Why NH Men Die Young: Cardiovascular Disease, Suicide, and the Masculinity Factor

The Best Hikes in The White Mountains of New Hampshire: Part 1 — Leave The Map

A candid look at why Granite State men under 50 are dying more often than women — and what’s stopping them from asking for help

The uncomfortable starting point: men are dying earlier

Across the United States, men die younger than women at every age group, and they die more often from preventable causes — heart disease, accidents, and suicide top the list. National data show higher death rates for males than females in each working-age bracket; for example, men 25–34 and 35–44 have roughly 2–3 times the mortality rate of women the same age. (Sci-Tech Today)

New Hampshire follows that pattern. Heart disease, cancer, and accidents are the top causes of death overall in the state, mirroring national trends. (State Regs Today) But when you zoom in on people under 50, the picture shifts:

Unintentional injury (especially overdoses and crashes) and suicide dominate the top causes of death for Granite Staters aged 10–34.
From 2013–2022, suicide was the second leading cause of death for ages 10–34 in NH, behind unintentional injuries. (Naminh)
Suicide was also the fourth leading cause of death for ages 35–44 in 2023. (NH Coalition for Suicide Prevention)

And those suicides are overwhelmingly male. A major 2025 New Hampshire Suicide Prevention Council report shows that between 2016 and 2022:

78% of suicide deaths in NH were male, despite men and women being close to a 1:1 ratio in the population.
Among youth and young adults aged 10–24, 77% of suicide deaths were male. (Naminh)

At the same time, heart disease — traditionally thought of as a “grandfather” problem — is quietly killing and disabling men in their 30s and 40s, often after years of undiagnosed high blood pressure, high cholesterol, and untreated stress. Nationally, heart disease remains the leading cause of death for men, and cardiovascular disease accounts for about 1 in 3 deaths overall. (CDC)

So if you’re a man in New Hampshire under 50, your biggest threats aren’t random. They’re a cluster:

Cardiovascular disease, suicide, addiction, and risk-heavy behavior — all wrapped in cultural expectations about what a “real man” should be.

This report looks directly at that cluster. Not to scold men, and not to romanticize stoicism, but to ask:

Why are New Hampshire men under 50 dying at higher rates than women?
Why do they so often die from things we could prevent?
And what is it, exactly, about masculinity — especially in a “Live Free or Die” state — that keeps men from getting help in time?

The data: what’s killing men in the Granite State

Suicide: high rates, male-dominated

New Hampshire’s suicide rate is about 35% higher than the national average, placing the state around 12th highest in the country. (NH Coalition for Suicide Prevention)

The latest suicide overview for NH (2016–2022) shows: (Naminh)

Total suicides (2016–2022): 1,756
- Male: 1,374 (78%)
- Female: 382 (22%)
By age group:
- 12% of deaths were ages 10–24
- 67% were ages 25–64
- 20% were 65+

And when you look specifically at young people:

Between 2018 and 2022, 219 NH youth and young adults (10–24) died by suicide.
77% of those deaths were male.
Firearms were the most frequently used method among youth and young adults, followed by hanging. (Naminh)

Table 7 in the same report shows crude suicide death rates per 100,000 by age group (2018–2022): (Naminh)

Ages 10–17: 5.0 (NH and US are similar)
Ages 18–24: 18.6 (NH; higher than the US 16.3)
Ages 25–39: 22.9 (NH vs 18.4 US)
Ages 40–59: 23.6 (NH vs 18.8 US)

Suicide isn’t just more common in New Hampshire than nationally — it’s especially elevated for people in their late teens through mid-life. And within that, it’s a male story.

