“Toughing It Out”: A Psychiatrist on the Barrier Keeping Young Men From Help

September is Suicide Prevention Month, and Nikole Benders-Hadi, M.D., a psychiatrist and chief medical officer at Talkspace, wants to change how people recognize a struggling young man before it becomes a crisis. Depression and anxiety, she says, rarely look the way people expect them to in this group. Instead of sadness or withdrawal, the signs often show up as irritability, risk-taking, overworking or substance use, behaviors that can look like personality traits rather than symptoms of something deeper.

That mismatch between what struggling actually looks like and what people are trained to watch for, Benders-Hadi says, is exactly why so many young men go unnoticed, by the people around them and often by themselves. We spoke with her about why “toughing it out” is such a powerful barrier to care, how a parent or partner can open a conversation without shutting a young man down, and what she wants young men to understand about what asking for help really means.

How do mental health struggles tend to show up differently in young men compared with other groups, and why do those signs often get missed or misread?

Nikole Benders-Hadi, M.D.: Mental health difficulties in young men often don’t match the textbook picture of depression or anxiety, which is a big part of why they get missed. Instead of sadness, they’re more likely to show up as irritability, anger, or agitation — emotions that feel more “socially acceptable” for men to express. That same conditioning shows up in risk-taking, substance use or overworking, all of which can function as ways to distract from or numb what’s actually going on rather than face it directly. The trouble is that these signs don’t just make it harder for a man to recognize his own struggle and seek help; they make it harder for the people around him to recognize it too.

How much do social expectations around “toughing it out” actually shape whether a young man asks for help, and where do you see that playing out most?

NBH: Societal expectations are one of the biggest barriers to young men seeking help. The pressure to “tough it out” doesn’t just make men reluctant to ask for help; it teaches them to minimize what they’re feeling in the first place, so the struggle often doesn’t register as something worth naming, let alone acting on. And when it does register, asking for help still risks feeling like an admission of weakness.

If a parent, friend or partner suspects a young man in their life is struggling but he’s not opening up, what’s the best way to start that conversation without shutting him down?

NBH: Start small and low-pressure, like going for a walk or doing something casual together. It’s also important to lead with an observation, not an assumed diagnosis. You can also model vulnerability by sharing a personal challenge of your own, showing that it’s OK to talk about difficult emotions and that asking for support is a sign of strength, not weakness.

Are there specific warning signs that loved ones should be paying closer attention to in young men specifically, things that might not fit the picture people expect?

NBH: Similar to what was outlined above, signs can include being quick to anger, engaging in extreme risky behaviors like gambling or dating irresponsibly, substance abuse and overworking themselves can all be indications it may be time to seek help.

What would you want young men themselves to know this Suicide Prevention Month about what asking for help looks like, and why it isn’t a sign of weakness?

NBH: Keeping your mental health in top shape is just as important as your physical health. It’s helpful to think about therapy the way you think about going to the gym: a tool for getting stronger.