Masculinity and Cancer Survivorship: A Systematic Review.

1 |
Background
Nearly half of all men will receive a cancer diagnosis in their lifetime [1]. With the consistently rising number of living cancer survivors, understanding and addressing the complex and long-term survivorship care needs of men is of central importance [2]. However, relative to women, the psychological and social survivorship care needs of men with cancer have been understudied [3]. Although much of what the field of psycho-oncology has identified as factors that promote (e.g., disease information, social support, adaptive coping skills) and hinder (e.g., chronic physical and psychological stress, social isolation) biopsychosocial functioning after cancer [4], the influence of masculinity and male gender role beliefs have also garnered clinical and research attention over the past 3 decades as a potentially important influence on cancer-related quality of life and psychological adjustment among male-identifying cancer survivors.
Men commonly identify disturbances in masculinity after cancer [5, 6], including declines in masculine self-esteem [7], and connect masculine identity to their maintenance of health-related quality of life after cancer [8]. Masculinity and related gender role processes have demonstrated relationships with cancer survivorship outcomes, particularly in patients with a cancer that impacts the reproductive system or urinary function. For instance, in men treated for prostate cancer traditional, rigid, or restrictive masculinity has been associated with worse urinary and sexual functioning [9–11], increased depression and anxiety [12, 13], and lower health-related quality of life [14, 15]. With limited intervention focus on masculinity disturbance, the impact on cancer survivorship outcomes can persist over long periods of time [16].
The research literature on masculinity and cancer displays notable heterogeneity in masculinity constructs and theoretical assumptions. Theories of masculinity have described “multiple masculinities” to acknowledge the complex and context-dependent nature of notions of masculine gender [17, 18]. However, several theoretical paradigms have most prominently been used to argue for the influence of masculinity in cancer outcomes. One common paradigm has been the consideration of masculinity as a set of hegemonic social norms and rules that emphasize the hierarchical nature of masculinity within a given culture or society [19]. From this perspective, the emphasis has been on traditional, restrictive, and rigid rules of gender-appropriate behavior and attitudes [20, 21]. Such conventional, and largely Western, behaviors and norms emphasize the importance of self-reliance, dominance, stoicism, sexual prowess, the importance of work and success, and emotional control [22]. In fact, the social constructivist gender role strain paradigm states that rigorous adherence to traditional gender roles can result in psychological strain when these roles are incompatible with the lived experiences of the individual [20]. In the context of cancer, espousing such rigid norms might prevent men from effectively managing the demands of cancer, such as garnering social support, expressing and processing emotions, or optimally engaging in cancer care and recovery [23].
A related theoretical perspective on masculinity has focused on cancer incongruity, or the degree to which cancer and cancer-related experiences contrast with masculine self-image [10, 24]. From this perspective, physical symptoms (e.g., fatigue, weakness, urinary incontinence) and impacts of treatments (e.g., erectile dysfunction, hair loss, loss of work) are perceived as inconsistent with the preferred self. Cancer-related masculine threat (CMT) entails the interpretation of cancer-related events, changes, and experiences with feelings of inadequacy, shame, or loss of control, as these symptoms and side effects directly challenge traditional masculine ideals [10, 25, 26]. This threat to masculinity may affect men’s psychological well-being, leading to negative outcomes such as depression, anxiety, or restricted coping, which may complicate the cancer recovery process and reduce engagement with healthcare services [10, 25, 26].
Relatedly, masculine self-esteem has been a focus in cancer survivorship. Assessments of masculine self-esteem have also largely adopted a focus on the incongruity of cancer and aspects of masculine self-image. For instance, masculine self-esteem has often been measured by the Masculine Self-Esteem Scale (MSES) [27]. The MSES measures the appraisal of masculinity in response to cancer (e.g., “I feel as if I am no longer a whole man”, “I feel I have been too emotional”). Both CMT and masculine self-esteem rely on patients’ perceptions of themselves, their emotions and emotional expressiveness, and the impact on their masculine ideals after cancer.
A less commonly employed construal of masculinity has been the adoption of a trait-based approach. For instance, unmitigated agency, a set of negative agentic personality traits characterized by focusing on oneself to the point of exclusion of other people, has been linked to stereotypical notions of masculinity and the male gender role [28, 29]. Relevant to cancer survivorship, it has been examined in men with prostate cancer with associations to declines in physical functioning and health-related quality of life, and has been shown to impair men’s ability to benefit from social support after cancer treatment [30–32].
Finally, an emerging perspective on masculinity in the cancer literature involves the consideration of gender roles within a broader sociocultural context. For instance, machismo culture within Latin American cultures draws attention to the potential reluctance of some men to engage in discussions of cancer and cancer risk. This might stem from fear of stigmatization associated with physical illness or concern about a perceived loss of independence or strength [33]. To date, much of the work on machismo and cancer has been theoretical [34], qualitative [33], or focused on screening and prevention rather than survivorship [35].
As described, these perspectives on masculinity and cancer mostly emphasize a deficit-based conceptualization in which masculine norms and processes hamper overall adjustment to cancer. However, masculinity is neither uniformly restrictive nor maladaptive. Rather, it is contextually constructed and shaped by social, cultural, and situational factors. Many values often linked to masculinity such as family responsibility, perseverance, and sexual importance can serve as adaptive motivators for recovery and health-promoting behavior [36, 37]. For example, following prostate cancer, the masculine value placed on sexual importance may encourage men to seek care for sexual rehabilitation, reframing help-seeking as an action consistent with maintaining vitality and relational intimacy. Similarly, family responsibility and provider roles may motivate adherence to treatment and engagement in health behaviors. Attending to these contextual expressions of masculinity allows for a more nuanced understanding of how masculine ideologies can both challenge and facilitate men’s adjustment to cancer.
The focus on masculinity and cancer has been growing in the field of health psychology. Despite this growth, few studies have offered clinical or intervention-based translation of this work. The aim of this review was to identify and evaluate existing quantitative literature regarding the relationship between masculinity and health-related quality of life, including mental and physical well-being, among male cancer survivors. Synthesis of this growing yet broad literature will serve to further understand the complex interaction between masculinity and cancer survivorship, suggest opportunities for intervention and treatment considerations, as well as identify research gaps and limitations in the current literature.

