The role of music therapy and music-based interventions in male mental health: a narrative review of mechanisms, barriers, and clinical implications.

Background/Objectives: Men bear a disproportionate burden of undertreated mental health problems globally yet consistently underutilize formal psychological services, primarily due to traditional masculine norms that frame help-seeking as incompatible with masculine identity. Music therapy and music-based interventions offer a promising pathway that may circumvent these barriers by providing masculinity-congruent, non-clinical contexts for emotional expression and social connection. This narrative review synthesizes evidence on the mechanisms, outcomes, and clinical implications of music therapy and music-based interventions for male mental health, advancing the gateway mechanism hypothesis as a novel theoretical framework. Methods: A systematic search was conducted across PubMed and the University of Alberta Library Primo discovery platform in June 2026, searching across PsycINFO, CINAHL, MEDLINE, Academic Search Complete, Web of Science, Scopus, and additional databases. Search strings targeted music therapy in combination with male mental health, depression, anxiety, veterans, PTSD, and related terms, yielding a combined multi-database pool of approximately 1,243 results. After screening for relevance and applying inclusion criteria, 38 peer-reviewed sources were included in this narrative review conducted in accordance with SANRA guidelines. Results: Evidence from randomized controlled trials, systematic reviews, and qualitative studies supports music therapy's effectiveness for depression, anxiety, PTSD, and trauma across predominantly male populations, with the strongest evidence in military veterans. The gateway mechanism hypothesis proposes that music functions as a masculinity-congruent, low-threat entry point through which men gradually develop psychological safety, engage in licensed emotional expression, and move toward help-seeking. The most direct experimental support comes from the Boys Do Cry RCT, which found that a music video significantly improved men's help-seeking intentions compared to non-musical control conditions. Evidence gaps persist around racialized, Indigenous, and 2SLGBTQ+ men, and around non-Western and low-income contexts. Effect sizes where reported are small to moderate; most studies are limited by small samples, heterogeneous designs, and absence of sex-disaggregated reporting. Conclusions: Music therapy represents a clinically meaningful, non-stigmatizing, and evidence-supported pathway to male mental health engagement. Practical implications include framing music-based programs around musical participation rather than mental health, prioritizing group formats, and selecting genres that align with participants' masculine cultural identity. Future research should employ longitudinal designs testing the gateway mechanism directly, incorporate validated masculinity norms instruments, ensure sex-disaggregated reporting, and develop culturally adapted approaches for diverse male populations globally.