Why do men with HS often delay seeking mental health support?

Several factors contribute to delayed help-seeking in men with HS. Social norms around masculine stoicism discourage men from expressing emotional distress. The location of HS lesions (groin, buttocks, perianal area) creates intense shame that makes disclosure feel impossible. Many men also do not recognize depression or anxiety as medical conditions requiring treatment, instead attributing their low mood to the physical pain itself. Normalizing mental health conversations in HS communities is a critical first step.

Is depression common in men with HS?

Yes. Studies consistently show that people with HS have significantly higher rates of depression and anxiety than the general population. One large study found that nearly 1 in 3 people with HS met criteria for depression. Men may underreport depressive symptoms, meaning the true prevalence in men with HS is likely higher than published figures suggest.

How does shame from HS affect men differently than women?

Men with HS often experience shame related to perceived weakness, loss of physical capability, and concerns about sexual desirability. The location of lesions in the groin and perianal area is particularly stigmatizing for men, who may fear judgment from partners or healthcare providers. Men are also less likely to have peer support networks where chronic illness is openly discussed, leaving them more isolated with their shame than women in similar situations.

What type of therapy is most helpful for men with HS?

Cognitive Behavioral Therapy (CBT) has the strongest evidence base for chronic illness-related depression and anxiety. Acceptance and Commitment Therapy (ACT) is also well-suited to HS because it focuses on living a valued life alongside chronic pain rather than eliminating the pain. For men who resist traditional therapy, structured online programs, peer support groups, and brief solution-focused counseling can be effective entry points.

Can treating HS improve mental health?

Yes. Clinical trials of biologic treatments for HS consistently show improvements in depression and quality-of-life scores alongside physical improvements. However, mental health does not always improve in parallel with skin improvement, particularly in men who have experienced years of shame, social withdrawal, and relationship strain. Addressing the psychological impact directly, not just the physical disease, leads to better overall outcomes.

Men's HS SeriesMental Health

HS and Men's Mental Health: Shame, Silence, and the Weight No One Talks About

Men with hidradenitis suppurativa carry a psychological burden that rarely gets named. This article addresses it directly.

Reviewed by medical team5 min read5 references

Part of the Men's HS Series - practical guides written for men with HS

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Hidradenitis suppurativa is a physically painful condition. But for many men, the psychological weight is just as heavy. Shame about lesion location. Silence around a condition that feels too embarrassing to name. Years of misdiagnosis that erode trust in healthcare. Relationships strained by pain, odor, and self-consciousness.

Men with HS are significantly less likely than women to seek mental health support, even when they are experiencing clinical depression or anxiety. This article addresses the psychological burden of HS in men directly, without minimizing it or dressing it up.

The Shame Factor: Why HS Hits Men Differently

Shame is not a side effect of HS. For many men, it is the dominant experience of the disease. The location of lesions in the groin, buttocks, and perianal area creates a specific kind of shame that is hard to articulate and harder to share.

Diagram showing the shame and isolation cycle in men with hidradenitis suppurativa: shame leads to concealment, concealment leads to social withdrawal, withdrawal delays diagnosis, worsening disease reinforces shame — Diagram showing the shame-isolation-delay cycle common in men with HS: shame leads to concealment, concealment leads to social withdrawal, withdrawal delays diagnosis and treatment, worsening disease reinforces shame.

Masculine norms create silence

Social expectations around stoicism and self-sufficiency make it harder for men to acknowledge emotional distress. Many men describe their HS as 'something I just deal with' for years before seeking any kind of support.

Location amplifies shame

Lesions in the groin, inner thighs, buttocks, and perianal area are associated with hygiene and sexuality. Men often fear that healthcare providers or partners will misinterpret the condition as a sexually transmitted infection or a result of poor hygiene.

Isolation compounds the burden

Men are less likely to have peer networks where chronic illness is openly discussed. Women with HS have more access to online communities and support groups. Men often carry the psychological burden alone, which worsens both mental health outcomes and disease management.

Delayed diagnosis extends the wound

The average time from first HS symptom to correct diagnosis is 7 to 10 years. For men, this delay is often longer. Years of being told 'it's just a boil' or 'lose weight' by healthcare providers creates a specific kind of medical trauma that persists even after diagnosis.

What the Research Shows

The psychological burden of HS is not anecdotal. It is well-documented in clinical literature, even if it is underaddressed in clinical practice.

~30%

of people with HS meet criteria for depression

Significantly higher than the general population rate of 7-10%

7-10 years

average delay to correct HS diagnosis

Each misdiagnosis year adds to psychological burden and erodes trust

higher risk of anxiety disorders in HS vs. general population

Driven by unpredictability of flares, pain, and social stigma

Significant

quality-of-life impairment comparable to psoriasis and rheumatoid arthritis

HS consistently ranks among the highest QoL-impairing dermatological conditions

Importantly, mental health does not automatically improve when HS is treated. Men who have spent years in shame and isolation often need direct psychological support alongside medical treatment to recover their quality of life.