2 |
Methods
2.1 |
Protocol Registration
A protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with Reg. No. CRD42023432112. The protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol guidelines (PRISMA) [38].

2.2 |
Search Strategy
Three electronic databases (i.e., PsycINFO, CINAHL, PubMed) were searched from database inception through March 2025. The search strategies devised were adapted for each of the three electronic databases using Medical Subject Headings (MeSH), free text, and keywords. Search terms for all three databases are included as online supplemental material. Searches were also supplemented by manual searching of recent articles and scouring of relevant published reviews to maximize inclusion.

2.3 |
Inclusion Criteria
Studies were included in this review if: (1) the manuscript was a peer-reviewed, original study of male cancer survivors (of any cancer type or stage); (2) included quantitative measurement of masculinity-related variables; and (3) reported associations of measured masculinity-related variables with health-related quality-of-life or well-being (mental or physical). Papers that were purely qualitative, had no human subjects, or were not published in English were excluded. In this review, masculinity-related variables were broadly construed to include the wide spectrum of the relevant gender-linked measures and constructs across the psychological cancer literature.

2.4 |
Screening and Data Management
Articles were retrieved from each database and uploaded to the Covidence platform. Following the removal of duplicates, titles and abstracts were screened for inclusionary criteria. Initially, screening was conducted by two independent reviewers (ZW & MH) with disagreements discussed until consensus was reached. In the second screening level, all eligible articles were included for full-text screening. Again, two independent coders read the full text for consideration for inclusion.
Data was manually extracted and included author information, year of publication, location of the study, and study design. Information about the study population/cohort was recorded, including available demographic information (age, race/ethnicity, educational attainment), as well as cancer type and stage, cancer treatment information, time since diagnosis, and time since primary cancer treatment completion. Information about the assessment of masculinity was recorded, including the construct of focus, the measurement tool, the average measured score, and observed statistical relationships of masculinity and cancer survivorship outcomes. Outcomes included measures of health-related quality of life, mental well-being, and physical functioning.
Methodological quality was assessed using the revised Joanna Briggs Institute Critical Appraisal (JBI) tool for cross-sectional studies [39]. The JBI evaluates studies across 8 dichotomous (yes/no) quality indicators to yield an overall quality score as a sum of total “yes” ratings. Poor study quality is indicated by scores of 1–3, medium quality as scores 4 to 6, and high quality is designated by scores of 7 or 8. Studies were evaluated independently by two trained raters (ZW & RS). Disagreements were resolved through discussion or by a third rater. No studies were excluded based on the quality appraisal score.
This review applied the narrative synthesis method. To ease synthesis, findings were grouped with three broad, yet overlapping, categories: mental and psychosocial well-being, physical functioning and symptoms, and general and health-related quality of life.

