quietly fuels feelings of shame, inadequacy, and isolation - impacting identity and emotional wellbeing as much as physical health.

I also notice that men often distance themselves from their feelings by speaking in the second or third person: “So you pick yourself up because what else can you do?” or “When you experience that, it feels like this is hard.” Over time, therapy becomes a space to shift back toward “I feel” language and reconnect emotion with self.

Relationships, Careers, and New Demands

Relationships and work are central themes for many male clients:

• Communication struggles with partners or managers.

• Questions about leaving the corporate world.

• Dating with intention while managing emotional availability.

• Codependency risks when loneliness runs high.

  
  

Friendship loss also plays a role - when peers move away or start families, men can feel left behind.

At the same time, shifting gender roles and new personal expectations bring added stress. Therapy offers a rare space for men to explore these pressures openly, without judgment.

Why This Conversation Matters

Whether through loneliness, shifting roles, or silent struggles like infertility, men are navigating complex challenges that affect how they see themselves and how they connect with others. What I notice in the therapy room reflects a broader cultural shift: men are slowly being given permission to explore vulnerability, even when society hasn’t always allowed it. My hope is that by naming these patterns, we can reduce stigma, create healthier relationships, and encourage men to see their mental health as something worth tending to with the same care as their physical health.