Lloyd Austin didn’t want to share his prostate cancer struggle. Many men feel similarly.
Lloyd Austin's struggle with prostate cancer − or, more specifically, his refusal to readily disclose it to the public − has launched a firestorm of criticism and put the White House on the defensive.
Men's health experts, however, say the defense secretary's hesitancy shouldn't come as a surprise; men commonly struggle with sharing weaknesses, in part, due to our culture's view of masculinity, even when it comes to important health matters.
Add on top of that the complications of prostate cancer in particular − which can include the loss of sexual functioning − and you have an illness that's especially difficult for men to admit they have, though it is one of the most common cancers.
"I find that it's something that a lot of men don't talk about," Dr. Samuel Haywood, a urologist specializing in prostate cancer, says. "Men can be very stoic, and they don't like to talk about their health issues."
Lloyd Austin, prostate cancer and why it was kept a secret
Facing a fury of questions about Austin's illness, the Pentagon finally disclosed Tuesday he has been hospitalized since Jan. 1 because of complications from prostate cancer surgery. The Defense Department didn't alert the White House that Austin was in the hospital until three days after he was admitted and didn't make the information public until late last Friday, the day after the White House was notified. Even then the Pentagon did not divulge − to the president or the public − the nature of his illness.
The Pentagon's press secretary, Air Force Maj. Gen. Pat Ryder, told reporters Tuesday the nature of Austin’s illness was behind his reluctance to release information about it.
“Prostate cancer and the associated procedures are obviously, deeply personal," Ryder said, adding that Austin takes responsibility for failing to disclose his illness but plans to stay in the job.
More:Defense Secretary Lloyd Austin discloses illness that has kept him hospitalized
What Lloyd Austin's reluctance says about masculinity
Psychologists say cultural attitudes and pressures regarding masculinity could have played a role in Austin's hesitancy to reveal his diagnosis.
These expectations include that men remain sexually vigorous and self-sufficient throughout their lives. Prostate cancer can sometimes cause erectile dysfunction and urinary incontinence, according to the Mayo Clinic, causing deep shame for some men.
"Masculinity is, in part, based on self-efficacy, and things like losing control of your bladder or experiencing pain when urinating or having a difficulty with sexual functioning can really impact men's self-esteem," says Erik Anderson, a licensed marriage and family therapist who specializes in men's issues and anxiety. "To admit that difficulty in functioning, it really feels like talking about a very vulnerable part of yourself."
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Illnesses that affect sexual function can be particularly shameful for men, many of whom base their self-worth and manhood on sexual performance, Anderson says. That shame, he says can lead to depression, social withdrawal and anger with oneself.
Ronald Levant, a professor emeritus of psychology at The University of Akron and author of "The Tough Standard: The Hard Truths About Masculinity and Violence," adds the expectations men hold themselves to regarding physical prowess also lead them to stay silent.
"The last thing people want to do when they're feeling ashamed of themselves is talk about it," he says.
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Men need to talk about health − especially prostate cancer
Prostate cancer affects more than 1 in 8 U.S. men, and 1 in 6 African American men during their lifetime, the doctors who oversaw Austin's treatment said in a statement released by the Pentagon Tuesday. The nonprofit American Cancer Society said it's the most common form of cancer in men other than skin cancer, and the risk of getting it increases with age. Austin, the first Black defense secretary, is 70.
Haywood says prostate cancer is very treatable, and only about 3% of men die from it. Still, he says men's reluctance to share their health issues with each other makes treating prostate cancer more difficult. This is because family history impacts one's prostate cancer risk, and many men don't know if they have a family history of the illness, because their relatives don't want to talk about it.
"The only way that we can help you is if we talk about it to each other," he says. "While there's no self-check for prostate cancer, it'd be great if it was something that men were talking about and saying, 'Hey, did you get your prostate checked? Have you talked to your doctor about this?' That would be an ideal world."
Anderson adds there's a special strength men display when they share their vulnerabilities.
"Men acknowledging their vulnerabilities are not necessarily becoming weak, but can still be strong while talking about vulnerable things that they experience," he says.
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Contributing: Eduardo Cuevas, Tom Vanden Brook and Michael Collins