How Social Expectations of Masculinity and Femininity Make Us Sick

Yes, literally — and they can impact both our mental and physical health

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Essentialist views on gender are still quite popular today.

Even high school textbooks and popular science texts frequently tout the idea that ‘men are from Mars, and women are from Venus’, suggesting that this blue-and-pink division is simply hardwired into our very biology down to the cellular level and, hence, unavoidable.

But for something so supposedly ‘innate,’ society certainly has been going to great lengths to enforce acceptable behaviours for each category. In my research on gender norms, I’ve encountered countless sermons, homilies, lectures, letters, pamphlets, books, etc., outlining the strict duties of each gender, often accompanied by the claim that this is the natural ‘order of things.’

A bird doesn’t need lessons to sing — it just does. A human, though? It seems we need constant guidance to ‘human’ correctly.

Another persistent idea in texts on gender essentialism — both through the ages and today — is that following these norms of ‘traditional’ femininity and masculinity is ultimately ‘for our own good’ and beneficial to our well-being. (As a bonus, some religious teachings promise it may even secure us a place in the Good Place after death.) The obvious problem with such logic is that this ideology has also justified discrimination against women for centuries. Hardly a testament to its ‘positive’ impact, is it?

But there’s another consequence we rarely discuss: the toll these gendered pressures can take on our health.

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There’s an iconic scene in Monty Python and the Holy Grail where the Black Knight, after losing both arms, insists, ‘it’s just a flesh wound,’ and carries on fighting. It captures the absurdity of the ‘tough guy’ trope pretty well.

This trope isn’t just for laughs, though. The expectation for boys and men to be tough, strong, self-reliant and emotionally restrained (but expressing anger is somehow permitted) rooted in prevailing constructions of ‘traditional’ masculinity does seem to have real-world consequences. On average, men are far less likely than women to visit the doctor for regular check-ups, up to 50% less likely to seek medical attention, and even less likely to be honest about their health history and current symptoms.

One recent qualitative study published in the American Journal of Men’s Health and conducted among over 40 heterosexual, married, and highly religious men found that men’s healthcare avoidance is indeed, in large part, due to these masculine norms. Common responses included men reflecting on how they are supposed to be tough, ‘push through the pain,’ and not see the doctor because ‘men don’t do that.’ One participant noted, ‘Why go to the doctor when […] you can fix it yourself.’ Another recounted the story of injuring his legs and then ignoring his wife’s pleas to seek help because of ‘pride.’

Unfortunately, this mindset can, in turn, have lasting and detrimental effects on men’s health.

Another recent study from the University of Chicago found, for instance, that strong alignment with stereotypically masculine norms can negatively impact men’s cardiovascular health. Through the analysis of health metrics and self-reported behaviours from over 12,300 people over 24 years (1994–2018), the researchers discovered that men who more closely adhered to these norms were significantly less likely to report that a healthcare professional had ever told them about cardiovascular disease risk conditions — meaning they either don’t get screened at all, they don’t pay attention to their diagnosis when they do, or downplay it. Even when diagnosed, these men were less likely to follow prescribed treatments.

There are certainly more factors that contribute to this, but it’s perhaps not surprising that men are generally more likely than women to develop heart disease and die from it at younger ages. Men are also at a higher risk for both mortality and morbidity.

However, social pressures to uphold the masculine identity could also be impacting men’s mental health, as men are much less likely than women to seek help for mental health difficulties and tend to hold more negative attitudes towards the use of mental health services. Stigma likely plays a part in it, too. In particular, the idea that admitting to internal struggles is a sign of ‘weakness’ and so it’s categorically ‘unmanly.’ Unsurprisingly, according to a study by the American Psychological Association, men who conform to stereotypically masculine norms report worse mental health outcomes compared to both men who don’t conform as rigidly and women.

Even seemingly neutral everyday choices, like diet, are influenced by pressures to conform to gender norms. I recently wrote about the association between meat consumption and masculine ideals, which pushes men to consume significantly more meat than women across nearly every country. But this also likely results in men eating fewer vegetables and fruits than women, putting them at higher risk for serious health issues — including heart disease and stroke.

‘Traditional’ masculinity norms can even have consequences that reach beyond individual health. Diets rich in meat, especially beef, also contribute substantially to carbon emissions, a leading factor in climate change, which doesn’t only make us more and more sick — it’s deadly.

Still, social expectations of femininity can be quite damaging, too.

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On planet Venus, things might appear picture-perfect at first glance. Yet the polished facade of femininity some women present is often just that, a facade. A mask hiding simmering frustrations, unmet needs, crossed boundaries, or suppressed ambitions.

While masculinity screams, ‘it’s just a flesh wound’, femininity whispers, ‘I’m fine, don’t worry about me.’ After all, women are taught from a very young age that our agreeableness is our best asset, so we better ignore our own needs, push any ‘unfeminine’ feelings down — particularly anger — and put those of others first.

In an article in Time magazine, psychologist Maytal Eyal points out that leaning into these socially prescribed expectations of feminine behaviour can actually impact our health:

‘Be more disappointing’ is not a piece of advice most people would pay money to hear, but in my therapy office, it’s often the most valuable guidance I can give. My clients are mostly women, and nearly all of them struggle with a fear of disappointing others. Our culture rewards women for being perpetually pleasant, self-sacrificing, and emotionally in control, and it can feel counterintuitive for my clients to say ‘no’ — or firmly assert their wants and needs. But my work is about helping them realise that their health might literally depend on it.

