Learned silence: gay men who wait too long to seek psychological help

First things first: if you are thinking about suicide, reach out today. In Spain, call 024: it is free, confidential and open 24 hours a day, with a chat option too. If there is immediate danger, call 112. If you live elsewhere, your country has its own helplines; if you don't know them, call your local emergency number. What follows is general information and is no substitute for a professional.

There is a phrase many men have said a thousand times. "I'm fine." We say it at family dinners, at work, with our friends. We say it even when we haven't slept properly for weeks, when nothing feels worth doing, when there's a knot that won't go away. And we say it most of all when someone actually means the question.

This piece is about that. About why men, and gay men in particular, take so long to ask for psychological help. About what the data says. About the signs that tell you it's time to stop waiting. And about how to take the first step, even a small one.

A silence we learn

Nobody is born knowing how to keep quiet. Silence is learned, and it's learned early. "Boys don't cry." "Don't be soft." "It'll sort itself out." You hear these things at home, in the playground and on TV, and they leave a very clear message: a real man just gets on with it.

In 2020 the World Health Organization's Regional Office for Europe published a report on masculinities and mental health help-seeking. Its main conclusion is simple: men seek help less than women and are far more likely to die by suicide. Part of the reason lies in certain norms about what a man "should" be: self-reliant, emotionally contained, always in control.

The report notes something else. Many men don't recognise their own depression. Instead of sadness, it shows up as irritability, overwork, more drinking or risky behaviour. And help is often sought only once there's already a crisis, or when someone close keeps insisting.

When I read that report, I think about time. In my case, the diagnosis came at 41: severe major depression, social phobia, post-traumatic stress disorder, avoidant personality disorder and anxiety. I wrote about it in Diagnosed at 41. The wounds went back a long way, to childhood. It took decades for them to have a name.

Why it weighs even more on gay men

Add growing up gay to the rule of "tough it out" and the silence doubles. Many of us learned to hide before we even knew what we were hiding. To watch our voice, our gestures, our clothes, what we said. To monitor every detail so nobody would notice.

That constant vigilance has a name in research: minority stress. It is the wear and tear left by discrimination, fear of rejection and the need to conceal yourself. And it has a curious side effect: someone who has spent years hiding one part of himself gets very good at hiding anything else. Pain included.

There's also a historical trap. For decades, medicine treated homosexuality as an illness. The WHO didn't remove it from its list until 1990. For many gay men, especially older ones, going to a psychologist can set off an old alarm, as if admitting to depression proved right the people who used to call us sick. It's worth saying plainly: seeking help for depression has nothing to do with that old prejudice. Being gay was never the problem. The problem is the weight that was piled on us.

And there's a more modern trap too. Some gay spaces reward always looking perfect: the body, the party, the photo, the smile. In that world, saying "I'm not OK" can feel like going off script. That's why the pain so often gets covered up with more noise.

My song "Ruido en mi mente" ("Noise in my mind") has a line that sums it up better than any explanation: "Ahogo mi grito pero no hay quien lo ve" ("I smother my scream but no one sees it"). That's learned silence. Screaming inside while, from the outside, it looks as if nothing is happening.

What the data says

Numbers don't tell personal stories, but they help show that this isn't a problem for just a few people.

• In Spain, most suicide deaths are men. According to the final figures from Spain's National Statistics Institute, released by the Ministry of Health in December 2025, 3,953 people died by suicide in 2024. Of them, 2,902 were men: 73.4%. The male rate is three times the female rate.
• LGBT people report more than twice the rate of suicidal thoughts or attempts. The study The State of Mental Health in Spain, by the Spanish Mental Health Confederation and the Mutua Madrileña Foundation, found 32.1% compared with 14.5% in the general population. Only 43.6% of LGBT people rated their mental health as good or very good, against 62.5% overall.
• The risk is especially high for gay and bisexual men. A systematic review published in BMC Psychiatry, which pooled 25 studies, found that lesbian, gay and bisexual people had at least a 1.5 times higher risk of depression and anxiety. For gay and bisexual men, the risk of a lifetime suicide attempt was around four times that of heterosexual men.
• Many people are still hiding. In the large survey by the EU Agency for Fundamental Rights, with more than a hundred thousand LGBTIQ participants, only 52% said they are often or always open about who they are.