Cardiovascular disease: the slow-burning male killer

Cardiovascular disease (CVD) — heart attacks, strokes, and related conditions — is still the number one cause of death in the U.S., and New Hampshire is no exception. (CDC)

Key national facts:

Heart disease is the leading cause of death for men in the United States. (CDC)
In 2023, about 919,000 people died from cardiovascular disease, roughly 1 in every 3 deaths. (CDC)
Over half of U.S. men (50.6%) had high blood pressure in 2017–2020, a major risk factor. (CDC)

In New Hampshire specifically, a recent cardiovascular outlook report notes that:

CVD remains a leading cause of death, with heart disease and stroke ranking among the top killers.
After years of decline, cardiovascular mortality has begun to rise again, reflecting worsening risk factors like obesity, high LDL cholesterol, and uncontrolled blood pressure. (Take Health to Heart)

Heart disease deaths still skew older overall, but that’s misleading. Men often start experiencing silent damage in their 30s and 40s — elevated blood pressure, clogged arteries, diabetic changes — long before they would traditionally be labeled “heart patients.” Clinical guidance points out that heart risk in men begins to climb sharply after age 45, and many sudden fatal heart attacks occur in men with no prior diagnosis. (St. Mary’s Medical Center)

Put simply:

By the time a New Hampshire man in his 40s drops on a jobsite or in his driveway, the medical system has usually been missing him for years.

Add in drugs, alcohol, and risk

New Hampshire’s overdose crisis is well known, and overdoses are counted under “unintentional injuries” — the same category that already ranks as the top killer for ages 10–34 and a major cause through mid-life. (Naminh)

That same injury category also absorbs:

Car and motorcycle crashes
Workplace injuries (especially in construction, logging, and manufacturing)
Risk-heavy recreation (ATVs, snowmobiles, backcountry hiking)

Men are over-represented in all of those. So when we ask why NH men under 50 die young, we’re really asking about a bundle of overlapping risks:

Heart disease and stroke developing earlier and progressing silently
Suicide, often via firearms
Overdose deaths, often blended with depression, chronic pain, or economic stress
Risky work and recreation, often wrapped in “toughness” culture

Those numbers don’t sit in a vacuum; they sit in a culture with a very particular script for men.

“Live Free or Die,” masculinity, and the New Hampshire mindset

New Hampshire’s official motto — “Live Free or Die” — was adopted in 1945 but traces back to a 1809 toast by General John Stark: “Live free or die: Death is not the worst of evils.” (New Hampshire Government)

That phrase isn’t just on license plates; it’s part of the state’s identity:

Independence
Skepticism of authority
A preference for self-reliance over systems

None of that is inherently unhealthy. But mix it with traditional male norms — stoicism, emotional control, risk-taking — and you get something that shows up in hospital charts and autopsy reports.

Public health researchers now describe “harmful” or “rigid” masculinity norms as a genuine health risk. The World Health Organization and academic experts note that:

Rigid male norms encourage men to ignore pain, avoid vulnerability, and downplay illness.
These norms are linked to higher rates of heart disease, stroke, violence, substance misuse, and suicide. (Brown School of Public Health)

A 2024 study from University of Chicago researchers found that men who scored high on “stereotypical male gender expression” were less likely to report or be treated for cardiovascular risk factors like high blood pressure — even when objective measurements showed they had those conditions. (UChicago Medicine)

Translated:

The more a man sees himself (and is seen by others) as “a real man,” the less likely he is to admit he’s in trouble — physically or mentally — until that trouble is life-threatening.

In New Hampshire, that plays out on top of:

Strong gun culture and high firearm ownership, which intersect with suicide risk. (Johns Hopkins Public Health)
Rural communities where neighbors help each other, but professional help can be far away.
A political culture that prizes minimal government intrusion, which can translate into under-investment in public health and mental health infrastructure. (NH DHHS)

That combination — stoic masculinity plus “live free” individualism — helps explain why men in the Granite State are so over-represented in cardiovascular deaths, suicides, and overdoses long before age 50.

Why men don’t show up: the barriers they’ll never list on a form

When you ask men directly why they don’t seek help, you mostly hear individual-level answers:

“I didn’t want to be a burden.”
“I figured it would go away.”
“I didn’t want to look weak in front of my kids/coworkers.”

But the research suggests something more structural and cultural is going on.

