Stress isn’t equal – and neither is support.

Despite growing recognition of mental health issues, the fundamental biological differences between men and women, known as sex dimorphisms, are still often overlooked, although they are crucial to understanding how mental health is experienced. That’s what makes it interesting to take a bi-dimensional approach to this topic, focusing on differences in stress response and the social and cultural contexts contributing to mental health. Combined, these two factors allow a deeper understanding of mental health experience and underline the importance of a topic that, against all odds, is still unfairly stigmatised.

The HPA (hypothalamus-pituitary-adrenal) axis connects the central nervous system to the hormonal system. It’s designed to help the body adapt to environmental demands, as well as maintain homeostasis, the body’s inner balance, like blood sugar, temperature, or heart rate. Under stress, the body releases cortisol, which in normal amounts is a good thing. But when there’s too much of it, cortisol is often linked to psychiatric disorders or cardiovascular problems.

Several studies show that women are subjectively more vulnerable to stress, all while having a longer life expectancy than men. So, if women report feeling more stressed but don’t seem to suffer the negative long-term health consequences, could it be because they are less biologically reactive, in other words produce less cortisol than men?

To be fair, I might have jumped ahead a bit. Before cortisol is released from the HPA axis, it requires, among other things, ACTH, a hormone that signals the body to start producing cortisol. Overall cortisol, and therefore ACTH, levels tend to be higher in men. In women, these levels vary significantly depending on factors like age, the menstrual cycle, or for example the use of oral contraceptives.

Men having higher cortisol is evidence that their HPA axis is more reactive to acute psychological stress. This refers to a situation that mentally or emotionally challenges a person, whether it’s triggered by thoughts, feelings or social interactions. Men’s stronger HPA axis response may relate to greater cardiovascular risk, which may be related to shorter life expectancy, explaining why women have higher life expectancy even when they report to being more stressed.

It is important to consider the context in which stress reactions occur. Though men overall have higher cortisol levels, women may react more strongly to specific stressors, particularly interpersonal stress situations. The link between interpersonal stress and depression and anxiety is well supported by research, which may help explain why women are more frequently affected.

Stress reactions are complex, and what I’ve presented here is an extremely broken down version. Still, biological differences can help understand how mental health is experienced the way it is, and why it affects our society as it does.

It doesn’t come as a surprise that men are less likely to receive mental health treatement than women. Statistically, fewer men access psychological therapies, and they are more likely to die, not attempt, by suicide and to suffer from substance abuse.  A lot of this can be traced back to societal and long-standing stereotypes. From an early age, boys are taught the image of an invulnerable soldier, who’s never a burden to anyone, and who risks ridicule if he admits to his vulnerability. Despite efforts in recent years, men’s mental health struggles remain particularly stigmatised. Whilst there have been small signs of improvements, we are only now beginning to scratch the surface. Much of this also depends on the culture in which boys grow up, and the underlying expectations within. Certain cultures are more open to change, though even those are having a hard time overcoming the consequences of decades of imprinting. Other cultures unfortunately seem to be moving in the opposite direction.
As a result, too many men can only express basic emotions – happy, horny, hungry – while more complexe feelings remain unspoken. It’s a topic that we need to talk about more and not keep sweeping under the rug.

Mental health for women, on the other hand, stopped being a taboo a long time ago, though the pressure that lies on women hasn’t become any lighter. It’s less about about being financially successful or showing dominance to prove you’re capable, instead it’s an emotional pressure. Women are expected to be caregivers, to be emotionally available at all time, not just for themselves but for everyone around them. Oftentimes, society expects them to put others first and sacrifice their own well-being. Women who don’t fit into this image are “aggressive feminists” and seen as cold or selfish. It is almost like it is impossible to be a woman, you can never get it right. Be nice to everyone all the time but don’t cripple apart, be thin, be beautiful, look youthful, but don’t have an eating disorder, get plastic surgery, or wear too much make-up. Both men and women suffer from different mental health issues. If men could step out of their dominant role, to which most of them cling in vain, often out of habit, fear or societal pressure, women would not only feel less oppressed. They would also carry a lighter emotional burden, no longer being responsible for everyones feelings, allowing them to ease their own mental health struggles. It is far too easy to say that men are at fault. They suffer too, and it’s time to recognize that. Ironically, the patriarchy, which usually benefits them, works against them when it comes to expressing vulnerability. Yet our society is based on a system that made sense a really long time ago. In the meantime, things have fundamentally changed. The traditional, rigid roles of the sexes have given way to self-expression that comes with greater flexibility and adaptability. It is my hope that society will transform accordingly, with a renewed support for mental well-being.