When Andrew Creighton was a teenager, he was 5-foot-6 and 180 pounds — “chubby” as he describes it (or borderline obese, according to the National Institute of Health’s body mass index). In college, he set out to lose the excess weight and told his male friends he was embarking on a fitness plan. Most responded with a cursory, “Good for you” before quickly changing the subject. A few of his closest friends, however, were especially supportive, offering to go to the gym with him.

Today, Creighton is a svelte 145-pound, 21-year-old business student at the University of Maryland. He exercises nearly every day, running once or twice per week and lifting weights six to seven days a week, often with the aforementioned male friends.

But at no point during Creighton’s transformation did he and his friends discuss the emotional aspect of struggling to stay in shape — the shame of feeling overweight and the anxiety of being judged by others. Instead, their fitness conversations revolved around workout regimens and eating lots of protein. The closest they came to broaching the emotional aspect, Creighton says, was thinking about how women would perceive their bodies and calling each other “fatass.”

“Men generally have the same self-esteem issues as women, but aren’t as comfortable openly talking about it,” Creighton says.

“In general, no, men don’t discuss [body image],” says Roberto Olivardia, a clinical psychologist at the Harvard Medical School, where he specializes in male body dysmorphic disorder (commonly referred to as “bigorexia”). “There’s this strange acceptability around men being hearty eaters and beer drinkers and watching football and eating mozzarella sticks. And there’s something culturally feminine about being emotional about the way you look.”

This essentially means men are left to talk about their insecurity without actually talking about it. The most common tack is humor — e.g., Creighton and his friends clowning on each other about being fatasses. These jokes, however, can just be an excuse for them to safely confess to their real body image issues. They also can sting. “In a way, it’s, Haha, it’s a joke. But it doesn’t mean men hearing ‘fatass’ take it lightly,” Olivardia says. “I have a patient whose friend told him he has a dad bod. And, haha, they were all laughing. At first, he said it was no big deal. It was only when he was talking to me that he revealed he had some negative feelings about it.”

The reticence to discuss these underlying issues is a reticence to be viewed as a “whiny” woman who constantly complains about her weight with her female friends.

In a Reddit thread about how men broach body image issues, one user writes:

“Generally, [men] know when we eat like shit and don’t exercise, and that it’s bad for us. Just like women do. But we don’t use our friends as crutches to justify continuing this bad behavior in a crab-bucket mentality, we just do it full knowing the consequences. We know eating right takes work. We know working out is hard. We don’t need to bitch to our guy friends about it, hoping they validate our feelings and failures.”

Instead, men tend to discuss fitness and body weight issues in strictly action-oriented terms, Olivardia says. They discuss specific exercises and how they should be grouped together; the relative merits of different gyms; and workout frequency and their personal records in various lifts. And while they don’t talk about dieting, per se, they speak at length about “macros.”

“My friends and I never talked about dieting when we were getting in shape,” Creighton recalls. “We just talked about meat a lot. You want to gain muscle, eat a lot of protein — steak, chicken and eggs.”

Others prefer to outright deny that men worry about such things. “No men I know are interested in those things very much, myself included,” writes another Reddit user. “It’s good to eat healthily and exercise but we know that already so there isn’t much to talk about. As for the whole vanity thing…meh.” [All sic.]

Perhaps the most unhealthy way men deal with their body image issues is by going to the absolute opposite extreme — taking a perverse pride in being overweight and wearing it as a mark of their manhood. The underlying message is that only some pussy, feminine soy boy would care about being skinny. “It hurts us as men,” Olivardia says. “We don’t live as long as women, and one of the reasons why is we’re less likely to pay attention to what we eat.”

Beneath it all, though, is a lingering desire to discuss these issues openly and honestly. Why all the protest otherwise? And the irony is that not discussing it is the very thing that prevents men from achieving better health.

“Men, in general, aren’t socialized to be connected to our emotions in the same way women are,” Olivardia adds. “Truth is, if men are emotionally connected to their bodies, they’ll be more motivated to change their habits. You have to feel connected to something to be motivated to do something about it.”