The Delayed Diagnosis Wound

Being told for years that your condition is 'just boils,' 'poor hygiene,' or 'something you should lose weight to fix' is a form of medical invalidation that leaves lasting psychological marks.

Timeline showing the typical HS diagnosis journey for men: first symptoms, misdiagnosis phase with wrong labels, psychological impact accumulation, correct diagnosis, and recovery path — Timeline showing the typical men's HS diagnosis journey: first symptoms, repeated misdiagnoses, psychological impact accumulation, eventual correct diagnosis, and the recovery path.

What Men With HS Are Often Told Before Diagnosis

"It's just an ingrown hair" - repeated for years
"You need to lose weight" - without any further investigation
"Keep the area clean" - implying the cause is poor hygiene
"It's a pilonidal cyst" - treated surgically without addressing the underlying disease
"Come back if it gets worse" - dismissing the current severity

Each dismissal reinforces the belief that the condition is not real, not serious, or is somehow the patient's fault. Men who have experienced this pattern often develop what researchers call "medical mistrust" - a reluctance to seek care that persists even after receiving a correct diagnosis.

Acknowledging this history, both to yourself and to new healthcare providers, is an important part of rebuilding a productive relationship with medical care.

Relationships, Intimacy, and Self-Worth

HS affects intimate relationships in ways that are rarely discussed openly. For men, the combination of lesion location, pain, odor, and shame creates specific barriers to physical and emotional intimacy.

Fear of disclosure

Many men with HS avoid new relationships or delay physical intimacy because they do not know how or when to disclose their condition. The fear of rejection is real and often based on past experiences of negative reactions.

Sexual avoidance

Pain, active lesions, and self-consciousness about appearance and odor lead many men to avoid sexual activity even in established relationships. This avoidance, if not communicated, can create distance and misunderstanding with partners.

Identity and masculinity

For men who strongly associate physical capability and appearance with their sense of self, HS can feel like a direct attack on identity. The inability to do physical activities, the visible scarring, and the dependence on medical care can all challenge a man's sense of who he is.

Partner burden and guilt

Men with HS often feel guilty about the impact of their condition on partners - the wound care, the cancelled plans, the financial cost of treatment. This guilt, if unaddressed, can become a source of ongoing psychological distress.

A Note on Disclosure

There is no perfect time or script for disclosing HS to a partner. What matters is finding a calm moment outside of a physical encounter, using clear language ("I have a chronic skin condition called hidradenitis suppurativa"), and giving the other person time to process. Most people respond better than anticipated. The anticipatory anxiety is usually worse than the actual conversation.

Practical Support Strategies for Men

Mental health support for men with HS does not have to look like traditional therapy. There are multiple entry points depending on what feels accessible.

Name what you are experiencing

Depression, anxiety, shame, and grief are not weaknesses. They are normal responses to a painful, stigmatized chronic condition. Naming the experience is the first step toward addressing it.

Talk to your dermatologist about mental health

Many dermatologists now screen for depression and anxiety in HS patients. If yours does not, raise it directly. 'I have been struggling emotionally with this condition' is a complete sentence that opens the door.

Consider CBT or ACT therapy

Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have the strongest evidence base for chronic illness-related psychological distress. Both can be accessed online if in-person feels like too high a barrier.

Find at least one person who knows

Carrying HS entirely alone is a significant psychological burden. Finding one person - a partner, friend, family member, or online community member - who knows about your condition reduces isolation meaningfully.

Use structured online resources

If formal therapy is not accessible, structured online programs for chronic illness and depression (such as those based on CBT principles) can provide meaningful support. The HS Foundation and patient advocacy organizations also offer peer connection resources.

Address the physical and psychological together

Treating HS medically without addressing the psychological burden leaves half the disease untreated. Advocate for a care plan that includes both. Some academic medical centers have integrated dermatology-psychology programs specifically for conditions like HS.

Reality Check

The psychological burden of HS in men is real, documented, and undertreated.

Shame, silence, and delayed diagnosis are not personal failures. They are predictable outcomes of a stigmatized condition in a culture that discourages men from seeking help.

Addressing the mental health impact of HS is not optional. It is part of treating the disease.

When to Seek Urgent Mental Health Support

If you are experiencing any of the following, please reach out to a mental health professional or crisis service immediately:

Thoughts of self-harm or suicide
Feeling that life is not worth living because of your condition
Complete withdrawal from relationships and daily activities
Inability to care for yourself or manage basic daily tasks

Crisis Text Line: Text HOME to 741741. National Suicide Prevention Lifeline: 988.

Related Resources

HS and Depression & Anxiety

In-depth guide to the mental health comorbidities of HS

Intimacy and Relationships with HS

Guidance on disclosure, physical intimacy, and relationship strain

Men's HS Hub

All articles and resources in the Men's HS Series

HS Support Groups

Online and in-person communities for people with HS

Frequently Asked Questions

Medical Disclaimer

This article is for educational purposes only and does not constitute medical or mental health advice. If you are experiencing depression, anxiety, or thoughts of self-harm, please consult a qualified healthcare professional. In a crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.