Do men have a unique experience of schizophrenia? Emerging research highlights the potential differences.
Sex and gender exist on a spectrum. We use the terms “males,” “men,” and “women” throughout this article to reflect the terms that have been historically used to gender people. But your gender identity may not align with the categories and associated risk factors listed below.
A doctor can help you better understand what schizophrenia symptoms will look like for you.
If you’re a man living with schizophrenia, getting all the facts on how your experience may be unique to your gender can help you receive better care.
Research about gender differences in schizophrenia is still emerging, but important considerations for men include substance use, negative symptoms, and possibly your testosterone levels.
Here’s a quick breakdown of the general differences between men and women living with schizophrenia:
|Gender differences in schizophrenia||Women||Men|
|more severe positive symptoms||✓|
|more severe negative symptoms||✓|
|younger age of onset||✓|
|better social functioning||✓|
|higher rate of substance use||✓|
|worse overall course of illness||✓|
Schizophrenia symptoms are grouped into two categories across all genders: positive and negative.
It’s important to understand that the words “positive” and “negative” don’t refer to “good” or “bad” symptoms, but to differences in mental, emotional, and physical experience or function.
Positive symptoms mean something is added to the person’s experience or function. For example, if your partner stated that they saw a deceased relative in the other room, then they perceived something that was not actually present. This would be considered a hallucination and grouped as a positive symptom.
Likewise, negative symptoms mean something is taken away from the person’s experience or function, such as speaking ability. For example, if your partner hasn’t been talking, then a verbal and social function has been reduced. This would then be grouped as a negative symptom.
According to a
- more severe negative symptoms
- greater impairment in thinking ability
- less severe positive symptoms
These nuances are concerning for men because negative symptoms and thinking impairments are not reversible. They often interfere with a person getting or staying in treatment. (Positive symptoms, on the other hand, are more responsive to medications.)
According to a
Possible negative symptoms of schizophrenia in males
- emotional withdrawal or lack of emotional expression
- social withdrawal or isolation
- poor rapport
- not speaking or saying very little
- lack of energy
- loss of interest or feelings of pleasure
Possible positive symptoms of schizophrenia in males
- Hallucinations: auditory or visual experiences that appear real but are imaginary
- Delusions: beliefs that something is true despite evidence that proves it’s false
- Paranoia: irrational distrust of others and feeling that others are “out to get them”
- Catatonic behaviors: sudden rapid, slowed, or stilled behavior that could appear out of context or purposeless
- Disorganized speech or “word salads”: jumbled sentences, rapid topic changes, use of nonsense words
Does psychosis look different in males?
Broadly defined as a loss of connection with reality, episodes of psychosis are often characterized by the positive symptoms of schizophrenia — in particular, delusions and hallucinations.
Men have a relatively similar overall experience of psychosis as women. However, since men experience less severe positive symptoms, hallucinations and delusions may occur less frequently, according to a
When they do occur, the specific types of delusions, such as themes involving persecution or religion, may be more likely to occur across genders, according to a
For example, researchers noted that men had more religious delusions and women had more sexual delusions.
Generally, the breadth of evidence to support particular gender differences in the experience of psychosis is still developing.
Although the cause of schizophrenia is unclear, there are known associations and risk factors, including:
- abnormalities with brain structure and neurotransmitters
- pregnancy and birth complications
- substance misuse
- environmental factors
The most well-studied risk factor is genetics. A large
This means that if a brother, sister, parent, aunt, or uncle has schizophrenia, then you would be more likely to develop it. Generally, only about
A note on genetic predispositions
Your genes play a role in whether you will develop some mental or physical health conditions, but they’re only one piece of the puzzle.
Special considerations for men
A 2016 study noted that continual use of cannabis affected the first episode of psychosis in schizophrenia in the following ways:
- increases severity of positive symptoms
- potentially leads to diagnosis at a younger age
- may reduce medication compliance
- may mask early symptoms
The use of cannabis in this study occurred over a 12-month period, but it did not state how much and how often cannabis was used. Generally, though, longer use was associated with worse outcomes.
Ensuring that your testosterone levels are within the standard limits may help reduce the severity of your negative symptoms, according to a small
While research is limited, it may still be worth talking with your healthcare team about your testosterone because it plays an important role in your overall mood and many biological functions as a male.
A schizophrenia diagnosis begins with a visit to a mental health professional. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), diagnosis begins with screening for the criteria below:
- at least one of either delusions, hallucinations, or disorganized speech
- at least one of either disorganized behaviors or negative symptoms
- impairment of social or occupational function
- symptoms are unrelated to a secondary cause, like other mood disorders or substance use
A diagnosis is made over the course of 6 months, and 1 of those months must include the above criteria for a significant amount of time during that month.
It’s best to speak with a mental health professional to fully understand whether you fully meet the criteria for a schizophrenia diagnosis.
When does schizophrenia develop in males?
The usual age of onset for schizophrenia in men is their early 20s — between 18 and 25 years old. This is younger than women, who are usually diagnosed between ages 25 and 35 but are sometimes diagnosed at older ages.
Men may be more susceptible to schizophrenia at a younger age than women potentially because women have higher levels of estrogen, according to a 2021 study.
Estrogen helps regulate important neurotransmitters that play a role in schizophrenia onset, but the neuroprotective relationship is not well understood.
Both medication and psychotherapy commonly treat schizophrenia. While medication can help manage episodes of psychosis, psychotherapy may help prevent recurrence and manage symptoms.
Cognitive behavioral therapy (CBT) is often offered to people living with schizophrenia as a standard treatment recommendation. But the effect of CBT is mixed and outcomes are unclear.
On the other hand,
First-line medications for schizophrenia include antipsychotics, which are most commonly used to manage episodes of psychosis. These medications can include:
- chlorpromazine (Thorazine)
- haloperidol (Haldol)
- penfluridol (Semap)
- perphenazine (Trilafon)
- pimozide (Orap)
- thioridazine (Mellaril)
- trifluoperazine (Stelazine)
- zuclopenthixol (Clopixol)
Importance of routine to manage schizophrenia
If your psychiatrist prescribed medication, it’s very important that you continue to take it on a regular basis. Sticking with your clinician’s recommendations can help prevent worsened events and self-harm.
If you feel that your medications aren’t helping, you can contact your mental health professional so they can make necessary adjustments. They may also recommend additional treatments, like psychotherapy, if you need a different kind of support.
Importance of support to manage schizophrenia
Managing schizophrenia can often include involving your whole family. If you’re living with family members, making a decision to inform them of your needs can help support your overall well-being.
As a man, you may also tend to isolate yourself when you feel your symptoms are returning. It’s critical at those times that you reach out to family members or other support groups who can communicate with you regularly.
There are a few key considerations for a man living with schizophrenia: age of onset, substance use, negative symptoms, and testosterone.
More severe negative symptoms may push you away from society, but remember that staying in touch with your support group, family, or friends can help you stay healthy.
If you need support, you can check out some of these helpful resources:
For a deeper dive on the topic, you can listen to our 2020 podcast: “Inside Schizophrenia: Schizophrenia in Men.”