Publisher’s note: This article is published here under a pseudonym. It was written by a mainstream journalist who encountered significant push back and refusals when he tried to have it published in more mainstream channels. Thus he turned to us here, where the facts matter more than the narrative. PE

The Seattle Times released an article earlier this year explaining that the suicide rate for teenage girls has skyrocketed: 524 died by suicide in 2015, a 200 percent increase from 2007. The article is filled with questions on the state of modern teenage life and hypotheses on the rise of teenage female suicide. Within the article, whispered at the end of a paragraph for passing context, is a far more startling statistic: 1,537 teenage boys died by suicide that same year.

Males in the U.S. die by suicide so much more than females that the rate is an astounding 3.5 to 1, or 78 percent of all suicides. That equates to once every 15 minutes. The “gender paradox in suicidal behavior” has been the case as far back as records go — and though there are variations from country to country, this disparity is also present throughout the world. Men and boys of all cultures kill themselves more than women and girls.

Yet the professional response to this is one of neutrality. The website for the American Foundation for Suicide Prevention (AFSP) has comparative graphs of suicide by state, age, and even race, yet none for gender. There is no mention of gender beyond the 3.5 statistic, and no section discussing male suicide. Even in its opening video on the front page there are no men, save a few in the background of a crowd. There is similar sparse acknowledgement from the American Association of Suicidology (AAS) and the Suicide Prevention Resource Center (SPRC). The SPRC has an underdeveloped section about men in their “populations” tab.

Speaking with experts revealed a similar attitude. In a phone interview, Dr. Yeates Conwell of the University of Rochester Medical Center was asked by the author “if I wanted to lower the disparity in the U.S., what should I do?” His response was “I don’t know if I agree with that premise. The way we look at it is that there’s close to 45,000 deaths by suicide every year [in the U.S.], and the objective is to reduce that mortality.”

Doctor Jill Harkavy-Friedman, vice president of research at AFSP, expressed a similar attitude during a phone interview. Questions about the disparity were met with noncommittal responses: we are trying to keep all suicides down, and perhaps men should seek mental healthcare more.

This is not the medical community’s usual approach to a problem that affects a subgroup so heavily. Breast cancer, for example, is a gendered problem that is admitted as such. The American Cancer Society, breastcancer.org, and webmd.com/breast-cancer are explicitly female focused. We have charity drives and pink ribbons. The NFL launched the “A Crucial Catch” program in 2009, which raises about $1.9 million annually. The awareness programs are filled with celebration, panache, and a large viewership. There is no concomitant response for male suicide.

Males do have an organization or two around the globe. There is Movember, an Australian movement about men’s health issues (including suicide) whose growth to worldwide fame was driven by their public relations move of sporting a mustache every November for awareness. The Coalition Against Living Miserably, or CALM, is a British organization and the only significant one in the world whose prime directive is male suicide prevention. There is the quasi-joke site Man Therapy, which is more a slight against men than anything: they can only understand their feelings if wrapped in a package of leather boots and Clint Eastwood movies.

Why is there a reluctance to approach suicide in a gendered manner when nearly 80 percent of all suicide deaths are male? It may come from the murky explanations for the disparity itself, leaving experts wary of committing to something that may lead to further suicides if wrong.

Experts have no concrete theory, but they do have hypotheses. Males on average have a smaller social group over time, so they have less support when they need it. They see their doctors less, so are less likely to be flagged as having a physical or mental problem that could put them at risk. Males also use more guaranteed methods of suicide, such as firearms, whereas females most often choose overdosing.

The basis for these are social, in the form of gender roles that can easily paint unflattering stereotypes about men: emotionally simplistic tough-guys who bottle up their feelings until they one day use a “manly” method to inflict self-death instead of reaching for help. Toxic masculinity teaching men that they should rather die than allow themselves to be vulnerable in a therapist’s office. The problem with the data available is that there is no concerted, field-wide analysis of it, which leaves both medical professionals and laypeople open to creating any number of theories and narratives.

The male disparity in the U.S. is 3.5 to 1, however females attempt suicide three times more than males; a curious reverse of the ratio. Dr. Julie Cerel, president of AAS, has said that “men notoriously don’t seek help,” which is true for doctor’s visits, but its connotation of men being stubborn may be misleading. The reverse ratio for attempts may mean that at the moment when someone can reach for help or reach for suicide, it is females who reach for suicide far more — and who could be called the “stubborn” gender, if we feel we have to make the judgement Cerel seemed to be making. The Seattle Times article noted Professor James Mazza of the University of Washington as saying “males have higher rates of ADHD, substance abuse or anti-social behaviors that are easier to spot, so they might have a better chance of receiving help [for a depressive episode],” yet females are diagnosed with the suicide risk of depression twice as much — meaning their gendered risk factor is being caught and getting a similar “chance of receiving help.”

Every theory can be easily filled with implicit blame, further encouraging the suicide prevention community from taking anything other than a neutral stance.

Among the theories available for the disparity, a discerning form comes from Dr. Silvia Canetto of Colorado State University, who applies to suicidal behavior what is called “cultural scripts theory.” According to cultural scripts theory, we all have scripts written out by culture, characters to play and lines to read, that tell us what to value and why we are valuable. How cultural scripts theory fits in with the values of men and women can be shown in the one exception to the rule for the worldwide gender disparity in suicide: China.