One figure from the Spanish study deserves a careful reading: LGBT people see a psychologist more often than average (33.9% compared with 20.8%). That's good news, because it means many people are already taking the step. But it doesn't contradict the rest. Going more often doesn't mean going in time. And for men, what the WHO describes is exactly that: arriving late, once the problem has grown.

Signs not to wait any longer

Many people think you have to be in a terrible state to deserve an appointment. That isn't true. You don't need a prior diagnosis or a crisis. These are some signs that, if they last for weeks, suggest it's a good time to ask for help:

• You wake up almost every day with no drive, or with an emptiness you can't explain.
• You've stopped enjoying things you used to like: meeting up, going out, sport, music, sex.
• You're sleeping or eating very differently from usual.
• You're more irritable, snapping at everything or arguing more than you'd like.
• You're drinking more, using more, or need to stay busy all the time so you don't have to think.
• You cancel plans you actually wanted to keep, because being around people feels like an uphill climb.
• Old memories come back uninvited and leave you on edge.
• You feel like a burden to others.

In "No me aparece una ilusión" I wrote a line that captures one of these signs well: "Siempre apartado entre tanta gente" ("Always set apart among so many people"). You can be surrounded by friends and still feel miles away.

And one sign that can't wait: if you're thinking about dying or ending your life, don't wait for an appointment. In Spain, call 024 today; elsewhere, your local helpline or emergency number. Asking or talking about it doesn't make things worse. Quite the opposite: it's the door to getting help.

Why the first step is so hard

There's something unfair about all this. What you need in order to ask for help is exactly what the distress takes away. Depression drains your energy. Anxiety turns a phone call into a mountain. Shame tells you it's not that bad, that others have it worse, that it'll pass.

For someone with social phobia and avoidance, as in my case, sitting in front of a stranger and talking about the most intimate things is exactly what fear tells you not to do. That's why I like to think of the first step as something very small. You don't need to tell everything. You just need to open the door.

How to take the first step

There's no single path, but these ideas can help you start:

• Write one sentence before you call. For example: "I haven't been well for a while and I'd like some help." You can read it out exactly as it is at the appointment.
• Start with your GP. In Spain's public health system, your local health centre is the way in. Your doctor can assess you and refer you to mental health services.
• If you go private, check qualifications. Look for a psychologist licensed to practise in a health setting, with a professional registration number. You can usually verify this with the professional body in your region or country.
• Look for an LGBTI space if you prefer. In Madrid, for example, COGAM offers free psychological counselling. There are more resources, sorted by situation, in the map from my "Mental health without taboo" series.
• Ask someone to come with you. A friend can help you search, make the call or go along on the first day.
• If talking on the phone freezes you, use chat. Spain's 024 has one.
• Remember the first appointment doesn't commit you to anything. If you don't click with that person, you can look for someone else. That's not a failure.

And if you're the one watching a friend, a brother or a partner slowly dim, don't wait for them to tell you. Ask how they really are, and stay to listen. Sometimes a man's first step starts with another man's question.

What I'd like you to take away

Asking for help doesn't make you less of a man. It doesn't make you less strong either. It takes a lot of courage to look straight at what hurts and say it out loud in front of another person.

In my case, a good psychologist is helping me keep going. I wrote about it in Thank you to my psychologist. It isn't a movie-style happy ending. It's work, and it's work with someone beside you. But it works.

If you've spent a long time saying "I'm fine" when you're not, maybe today is a good day to change just one word. It doesn't have to be perfect. It just has to be true.

If you need it today

• 024 (Spain): suicide prevention line. Free, confidential, 24 hours, chat available.
• 112 (Spain and the EU): emergencies, if there's immediate danger.
• Teléfono de la Esperanza (Spain): 717 003 717, emotional crisis support at any hour.
• Outside Spain: your country's helpline or emergency number.

Asking for help works. With support, things change.