3 |
Results
3.1 |
Article Selection
A total of 2999 articles were retrieved across all databases. After the removal of duplicates (n = 1303), the titles and abstracts of 1696 articles were screened, of which 1631 articles were excluded. The full text of the remaining 65 articles was screened, and a total of 31 studies were identified to be included in the review (see Figure 1).

3.2 |
Study and Participant Characteristics
Study characteristics are shown in Table 1. Studies were published between 1997 and 2025. The majority of studies reported cross-sectional relationships (n = 28), though longitudinal observations were reported in three studies. Studies were conducted in the United States (n = 19), Europe (including the United Kingdom) (n = 5), Australia (n = 6), and Canada (n = 1). Sample sizes ranged from 40 to 1425. There were 7532 participants across all included studies, though 6898 were unique individuals after accounting for multiple manuscripts of the same sample. The majority of studies included samples of only men with prostate cancer (n = 24), other studies included men with testicular (n = 3), penile (n = 1), and mixed (n = 3) cancers.
As shown in Table 2, the average age of participants was 62.5 years, with a mean duration of 49.2 months since diagnosis and 15.4 months since completing primary cancer treatment. Non-Hispanic White men were most often studied, with 16 studies reporting over 80% of participants identified as White men. Notably, Asian men were only represented in 4 studies, all of which were less than 8% of the total sample. Limited information was included in most studies regarding additional characteristics and socio-demographic indicators. For instance, 8 studies included no report of sample race or ethnicity. Likewise, many studies lacked detail regarding cancer stage or severity, treatment history, or other health care factors.

3.3 |
Masculinity Measures
As shown in Table 1, there was a total of 17 different masculinity-related measures employed across the included studies. The most frequently employed measures were the Masculine Self-Esteem Scale (MSES; n = 10) [27], the Conformity to Masculinity Norms Inventory (CMNI; n = 5) [56], the Personal Attributes Questionnaire (E-PAQ/PAQ; n = 4) [57], the CMT Scale (n = 4) [10], the Gender Role Conflict Scale (GRCS; n = 3) [21], and the Masculinity in Chronic Disease Inventory (MCD-I; n = 2) [47].
Other scales that appeared once across studies included the Need for Control and Self-Reliance Subscale of the Barriers to Help Seeking Scale [58], the Bem Sex-Role Inventory-Short Form [59], the Importance of Sex-Role Identity (ISRI) [40], the Inventory of Subjective Masculinity Experiences (ISME) [60] & Subjective Masculinity Stress Scale (SMSS) [61], the revised version of the Male Role Norms Inventory (MRNI) [62], and masculine identity threat as measured by a single item from the FACT-P [24]. Two studies examined masculine-related stoicism as measured by the Liverpool Stoicism Scale [63] and the Pathak–Wieten Stoicism Ideology Scale [64]. Finally, one study established an Emotional Expressiveness scale (EES) to assess masculine-linked difficulties in expressing and sharing emotions [31].

3.4 |
Study Quality and Research Bias Risk
Study quality ratings are available in Table S1. The majority of studies were rated to be of “medium” quality (n = 22), with 30% (n = 9) studies reflecting high quality ratings. As the aim of the present systematic review was to comprehensively describe observed relationships and not to assess effects of treatments or interventions, risk of bias of the included studies was not conducted.

