“Strong Enough to Suffer”: Emotional Suppression, Stress Exposure, and Physiological Health Among Men Across the Life Course

Abstract

This study examines whether habitual emotional suppression—a response-focused emotion regulation strategy documented to be more prevalent among men adhering to traditional U.S. masculine norms—predicts chronic physiological dysregulation across the life course. Using a cross-sectional sample of 412 men aged 25–70 years recruited in a single U.S. metropolitan region, we measured habitual suppression with the four-item Suppression subscale of the Emotion Regulation Questionnaire (ERQ), diurnal salivary cortisol collected across three weekdays as an index of hypothalamic–pituitary–adrenal (HPA) axis regulation, and inflammatory burden as a z-standardized composite of serum high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Masculine norm conformity was assessed using the Emotional Control subscale of the Conformity to Masculine Norms Inventory-46 (CMNI-46), and stressor exposure was indexed by a life events checklist. Structural equation models (SEMs) indicate that habitual suppression significantly predicts flatter diurnal cortisol slopes (β = 0.34) and elevated inflammatory burden (β = 0.28) after controlling for demographics, health behaviors, and medical factors. Suppression also acts as a stress amplifier, magnifying the physiological effects of stressor exposure beyond additive contributions. Age-stratified analyses demonstrate that suppression effects strengthen across the life course, consistent with cumulative biological loading. Mediation analyses indicate that suppression explains 38%–43% of the association between masculine norm conformity and physiological dysregulation. These findings position emotional suppression as a biologically consequential risk pathway through which masculine gender socialization is physiologically embodied among men in the United States.