Why are American men’s lives shorter than American women’s? Is it the bar fights? The motorcycle stunts? Well, no; but the answer might be related. Two psychology researchers say that ideas about “manliness” keep men from complaining, even when they’re sick or injured, and that the resulting health problems may be shortening their lives. The researchers published their findings in the journals Preventive Medicine and The Journal of Health Psychology

It’s called toxic masculinity, and it kills. Researchers have known for years that cultural pressure to be stoic, self-reliant, and aggressive is incredibly destructive. From birth, many boys are taught not to cry, to suppress their feelings and keep quiet about their problems. They're taught that men are more capable than women, and that they have to dominate other men—and women—in order to succeed. They're taught that stereotypically feminine traits and actions are inferior, and that it's weak to be "un-manly." These messages are everywhere, and they’re doing real damage.

Study authors Diana Sanchez and Mary Himmelstein wanted to know if these toxic messages could help explain men’s shorter lifespans. "Men can expect to die five years earlier than women, and physiological differences don't explain that difference," Sanchez said in a press statement.

But rather than looking at obvious issues like violence or addiction, Sanchez and Himmelstein looked at something both more common and less considered: doctor appointments. They wondered if macho behavior in the exam room (or in avoiding the exam room) could hurt men in the long run. 

The researchers conducted two separate studies using online questionnaires. In the first study, 250 men answered questions that revealed their ideas about masculinity and gender, as well as their preferences for male or female doctors. The researchers then sent a similar survey to an additional 250 men, but afterward, these men were asked to come into the clinic for appointments. Each man sat down with both male and female medical students and nurses to talk about his medical issues and concerns. 

For the second study, 236 men and 255 women answered survey questions about gender and masculinity, as well as the way they related to their own medical issues. 

The results of these surveys were not surprising, but they were definitely troubling. The first study showed that men who identified strongly with stereotypically masculine traits were more likely to choose male doctors—but once they’d chosen those doctors, they were less likely to discuss symptoms with them than they were with female practitioners. They felt that male doctors were more competent than female doctors, but they still didn't want to talk to them. "That's because they don't want to show weakness or dependence to another man, including a male doctor," Sanchez says. She says men felt more comfortable sharing concerns with female doctors, who were perceived as more understanding and nonthreatening. 

The results of the second study really drive the point home: Men who strove to fulfill so-called masculine ideals were less likely than other men to see a doctor when they were sick or hurt. They were more likely to minimize their symptoms and pain, and, understandably, they were more likely to have more serious health problems down the road. 

The researchers noted that stereotypically masculine traits can also be harmful for women; they found that women who strove to be stoic and self-reliant were less likely than other women to get medical help. 

Still, in this situation, at least, men were worse off. “Men have a cultural script that tells them they should be brave, self-reliant and tough,” Sanchez says. “Women don't have that script, so there isn't any cultural message telling them that, to be real women, they should not make too much of illnesses and symptoms."

The cultural pressure is real, and it's intense, but that doesn't mean we all have to give in to it. Men, the next time you decide to “man up” and ignore your pain, skip a doctor’s appointment, or cover up your symptoms, ask yourself: Are these harmful stereotypes really worth dying for?