3.5 |
Masculinity and Cancer Survivorship Outcomes
Across studies, associations of masculinity and relevant cancer survivorship outcomes were examined across a large spectrum of psychosocial, physical health, and functional indicators of health and adjustment. Results are displayed in Tables 3–5.
3.5.1 |
Mental and Psychosocial Well-Being
The associations between masculine-related factors and mental health indicators were reported in 27 studies (see Table 3). Outcomes in this domain most frequently reflect mental health, emotional, or social functioning, or indicators of depression or anxiety, but also include additional symptoms such as intrusive thoughts, psychological bother of symptoms, overall stress, and negative affect. Psychological resources such as optimism, self-efficacy, and coping factors were also represented.
Although null findings were observed [43], restrictive, hegemonic, and traditional forms of masculinity were associated with poorer mental health, greater mental health symptoms, and lower endorsement of psychological resources. This included CMT, gender role conflict, and masculine-linked self-reliance, dominance, and emotional control. This pattern was mirrored in the few observed longitudinal findings in which masculinity-linked factors predicted psychosocial symptoms and poorer emotional approach coping over time [10, 30].
At the same time, an opposite pattern was generally observed for masculine self-esteem. It was associated with better relationship factors and social functioning [11, 15, 51, 53], better mental health [9, 12, 14, 41, 51], and higher levels of psychological resources [9, 51, 53]. Of note, studies also reported that older age and longer time since diagnosis was associated with greater masculine self-esteem [12, 51].

3.5.2 |
Physical Health and Symptoms
As shown in Table 4, 19 studies reported associations of masculinity variables with aspects of physical health indicators or symptoms. Outcomes in this domain predominantly focused on prostate-specific symptoms (e.g., urinary function, erectile and sexual function, bowel function) and overall physical functioning. However, one study identified sleep quality as a health outcome [53].
Although null findings were observed [9, 31, 32, 40, 41, 43, 51], traditional and restrictive masculine constructs were associated with poorer physical functioning or more symptoms. For instance, endorsement of traditional masculinity norms was associated with poorer overall physical functioning [52, 55] as well as higher levels of urinary and sexual symptoms after prostate cancer [13, 41, 52]. Hoyt and colleagues [10] found that CMT predicted poorer bowel and urinary functioning among prostate cancer survivors who received radical prostatectomy or radiation therapy over time.
Seven studies focused attention on masculine self-esteem [9, 11, 12, 15, 27, 51, 64]. Generally, masculine self-esteem is associated with better physical health. These included better prostate cancer functioning [11, 51, 64] and better overall physical functioning [51]. Notably, Allensworth-Davies and colleagues [9] found no relationships of masculine self-esteem to indicators of physical health and function.

3.5.3 |
General Health and Health-Related Quality of Life
As shown in Table 5, a total of six studies assessed either health-related quality of life (HRQoL) (including functional well-being) and/or general overall health. Masculinity-related constructs demonstrated significant associations with HRQoL across multiple studies of prostate cancer survivors [42, 65]. Masculine self-esteem was more consistently positive, showing strong correlations with better HRQoL in both gay/bisexual and heterosexual men [48] as well as in other samples [15, 64]. Regression analyses further confirmed its predictive role, particularly among gay/bisexual survivors. In contrast, dominance and self-reliance were associated with lower functional well-being, whereas emotional control predicted higher well-being [65]. CMT was negatively associated with HRQoL, both correlational and in regression models [25]. Notably, other constructs such as stoicism and masculine identity showed no significant relationship with HRQoL in several studies [15, 40, 64]. These findings suggest that internalized aspects of masculinity, particularly self-esteem and emotional regulation, may play a more critical role in supporting HRQoL than rigid adherence to traditional masculine norms.
Fewer studies specifically examined self-rated general health, but those that did reported nuanced associations with masculinity-related traits. Helgeson and Lepore [32] found that unmitigated agency was modestly but significantly associated with poorer self-rated health among prostate cancer survivors, suggesting that excessively agentic or self-reliant attitudes may hinder perceived well-being. Galbraith et al. [40] reported a small positive correlation between masculine identity and better general health prior to treatment, though masculine identity was unrelated to broader quality-of-life measures in the same study.

