‘It feels like a badge of dishonor’: How to overcome the stigma surrounding men’s mental health

JOANNA HAYES [email protected] Jun 30, 2023 Updated 13 hrs ago

This article is a repost which originally appeared on Post Register

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Men often find it difficult to discuss mental health issues.

‧ Men make up to 80% of suicides.

‧ Everyone struggles with something.  Talking about it can go a long way towards helping.

Five years ago, Charles Hale walked down Park Avenue, having finally mustered the courage to seek help out of homelessness.

Hale looked up and saw the Idaho Falls Rescue Mission sign. His heart beating uncontrollably. His shame hanging over his head. He couldn’t carry the burden of addiction any longer.

What were the people at the Rescue Mission going to tell him? What were they going to think of him? Hale never thought he would find real help in Idaho Falls, a town full of strangers.

He took a deep breath and opened the mission’s front door. He had nothing with him. Hale sat down at the front desk and explained that he needed a safe place to sleep. He didn’t want to spend another night on the street. He had been without shelter for five years, spending cold nights in Phoenix, Spokane, Seattle and, now, Idaho Falls.

“You know how they say the grass isn’t any greener?” Hale said. “Well the streets aren’t any blacker. It didn’t matter where I went.”

After meeting with a volunteer at the Rescue Mission for a few minutes, Hale started to wonder if the Idaho Falls streets might be less black. He might get off of them this time around.

The volunteer asked Hale if he could pass a urinalysis, as the Rescue Mission requires their guests to be sober upon admission and throughout their stay.

Hale couldn’t. He had been struggling with addiction his entire bout with homelessness. The Rescue Mission sent him to the Behavioral Health Crisis Center while he got sober.

But Hale knew he didn’t want to stay at the crisis center. There was something different about the Rescue Mission. They smiled when he entered. He felt his heart beat slower. His shame lifted. The Rescue Mission would help him carry the burden.

“I had become jaded from seeing the world (on the streets),” Hale said. “My breakthrough moment was when I walked through those doors and saw someone with a smile. It broke me.”

Hale never thought he would end up homeless. No one does. His family was close. They went to church every Sunday. He got a bachelor’s degree in information technology and a master’s degree in business.

Hale climbed the corporate ladder in Phoenix for 15 years. He married a lovely woman and had three beautiful boys. And then his mental health took a turn for the worse. He lost his father and fell into a deep reliance on alcohol and drugs.

“It was three strikes,” Hale said. “I lost my father, then my career and then my wife and three kids.”

For five years, Hale struggled under the weight of grief and addiction.

“It feels like you’re wearing a placard around your neck saying ‘addict’ or ‘homeless.’ You don’t need people to tell you that you are less than. You already feel that,” Hale said.

Hale said many men find it difficult to open up about their struggles, especially when it comes to mental health.

“It feels like a badge of dishonor,” Hale said.

According to the Center for Disease Control and Prevention, men are four times more likely to die by suicide than women. Men make up 50% of the United States population but 80% of the suicides.

Kade Anderson, a psychiatrist with Ascend Mental Health Center in Idaho Falls, said the reason for that is layered. Anderson said men tend to use a more “final method,” such as firearms, when attempting suicide.

However, Anderson believes that the stigma surrounding men’s mental health also contributes to that statistic.

“Men can be afraid to admit weakness,” Anderson said. “They don’t want to talk about it. They want to do it all on their own.”

He said many people aren’t ashamed of other health struggles they have, but when it comes to mental health, they feel less than if they admit vulnerabilities. One way Anderson tries to combat stigma surrounding men’s mental health is through his own vulnerabilities.

“I tell my patients that I struggle with mental health, too.” Anderson said. “I have had to ask for help. I have zero shame. I think that helps them open up.”

Anderson said the best thing people can do is to be honest. Talk about wins. Talk about losses. Talk about the highs, and talk about the lows. He said the more open people are about their struggles, the more one realizes that everyone struggles with something.

Following Anderson’s advice is what brought Hale out of his cycle of addiction and struggles with depression. Hale knew he had to be honest about his situation in order to overcome it.

The Rescue Mission was different from any other safe house Hale had been to, and he had been to a lot. Safe houses focused on mental, physical and emotional health. But the Rescue Mission added spiritual health into the equation.

Hale found both “law and grace” while staying at the Rescue Mission. The workers were caring and loving, but they didn’t enable anyone, Hale said.

Hale joined the Rescue Mission’s recovery program. The seven-month course helped him find a job and permanent housing. He also found a mentor from a local church.

Today, Hale is the mission’s director of operations. He uses his story to help the men there overcome their battle with mental health.

He mentioned that over the past few months, he has seen men walk into the shelter who seemed to be struggling with their mental health, but they weren’t talking about it.

“(Men) can be concerned with stigma and they can’t make that connection. It’s heart-breaking,” Hale said. “Someone has told them they are suffering and it’s too hard to accept. They think ‘If I’m labeled this, how am I going to be successful?’”