In China females die by suicide at a rate of 3 to 1, concentrated in the rural areas. Women in rural China are the glue and workhorse of the family unit, expected to maintain care and keep the peace in households that are often multigenerational. The culture of China pressurizes this position. For example, when women are hospitalized due to mental illness, the average length of stay is more than 28 days, whereas for men it is more than 38. Dr. Su Zhonghua, vice president of Daizhuang Hospital, Jining Medical School, explained in a World Health Organization (WHO) article that “many female patients are [asked to be] discharged as soon as they show signs of recovering,” because they are needed at home. Add in a cultural script that supports suicide as a way to avoid shame and the widespread access to lethal means in rural China in the form of farming pesticides, and you have a lethal recipe: women who feel perpetually overworked, undervalued, and encouraged to die by suicide if they commit some social wrongdoing.

Perhaps, then, feeling valued is a key component to the problem. Is it easier for males to feel worthless than females? Do negative mental health factors build up or stay longer in males? Canetto’s research into the suicide rate of elderly men and women suggest that elderly men may be more rigid and narrow in their concept of what to value and what makes them valuable. Elderly men, for example, do not bounce back from their spouse dying or divorcing them as well as elderly women. They define their spouse as having value, and if that value vanishes, it is difficult for them to fill that void.

Harkavy-Friedman explained that “4.8 million people lost their jobs [in the recession] and they didn’t all kill themselves.” Even though mental illness is present in the majority of suicides, it is still the minority of people with mental illness who practice fatal and nonfatal suicidal behavior, and most people who suffer through extreme hardship do not become suicidal. Harkavy-Friedman suggested that there may be a separate “suicidal urge” that turns these risk factors dangerous. This may give further credence to the value idea within cultural scripts theory: it is not any specific factor or factors, it is these stressors reaching a mysterious tipping point that falls over into making someone feel valueless. A male rigidity in replacing values when the old ones are gone may be a component in the larger mysterious tipping point in males.

Whatever the reasons are for the gender disparity, there are only two areas to look at: nature and nurture. Research tends to focus on nurture. There is a body of research investigating biological causes, though it is somewhat underdeveloped. Conwell explained “I know people who have proposed to study the role of testosterone, for example, and its effects on suicide. I don’t know that that’s panned out. There is a body of neurobiological literature which says that altered neurotransmitter function, in particular serotonin, is a predisposition to impulsive and aggressive behavior. There may be gender-related differences in how that abnormality or imbalance in chemical messengers plays out in men.”

The long shadows of our bigoted past still haunt us in the present, threatening to birth new movements based on inaccurate interpretations of research. Cultural fears aside, however, is this an avenue worth pursuing?

Transgender people are much more likely to die by suicide if their chosen gender identity is shunned rather than accepted. The prevailing expert opinion is that transgender people are born that way, meaning there is a strong biological component. It would only do damage to suggest to transgender people that they can lower their suicide rate by going against biology and not reassigning their gender. If expert opinion is that transgender people’s brains differ in certain ways, do the brains of heteronormative men and women differ?

The answer is that they do. The gender disparity may be caused in part by biological drivers, compounded by cultural expectations that create additional pressures that are gender specific. Going back to Canetto’s research on the elderly: if, for example, males are biologically less flexible regarding value, the addition of the cultural expectation of the independent man who can hold his own only makes a difficult problem more complex and entangled. How biology and culture interact can be a crucial area of inquiry. It is important to note here that while research shows male and female brains differ, what that means is not understood enough to say anything definitive — if it means anything at all.

Cultural scripts theory still leaves out the value of value: whether what we currently tell people to value or not to value is a good idea or not, whether our cultural scripts are valuable or not. This must be answered before taking preventative steps, because we do not want to attempt to lower the gender disparity by telling males to stop performing a cultural script that we would be better off having (e.g., if you are pro-military and believe encouraging men to go to war and possibly coming back with the suicide risk factor of PTSD is worth the risk). The same issue is present in females who attempt suicide three times as much as men. Every cultural script has pros and cons, and it is a dangerous task discerning which outweighs the other.

The issue with addressing the gender disparity, as we are starting to see, is not necessarily that there is a lack of research; it is that to reduce male suicide, experts have to step outside of statistics and move into moral philosophy. Experts would have the job of taking the pen from biology and society and rewriting our cultural scripts — which if written wrong will literally kill people. And as we have seen with the enormous difficulties the “right to die” movement has faced in amicably ending the lives of those with terminal illness, presenting suicide and its risk factors in any way except blanket condemnation is met with swift resistance.

So experts abstain from addressing that side of the argument, instead providing the public with a list of risk factors floating in the medical aether: difficult access to mental health care, having a mental illness, early trauma, head injury, being overly stressed, access to lethal means (e.g., guns), and having a close relative that has died by suicide. The primary protective factors are social support and access to mental health care. They produce these lists and wait for other forces to write the novel of society.

The mental health community vehemently cares about suicide in general, and many have devoted their entire lives to saving both genders, but to highlight the higher suicide rate of males is to be viewed as off-message.

There is a clear gendered problem to suicide, thousands of men disproportionately killing themselves, and yet the suicide prevention community suggests “reducing the [total] mortality” and forwarding joke sites that belittle men. The AAS has a “suicide myths” section saying “Myth: only white males die by suicide… Fact: while some demographic factors contribute to a higher risk for suicide, it is important to remember that suicide does not discriminate.” Seventy-eight percent of all suicides complicates that statement.

Reading this article took about 15 minutes. And so another man goes, from being to nothingness.

If you or someone you know needs help, go to suicidepreventionlifeline.org or call 1-800-273-8255. For help outside of the U.S., find your country here.