4 |
Discussion
This systematic review examined quantitative evidence on the associations between masculinity-related constructs and key biopsychosocial health domains relevant to cancer survivorship, including HRQoL and mental and physical well-being among male cancer survivors. Thirty-one studies met the inclusion criteria, spanning nearly 3 decades of research and covering a broad spectrum of aspects of masculinity. The findings of this review underscore a consistent and clinically meaningful pattern: rigid adherence to traditional masculine norms, as well as masculine identity threats introduced by the cancer experience, are generally associated with poorer psychological adjustment, more physical symptoms, and lower HRQoL. In contrast, masculine self-esteem—defined as a positive appraisal of one’s masculinity in the context of cancer—emerged as a robust protective factor across several domains of survivorship.
The results reinforce long-standing theories within health and gender psychology, including social constructivist theories of gender role strain, whereby adherence to hegemonic masculinity norms (e.g., self-reliance, emotional suppression, dominance) can result in a negative health impact when those norms conflict with lived experiences [20]. Cancer, particularly when it affects bodily function, sexuality, and autonomy, presents a powerful disruption to many traditional masculine ideals. Consistent with this framework, masculinity-related constructs such as CMT, gender role conflict, and self-reliance were repeatedly linked to poorer mental health, lower emotional well-being, and maladaptive coping. This pattern was mostly observed in cross-sectional studies; however, some longitudinal support exists, suggesting not only concurrent associations but also potential predictive value over time.
Importantly, masculine self-esteem emerged as a distinct and consistent positive factor. Across various samples and outcome domains, masculine self-esteem was generally associated with better mental health, greater psychological resources (e.g., self-efficacy, optimism), and improved social and relational functioning. It was also the most robust predictor of HRQoL, particularly among gay and bisexual men—groups often underrepresented in survivorship research. This finding highlights the importance of distinguishing between traditional gender role adherence and subjective, flexible masculine self-concepts. Unlike rigid norms, masculine self-esteem may reflect an adaptive reconstruction of masculinity after cancer, aligned with recovery, resilience, and psychosocial integration.
Physical health outcomes revealed a more heterogeneous pattern compared with other survivorship domains, though consistent trends also emerged. Traditional masculinity was linked to greater symptom burden, particularly related to urinary and sexual functioning, while masculine self-esteem was again associated with better functioning. Interestingly, stoicism—a frequently stereotyped masculine trait—did not show consistent associations with health outcomes. These mixed findings may reflect that more complex relationships exist between masculinity and its biological and physiological manifestations that warrant further investigation.
A noteworthy subset of studies focused on CMT, a construct capturing men’s perceptions of how cancer and its treatments conflict with their masculine identity. Findings consistently showed that greater CMT was associated with poorer emotional well-being, lower quality of life, and worse physical functioning [10, 25]. This highlights the unique value of using cancer-specific masculinity measures, which directly assess how cancer and illness-related changes (e.g., erectile dysfunction, incontinence, appearance changes) challenge traditional masculine ideals. In contrast, general masculinity scales (e.g., CMNI, GRCS) capture broader gender role norms but may miss the nuanced ways masculinity is disrupted in the context of cancer. Integrating both types of measures may offer a more comprehensive understanding—capturing stable masculine traits as well as dynamic, cancer-specific identity disruptions.
4.1 |
Limitations
Despite recent advances, this review identified several key limitations in existing literature. First, most studies were cross-sectional, limiting causal inference. Second, samples were overwhelmingly composed of White, heterosexual, middle-aged men with prostate cancer, with minimal inclusion of racial/ethnic minorities, younger survivors, or men with other cancer types. Asian Americans were almost entirely absent, reflecting a critical gap in understanding how masculinity and survivorship are shaped by the intersection of culture and social context in underrepresented populations. This demographic homogeneity raises concerns about generalizability and underscores the need for more inclusive research.
Only a few studies examined masculinity from socioculturally nuanced perspectives (e.g., machismo) [9, 44], and almost none explored intersectional factors such as race, socioeconomic status, or sexual orientation in depth. Future studies will need to incorporate culturally congruent measures of masculinity. For example, although qualitative work has highlighted the influence of machismo in cancer survivorship among Hispanic men, no quantitative studies were identified. Moreover, the protective counterpart of machismo, caballerismo, a masculinity construct centered on emotional responsibility and nurturance, has been largely overlooked [66]. In fact, the growing recognition of multiple masculinities necessitates methodological approaches that are culturally responsive and context sensitive.
Heterogeneity in the conceptualization of masculinity-related variables was also evident across studies. While it is important to examine masculinity from diverse perspectives and dimensions, the immaturity of this literature limits the ability to draw definitive conclusions about any particular construct. Moreover, most existing measures have adopted a deficit-oriented perspective, focusing on the maladaptive aspects of masculine norms while missing opportunities to identify masculinity-linked strengths and resilience factors. Nevertheless, three conceptualizations appear to have the strongest preliminary support: strength-based indicators (e.g., masculine self-esteem), hegemonic masculinity norms, and masculinity-incongruent experiences (e.g., CMT). Lastly, all masculinity measures relied exclusively on self-report, raising concerns about social desirability bias, particularly given that men who strongly endorse traditional masculine norms may restrict emotional expression or disclosure of distress.