1. Masculine norms that punish vulnerability

Qualitative studies of men with depression show that internalized masculine ideals — self-reliance, emotional control, dominance — actively delay help-seeking. Men often reinterpret depression as a personal failing rather than an illness (“I should be stronger”), which keeps them away from therapists, doctors, and even close friends. (Frontiers)

Brown University’s School of Public Health summarizes it bluntly:

Harmful masculinity is now recognized as a public health problem that discourages help-seeking and feeds higher rates of violence and mental health struggles. (Brown School of Public Health)

In New Hampshire, local advocates echo this. NAMI NH’s “Men’s Mental Health: Two Perspectives” commentary notes that men account for roughly 75% of suicide deaths nationally and that many men have never talked about their mental health with anyone. (Naminh)

2. A health system not designed around men’s behavior

Primary care and mental health systems assume a kind of patient that doesn’t actually exist for many men:

Someone who schedules regular checkups
Someone who tracks symptoms and reports them accurately
Someone who has flexible work hours and comfort with “talking about feelings”

NH’s 2024 health-care workforce report points to significant shortages in primary care and behavioral health, especially in rural parts of the state like Sullivan County and the North Country. (NH DHHS)

So a man in his 30s working construction in Coos County has to overcome:

Internal stigma (“I’m fine, I just need to push through”)
Lack of time and money to take off work
A very real shortage of nearby providers
Systems that still feel culturally shaped around women and children more than blue-collar men

3. Firearms, privacy, and fear of judgment

In NH, firearms are often part of identity — hunting, sport shooting, collecting, self-defense. For many men, that’s not just a hobby; it’s wrapped up in family tradition and personal autonomy.

Now layer in the fact that guns are the most common method of suicide in the U.S. and in New Hampshire, and they account for a large majority of male suicide deaths. (Johns Hopkins Public Health)

When mental health or medical providers are perceived as “anti-gun,” many men pull back entirely rather than risk being judged or having their access restricted.

This is exactly why the NH Firearm Safety Coalition and the Gun Shop Project are so important: they bring firearm retailers, rights advocates, and suicide-prevention experts together to promote voluntary, temporary off-site storage and recognize the warning signs when a customer may be at risk. (Harvard Public Health)

Those initiatives are built on respect for gun culture, not contempt for it — which makes men far more willing to listen.

4. Economic stress and identity

Suicide fatality review in NH has flagged recent job loss and economic instability as key precipitating factors in some male suicides. (Naminh)

For many men, especially in trades, manufacturing, or the military, identity is fused with being a provider and protector. When that role is threatened — layoffs, injury, business failure, divorce — it doesn’t just hurt the wallet; it hits the core of “who I am as a man.”

Without a healthy language for fear, shame, or grief, that pain often gets rerouted into:

Drinking or drug use
Aggression
Withdrawal
Hopelessness that looks like “he just checked out” to others

Sometimes the first “symptom” anyone notices is a gunshot.

How New Hampshire is trying to respond — and where it falls short

New Hampshire isn’t ignoring this; in many ways it’s punching above its weight in innovation. But the gap between innovation and everyday reality is still wide.

Crisis services and 988

NH has adopted the Crisis Now model for behavioral health, with three pillars:

Someone to talk to: 988 Suicide & Crisis Lifeline and the NH Rapid Response Access Point (833-710-6477). In 2023, Rapid Response handled over 34,000 contacts and served more than 10,000 unique individuals. (Naminh)
Someone to respond: mobile crisis teams dispatched across the state (over 6,600 mobile crisis calls in 2023). (Naminh)
Somewhere to go: crisis stabilization centers in development. (Naminh)

That’s infrastructure most states are still struggling to build. But men will only use it if:

They believe crisis lines are for “people like me,” not just teens or those already in treatment.
They hear other men, especially veterans, first responders, and tradesmen, saying publicly, “I called. It helped.”

Firearm-focused suicide prevention

New Hampshire is the birthplace of the Gun Shop Project, now a national model. (Harvard Public Health)

Gun shops display materials on suicide warning signs and safe storage.
Retailers are trained to recognize red flags and offer voluntary storage or waiting periods.
Messaging is framed as protecting your family and your community, which resonates with masculine values of responsibility and protection.

This is masculinity-aware public health: it meets men where they actually live — at gun counters, hunting clubs, and ranges — rather than expecting them to show up in therapists’ offices first.

Workforce and access challenges

Despite progress, NH’s own workforce report acknowledges: (NH DHHS)

Severe shortages of behavioral health providers across rural areas
Difficulty recruiting and retaining clinicians
Growing demand outpacing supply, especially for substance-use and dual-diagnosis treatment

So even when a man reaches the point of saying “I’m ready,” he may run into waitlists, long drives, or insurance barriers — all of which reinforce the message: “See? No one can help you anyway.”