Everyone struggles with something, he said, it’s just whether they talk about it.

“We have all experienced a mental health crisis in our lives. Whether it’s you or someone you know,” Hale said.

June was Men’s Mental Health Month. If you or someone you know is struggling with their mental health, call or text 988 to reach the suicide hotline. You can also reach out to Ascend Mental Health Center at 208-419-3002 or the Behavioral Health Crisis Center at 208-522-0727.

Fertility Tests for Men: Options and How They Work

All About Male Fertility Testing

Medically reviewed by Carolyn Kay, M.D. — Written by Rhona Lewis on November 30, 2020

This article is a repost which originally appeared on Healthline

Edited for content

If you’re planning to father a child, know that fertility is a 50-50 deal: half egg, half sperm. So it probably isn’t coincidental that male fertility is a factor in 50 percent of infertility challenges.

This isn’t a blame game, though. It’s about empowering yourself with the knowledge you need to get the outcome you want. If you and your partner are having a hard time getting pregnant, it’s a good idea for you — both of you — to get checked.

Let’s take a look at male fertility testing and what may (or may not) be contributing to the challenge of having a child.

Factors that can affect male fertility

Research shows that male infertility affects up to 6 percent of men in North America. But what causes it? Several factors could contribute:

  • anatomical or genetic abnormalities
  • systemic or neurological diseases
  • infections
  • trauma
  • gonadotoxic radiation therapy
  • sperm antibodies

Can you just use a home fertility test kit and call it a day?

When you’re feeling the sting of another letdown, you may start weighing the pros and cons of home fertility tests. These lists give you a full picture:

The pluses

  • A home kit relieves you of the stress of providing a sperm sample in the doctor’s office.
  • Your concerns remain private.
  • The kits are inexpensive, as well as quick and easy to use.
  • A good kit, like SpermCheck Fertility can reliably tell you whether your sperm count is typical, low, or very low. This will help you plan your next step.

The minuses

  • Home kits won’t give you all the information you need. While they can tell you if your sperm count is normal or not, these numbers are only one factor in male fertility.
  • The range for low and optimal sperm counts varies between the kits.
  • Some kits don’t measure sperm counts below certain levels.

For these reasons, while a home kit might be a helpful first step, you’ll need to be medically evaluated by a doctor for a more complete picture of your fertility.

What to expect at an initial medical evaluation appointment

You’ve booked the initial appointment. Knowing that you’re prepped will ease any tension you may be feeling. Here’s a breakdown of what to expect.

First comes the physical exam. The medical practitioner will examine your penis and testicles.

Next, you’ll be asked questions about your:

  • medical history
  • lifestyle
  • sex life

Questions about your medical history may include:

  • Which medications do you take?
  • Have you had any sexually transmitted infections?
  • Have you had past surgeries?

Questions about your lifestyle may include:

  • How much do you exercise? (Give an honest answer!)
  • Do you smoke or take recreational drugs?

When it comes to your sex life, you can expect a frank discussion that includes any problems you may have, such as:

  • erectile dysfunction (ED)
  • delayed ejaculation
  • retrograde ejaculation

Semen Analysis

After the physical exam and the questions, you’ll be asked to provide a semen sample.

How semen analysis is done

Semen samples are given in two different ways.

You can ejaculate into a special container at the doctor’s office. If this isn’t an option because of your religious or cultural beliefs, you can use a special condom during intercourse.

Be prepared to possibly provide several samples, because sperm counts do fluctuate from one specimen to the next.

What semen analysis shows about fertility

You’ve done your part by providing the sample. Now it’s up to the clinician to analyze it. According to a 2015 study done in India, as much as 2 percent of all men have sperm measurements that aren’t optimal.

So what is your doctor looking for? In a nutshell:

  • Signs of infection. The presence of certain bacteria in semen can indicate infection.
  • Volume of semen. This is a measurement of how much semen in total is in your sample.
  • Sperm concentration. The World Health Organization (WHO) classifies sperm counts at or above 15 million sperm per milliliter of semen as average.
  • Vitality. This examines what percentage of sperm are alive.
  • Motility. Are the sperm moving? Above 63 percent motility indicates fertility, while less than 32 percent of sperm with motility indicates subfertility.
  • Morphology. How are the sperm shaped? Believe it or not, the majority of sperm in your sample won’t be perfect. But if more than 12 percent are of normal size and shape, it indicates fertility. A sample with less than 9 percent normal morphology could mean sub- or infertility. (Between 9 and 12 percent is inconclusive.)

So much for the numbers. Now let’s crunch them.

While the numbers help to distinguish between fertility, subfertility, and indeterminate fertility, none of them actually diagnoses infertility. That said, here are two things to keep in mind:

  • A semen sample with a decreased sperm concentration often also shows abnormalities in sperm motility and morphology.
  • The percentage of sperm with normal morphology is perhaps the best indicator of healthy semen.

Urinalysis

Sometimes, sperm cells pass all the standard medical tests for fertility, but you still have trouble growing your family.