This link between conforming to ‘traditional’ feminine norms and mental health struggles was first identified in the late 1980s by psychologist Dana Jack. Her research showed that patterns like compulsive caretaking, people-pleasing, and inhibited self-expression — behaviours she referred to as ‘self-silencing’ or ‘the activity required to be passive’ — are risk factors for poor mental health, especially depression. Later studies confirmed this correlation as well, with more recent ones also linking self-silencing to heightened anxiety and eating disorders.

But as Eyal notes in her article, self-silencing is tied to physical illness, too. A 2022 study from the University of Pittsburgh found that women of colour who strongly agreed with statements like ‘I rarely express my anger to those close to me,’ were 70% more likely to experience increased carotid atherosclerosis — a cardiovascular plaque associated with higher heart attack risk. Another study, also conducted by Jack and spanning 10 years with about 4,000 American participants, found that women who held back during conflicts with their spouses had a fourfold increase in mortality risk compared to those who voiced their feelings. This held true even after controlling for factors like age, blood pressure, smoking, etc.

Other research suggests that self-silencing might even worsen how women deal with cancer as well as contribute to chronic inflammatory conditions, such as irritable bowel syndrome and chronic fatigue syndrome.

It’s also no secret that women account for nearly 80% of all cases of autoimmune disease, which is still poorly understood, not least because it’s precisely women who are more likely to suffer from it. (And that’s on gender bias in medical studies.) Could it be that internalising cultural expectations of feminine ‘niceness’ play a role in it, too? Perhaps.

The health impact of conformity to feminine norms of behaviour is also evident in the past, for instance in the 1950s and ’60s, when those norms were particularly rigid. During this time, many housewives struggled with anxiety, depression and eating disorders, collectively referred to as the ‘housewife syndrome.’ Some turned to ‘mother’s little helpers’ — a class of psychoactive drugs known as benzodiazepines — or excessive alcohol consumption to cope with the strain of domestic ‘bliss’.

In many ways, our lives are luckily much better today, but in some others, not exactly. Although women have made major strides in the labour market and the majority have paid, full-time employment, we’re still expected to shoulder most domestic and emotional labour — which leads to a gender exhaustion gap — and engage in increasingly more arduous tasks of aesthetic labour. All of this can take quite a toll on our mental and physical health, too.

However you look at it, the pressure to conform to gender norms can undeniably impact our well-being.

So why are we still so terribly attached to them?

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If you were to compare gender ideals through the ages, say those in ancient Greece or Rome, with the norms during the Hanoverian, Victorian or Edwardian periods in England, you’d undoubtedly find similarities. But you’ll also find many differences. Both between and within different ancient cultures and modern eras. And even more so if you analyse them across the lines of class and race.

Rather than being a product of innate biological ‘hardwiring,’ concepts of masculinity and femininity are largely created, policed and maintained by social and cultural forces, shifting to suit the times. So, no — they’re not quite as ‘traditional,’ universal, or static as we’re often led to believe.

Today, definitions of masculinity and femininity still vary across the globe. In some countries — like the US or Japan — differences between the two are more dramatic, and the norms are more rigid, whereas in others — like the Netherlands or Denmark — the difference is less pronounced, and the norms are more flexible. Unsurprisingly, this influences broader aspects of culture, too. Countries that endorse stricter norms value competition, performance and status, especially among men; meanwhile, countries that don’t, place more importance on caring for others and quality of life — for everyone. It’s also the latter, more egalitarian societies that tend to report higher levels of happiness and overall well-being.

Even when viewing human behaviour through a primarily biological lens, you can’t ignore one of the most important aspects of our biological reality: our capacity for adaptative behaviour, which is, in no small part, thanks to our uniquely large brains. And the very reason why we have evolved to have them is because, time after time, we have successfully adapted to changing environmental challenges — and still can do that.

As we continue to evolve and adopt, it’s then worth asking ourselves: do we truly need to preserve rigid social norms of masculinity and femininity? Are they holding us back more than they’re helping us? Do they even offer us any benefits? And if so, who actually reaps them?

It’s no coincidence that it’s usually high-control environments — such as authoritarian states or restrictive religious communities — that most strongly pressure people to fit into strict moulds of masculinity and femininity and most severely punish those who stray away from them. Clearly defined, binary roles make it easier for those in power to impose a rigid social and political order.

But while this setup might serve a few, it doesn’t mean it benefits most. And clearly, it does not. For men, the expectation of being tough, self-reliant, and emotionally restrained discourages them from seeking help even when it’s genuinely needed. For women, the expectation of self-silencing for the sake of ‘agreeableness’ wreaks havoc on our minds and our bodies.

As a result, both men and women are pressured to suppress parts of themselves, their emotions, and their needs.

And both men and women end up paying the price.

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The problem is, of course, that realising any of this isn’t easy.

Gender norms are closely entangled with so many facets of life — dating preferences, relationship dynamics, career choices, etc. — and are reinforced through so many things in our environments. Still, I think it’s worth the effort to untangle it all and start appreciating human nature’s true complexity and diversity.

And if we do need scripts on how to be human, why not one universal ‘Good Human’ script that could combine the best aspects of both ‘traditionally’ masculine and feminine qualities?

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