What actually works: evidence-based ways to keep men alive

Let’s move from diagnosis to prescription. What does the evidence say actually helps men live longer, healthier lives in places like New Hampshire?

1. Reframing help-seeking as strength, not weakness

Studies of men who did get treatment for depression show that after engaging with services, many re-evaluated their ideas about masculinity and started to see seeking help as responsible, not weak. (Frontiers)

Effective campaigns and interventions tend to:

Use plain language, not jargon.
Center responsibility to family and community (“Your kids need you alive” hits harder than “You deserve wellness”).
Feature local men telling their own stories — veterans, cops, tradesmen, coaches — not generic public-health stock photos. (Brown School of Public Health)

2. Integrating mental health into primary care and cardiology

Men are more likely to see a doctor for chest pain than for panic attacks, even when the panic attacks came first. Integrating mental health into primary care and cardiology visits means:

Routine depression and substance-use screening during blood pressure or cholesterol checks.
Cardiologists and primary-care clinicians explicitly linking stress, isolation, sleep, and drinking to heart risk — and offering concrete options, not vague “you should talk to someone.” (CDC)

The University of Chicago masculinity/CVD study is also a wake-up call: clinicians shouldn’t assume that a man who looks “put together” and is joking about his numbers is actually managing his risk. In that study, men who endorsed more traditional masculine attitudes were less likely to have their hypertension and other risk factors diagnosed and treated, despite abnormal readings. (UChicago Medicine)

3. Lethal-means safety, especially around firearms

When a suicidal crisis hits, the time between decision and attempt is often minutes to an hour, not weeks. Removing or securing lethal means during rough patches dramatically reduces death, even if the underlying distress remains.

Evidence-based steps include: (Harvard Public Health)

Temporary off-site firearm storage during periods of intense stress, substance relapse, or marital crisis.
Lockboxes and safes with family-level agreements about who can access guns and when.
Training trusted peers (range owners, hunting buddies, veterans’ groups) to spot the signs of acute suicidal risk and initiate conversations.

This isn’t about confiscation; it’s about buying time.

4. Targeted prevention at key transition points

NH data show spikes in suicide risk at life transitions: late adolescence, early adulthood, mid-life, and very old age. (Naminh)

For men under 50, that means focusing on:

High school/college-age young men (especially in trades programs, the military, or first responders).
Men in their 30s and 40s facing divorce, job loss, or serious health news (like a new heart disease diagnosis).
Recently released inmates or people leaving rehab, who have elevated overdose and suicide risk. (CDC)

Programs that embed supports into those transitions — reentry programs, peer mentoring in workplaces, active post-rehab follow-up, veterans’ peer groups — have much better outcomes than “you can call this number if you feel bad.”

What New Hampshire could do next — concrete moves

A. Treat men’s health as a unified issue, not separate silos

Right now, heart disease, mental health, addiction, and suicide are often handled as separate policy worlds. But on the ground, they’re the same guy.

Policy makers and health systems in NH could:

Create a Men’s Health and Resilience Task Force that explicitly connects CVD, suicide, addiction, and occupational risk.
Use NH’s Health Care Workforce planning to prioritize male-friendly outreach — extended hours, mobile clinics at worksites, and partnerships with unions, veteran groups, and sports leagues. (NH DHHS)

B. Build masculinity-aware messaging into every campaign

Instead of generic “end stigma” posters, NH can lean into its own identity:

“Live Free or Die — but not from silence.”
“Strong enough to get checked.”
“Your crew needs you around. Get your heart and your head checked.”

Back those slogans with:

Testimonials from local men who survived heart attacks in their 40s or survived suicide attempts.
Visible campaigns in male-dominated spaces: job sites, gun shops, gyms, hockey rinks, police and fire stations. (Naminh)

C. Expand practical supports, not just hotlines

For many struggling men, the barrier isn’t just emotional — it’s financial and logistical.

NH could expand:

Low-barrier walk-in mental-health and addiction clinics with evening and weekend hours. (NH DHHS)
Integrated “cardio + mental health” visits in community health centers.
Paid time-off incentives or tax credits for employers who provide regular health screenings on site.