4.2 |
Implications
Findings from this review underscore the importance and need for culturally sensitive and gender-responsive clinical approaches. Clinically, healthcare providers should recognize how the masculine identity, shaped by sociocultural norms, influences the way men experience and engage in cancer care, express emotions, and seek support. A strengths-based approach to masculinity, as articulated in the work of Oliffe and colleagues, provides a valuable framework for practice. Such approaches emphasize leveraging positive masculine values, such as physical strength and self-reliance, in ways that promote health and recovery. For instance, interventions can channel men’s sense of physical strength to encourage engagement in physical activity, which is critical after cancer. Similarly, reframing emotional self-reliance as proactive self-care can normalize help-seeking as an expression of autonomy and agency. Applying these culturally and gender-responsive strategies can foster patient-centered communication and improve psychosocial outcomes for the diverse male cancer survivors.
Future studies should prioritize more inclusive sampling that could better reflect the racial, ethnic, and socioeconomic diversity. There is a need for culturally congruent measures of masculinity that account for both risk-related and protective constructs. Researchers should also explore how masculinity intersects with other social identities, such as sexual orientation, to influence survivorship experiences. Mixed-methods and longitudinal designs are also needed for future research to clarify causal pathways and reveal the role of masculine-related constructs in the survival trajectory among men living with cancer.
In addition, future research should also attend to the interpersonal and relational contexts that shape how masculinity is experienced and negotiated during survivorship. Assessing relationship dynamics and social support systems can clarify how external influences such as partners, family members, and broader social networks affect men’s adjustment, coping, and sense of identity after cancer. In particular, spousal caregivers and partners play a critical role in the survivorship process, frequently voicing concerns and observations that patients may be less inclined to disclose. Incorporating these perspectives may provide a more holistic understanding of patient identity and inform interventions that engage both survivors and their close relational supports.

5 |
Conclusions
This systematic review demonstrates that masculine-related factors may be important to cancer-related physical and emotional adjustment in men with cancer, particularly those who experience gender-specific cancers. Results indicate the importance of the conceptualization and measurement of masculinity variables as well as the need for additional research.
Models of cancer survivorship often focus on mitigating adverse impacts through surveillance, promotion of health-enhancing behaviors, and management of comorbidities. While such comprehensive approaches can improve outcomes and quality of life [67], most survivorship care models have been developed without careful integration of consumer perspectives or consideration of gendered experiences. Dunn and colleagues [68] advanced this area by proposing a cancer survivorship framework explicitly shaped by men living with prostate cancer. Their model emphasizes patient-driven domains including personal agency to improve self-management and engage social support, and shared decision-making to promote a men’s health-centered approach to survivorship care. Meaningful integration of men’s perspectives within survivorship care represents a critical step toward developing more patient-centered models that capture the diversity of survivorship experiences.
Finally, few studies incorporated clinical or intervention-focused approaches. Health professionals are called to translate these findings into effective clinical and intervention tools. This could include screening tools to complement standard distress assessments by identifying men at heightened risk for masculine threat, thereby helping clinicians better understand patients’ experiences and address unmet psychosocial needs. Such information may also inform intervention approaches that promote adjustment to cancer-related changes, foster acceptance of challenges to masculine self-image, and bolster positive components of masculinity and self-esteem. Interventions that integrate masculinity reconstruction, target CMT, or promote adaptive masculine self-concepts may have wide-reaching effects on survivor adjustment.

Supplementary Material
Sup TableTable S1: Quality assessment of included studies.

Additional supporting information can be found online in the Supporting Information section.