That could indicate a condition called normozoospermic infertility, meaning that the sperm cells themselves are infertile. Here’s where urinalysis comes in.

How urinalysis is done

At the doctor’s office or the testing facility, you’ll be given a plastic cup and asked to be provide a small, clean urine sample. Use the cleaning wipe you’ve been given to wipe around your urethra to prevent bacteria on your penis from entering the cup.

What urinalysis shows about fertility

A 2014 study shows that doctors can now test for normozoospermic infertility by tracking the levels of five biomarkers (small molecules) in urine.

While standard fertility tests may capture 75 percent of cases, the researchers were able to correctly identify 86 percent of the infertile men and 87 percent of the fertile men.

What does that mean for you? While there’s still more research needed in this area, researchers suggest that the variant levels of these biomarkers may point to physiological problems as the root of normozoospermic infertility.

Making sperm is an energy-intensive process and any spoke in the production wheel could disrupt proper sperm production. The more we learn about the biomarkers, the easier it will be to fix any physiological problems.

Hormone testing

The pituitary gland, hypothalamus, and testicles work together when it comes to sperm production.

Follicle stimulating hormone (FSH) and luteinizing hormone (LH) — acting together with testosterone, which is produced in the testicles — are involved in the process.

A simple blood test will show the level of these three important hormones in your blood.

FSH

This hormone contributes to sperm production.

High levels may indicate that your testicles aren’t functioning properly or have been damaged by disease, X-rays, or chemotherapy. Low levels may show that you aren’t producing sperm.

LH

This is produced in the pituitary gland. In the testes, LT binds to receptors in the Leydig cells to release testosterone, which is needed to produce sperm.

LH levels can also be measured after giving an injection of gonadotropin releasing hormone (GnRH). The advantage to measuring LH this way is that your doctor can then pinpoint whether the problem is with your pituitary gland or another part of your body.

Testosterone

Healthy testosterone levels for men range between 300 to 1,000 nanograms per deciliter (ng/dL). Keep in mind that after the age of 40, testosterone levels decrease by an average of around 1 percent every year.

Imaging to check for anatomical issues and any obstructions

In some cases, your doctor may ask for imaging to check that your anatomical structure is OK and that there are no obstructions.

Scrotal ultrasound

In this exam, a handheld probe is swept across your scrotum. The scan uses high-frequency sound waves to check for:

  • infections
  • cysts
  • a collection of fluids inside the testicles
  • tumors

The test also checks for testicular torsion and varicoceles. While many adult men have a varicocele and are never bothered by it, if you’re dealing with infertility, your doctor may recommend surgery.

Transrectal ultrasound

A small, lubricated wand is inserted into your rectum. The imaging helps your doctor to check your prostate and check that there are no blockages in the vas deferens. Blockages can be corrected with surgery.

Anti-sperm antibodies testing

Usually, sperm doesn’t come into contact with the rest of your body and immune system. However, injury, surgery, or prostate gland infections can interfere with this protective system.

And when sperm comes into contact with your immune system, the body may produce anti-sperm antibodies.

Your doctor may ask for an anti-sperm antibody test if the cause for infertility is still missing.

You’ll be asked to provide a sample of semen. The test checks your semen for antibodies that fight against your sperm by using a substance that binds only to affected sperm.

The higher the level of sperm affected by antibodies, the lower the chance of a sperm fertilizing an egg. (These antibodies can also be found in women, so your doctor may ask for your partner to get tested too.)

Doctors are divided over whether this testing is advisable. Some say it doesn’t help set a treatment plan for infertility; others advise taking medication to lower the body’s immune response.

Testicular biopsy

This test may come at the end of the line if the other tests you’ve done aren’t conclusive.

In this test, a sample is removed from the testicle, either with a needle or through a small cut. If the results of the testicular biopsy show that sperm production is normal, your infertility may be caused by a blockage or some other problem with sperm transport.

Genetic testing

Following the development of in vitro fertilizing techniques, research on genetic causes for infertility has expanded. Genetic abnormalities are found in 10 percent to 20 percent of men who have severe disorders with sperm production.

Genetic testing carried out on DNA can help rule out chromosomal abnormalities, especially in men with either azoospermia (no sperm present in the semen) or oligozoospermia (low sperm count).

The test results can:

  • relieve you of uncertainty
  • help you avoid unnecessary surgical or medical treatments
  • help you make informed decisions on what your next steps should be

If everything checks out A-OK for you and your partner

If you’ve done all the tests and everything has come up as normal, you may hear your doctor saying “idiopathic infertility.” Basically, this means that at the moment, there’s no way of figuring out the cause for your infertility.

While it won’t ease your frustration and pain, know that your uncertainty is shared by many. Idiopathic infertility is an extremely common infertility diagnosis in both men and women.

The bottom line

Depending on your diagnosis, you may find that you need to draw on reserves that you never knew you had.

But there are many options for medically assisted pregnancy. And remember many male infertility diagnoses can be successfully treated.