D. Keep innovating on firearms and suicide prevention

New Hampshire is already a national model here; doubling down could save even more lives:

Expand the Gun Shop Project to ATV dealers, feed stores, and other male-heavy retail spaces. (Harvard Public Health)
Develop a voluntary, legally protected “time-out” firearm storage framework that’s simple to use and widely advertised.
Train primary-care providers and cardiologists to talk about firearm storage the same way they talk about seatbelts and statins — calmly, non-politically, and focused on family safety.

What men, families, and communities can do right now

This isn’t just a job for policymakers. It’s a kitchen-table, shop-floor, locker-room job too.

For men

Get your numbers checked. Blood pressure, cholesterol, blood sugar, weight. If you’re over 35 and haven’t had a physical in a few years, that’s your starting point. (CDC)
Notice the early warning signs: persistent chest discomfort, shortness of breath on exertion, jaw or arm pain, crushing fatigue, sudden rage or hopelessness, escalating drinking or drug use, thoughts like “everyone would be better off without me.”
Talk to someone: a doctor, a therapist, a trusted friend, a pastor, a union rep, a coach. Silence is not stoicism; it’s corrosion.
Lock up firearms and make a crisis plan: where your guns go and who you call if you hit a suicidal or deeply impulsive moment. (Johns Hopkins Public Health)

For partners, families, and friends

Don’t wait for perfect words. “You haven’t seemed like yourself lately — I’m worried about you” is enough to open a door.
Be specific: “Let’s get your blood pressure checked,” “Let’s call 988 together,” “Let’s talk to your doctor about the stress you’re under.” (Naminh)
Normalize help: share your own experiences with therapy, medication, rehab, or support groups.

For communities

Invite local men to speak openly at town halls, Rotary meetings, union gatherings, and church events about surviving heart attacks, depression, or suicide attempts.
Partner with NAMI NH, the NH Suicide Prevention Council, and local health systems to host Men’s Mental Health nights at fire halls, VFW posts, and sports leagues. (Naminh)

References (selected)

Mortality, suicide, and NH-specific data

New Hampshire Suicide Prevention Council & NAMI NH. Final 2023 Annual Suicide Report (esp. Tables 7–10, youth and age-group data). (Naminh)
Zero Suicide NH. “New Hampshire’s suicide rate 35% higher than national average.” (NH Coalition for Suicide Prevention)
CDC WONDER & CDC NCHS, national death rates and state statistics. (CDC)
USAFacts and New Hampshire health statistics summaries on leading causes of death. (State Regs Today)

Cardiovascular disease and men

CDC. Heart Disease Facts and About Men and Heart Disease pages. (CDC)
American Heart Association. 2025 Heart Disease and Stroke Statistics Update and NH cardiovascular outlook. (www.heart.org)
Clinical articles on men and coronary disease risk trajectories. (St. Mary’s Medical Center)

Masculinity, help-seeking, and mental health

Brown School of Public Health. “Men, masculinity, and mental health.” (Brown School of Public Health)
Frontiers in Psychiatry. “Masculinity and Help-Seeking Among Men With Depression.” (Frontiers)
University of Chicago Medicine. Study on male gender expression and cardiovascular risk management. (UChicago Medicine)

New Hampshire culture, systems, and initiatives

NH DHHS. Mental Health portal and 2024 Health Care Workforce and Data report. (NH DHHS)
NH Firearm Safety Coalition, Gun Shop Project, and related Harvard Means Matter documentation. (Harvard Public Health)
NH state motto sources and cultural commentaries. (New Hampshire Government)

None of this is destiny. Heart disease can be treated early. Suicide is preventable. Addiction is treatable. What kills too many New Hampshire men under 50 isn’t just biology; it’s a set of rules about how men are supposed to act when they’re scared, sick, or overwhelmed.

Change those rules — in clinics, in gun shops, on job sites, and around kitchen tables — and “Live Free or Die” stops being a quiet prophecy for men in their prime and goes back to what it was meant to be: a demand for a life worth living, not an early exit.

Why NH Men Die Young: Cardiovascular Disease, Suicide, and the Masculinity Factor

A candid look at why Granite State men under 50 are dying more often than women — and what’s stopping them from asking for help

The uncomfortable starting point: men are dying earlier