Abstract
Male infertility is often framed as a profound threat to masculinity, particularly within patriarchal contexts where fatherhood is central to male identity. Drawing on nine months of qualitative research at a private fertility clinic in Lahore, Pakistan, this article analyzes men's responses to the social, cultural, and emotional disruptions triggered by a clinical diagnosis of male infertility. Interpretive thematic analysis of in-depth interviews with these men revealed that infertility does not simply produce emasculation or sense of loss. Rather, it pushes them to actively intensify and mobilize existing masculine scripts of endurance, provision, religious faith, and alternative pathways to fatherhood. The study employed the term inflating masculinity as an analytical lens to describe the ways these men expanded the boundaries of hegemonic masculinity without destabilizing its underlying logics. Participants reframed invasive medical treatments as tests of endurance, emphasized financial sacrifice as evidence of responsibility, invoked religious interpretations of infertility as divine trials, and, in some cases, reworked adoption as a legitimate expression of paternal authority. These strategies enabled men to maintain alignment with the dominant gender norms while negotiating reproductive disruptions. By grounding the analysis in men's situated narratives, this study empirically contributes to the sociological debates on masculinity and reproduction in non-Western contexts. Primarily, it adds that hegemonic masculinity is not merely challenged by infertility but actively negotiated and intensified through culturally specific practices. Taken together, these dynamics highlight the adaptive and relational nature of masculinity under conditions of reproductive uncertainty.
Keywords
Introduction
Unlike many Euro-American contexts where infertility is primarily understood as a private medical issue, in South Asia it carries a collective significance (Saeed, 2024). Reproductive concerns extend beyond the individual couple to become a matter of family and kinship. Elders’ and relatives’ involvement in decisions about treatments reflect broader hierarchies of age, gender, and lineage (Herrera, 2013). The religious framework further informs the medical diagnosis and its interpretations, where infertility is understood not only as a medical condition but also as an expression of divine will, fate, or a moral test. In this sense, infertility is simultaneously socially embedded and morally governed. The interpretive framework grounded in patience (sabr), supplication (dua), and acceptance of divine will does not merely provide coping strategies but actively shapes the normative expectations through which men's responses are evaluated. Consequently, stigma, responsibility, and intervention are distributed across extended family networks. Masculinity, therefore, is embedded within the wider social and moral economy rather than confined to the individual body (Inhorn, 2012).
Anthropological research within this socio-religious context has long described South Asian gender relations through agrarian metaphors, in which husbands are cast as farmers and wives as fertile land. The best farmers are those who possess the ability to cultivate the land and produce a successful yield, symbolically represented in the form of offspring (Ali et al. 2011). Fatherhood, therefore, is not simply a personal milestone but a public marker of identity and social legitimacy (Webb & Daniluk, 1999). Similarly, within Pakistan, masculinity is closely tied to izzat (honor), nasl (lineage), and the capacity to provide financially (Blell, 2018; Gulzar & Iqbal, 2017). These expectations are further reinforced through Islamic teachings, which position men as responsible providers and moral heads of the family.
When couples in Pakistan are unable to conceive despite sustained efforts and medical interventions, infertility becomes a site of uncertainty, social scrutiny, and familial pressure (Amjad, 2024). Within the religious framework, infertility is perceived as a condition that not only disrupts biological reproduction but also men's ability to fulfill culturally and religiously sanctioned gender roles. While women are mostly subjected to overt blame and public gossip, men encounter a quieter form of judgment. This includes insinuations and unspoken doubts that undermine their masculine authority and virility (Khan & Yahya, 2024). Due to the stigma that silences male vulnerability, research on men's emotional and social experiences of male infertility remains limited, particularly in Pakistan, despite rising numbers of cases (Amjad, 2022). This absence is striking given the centrality of fatherhood as a defining marker of masculine legitimacy (Greil et al., 2010).
Existing research demonstrates that infertility in men generates a crisis of what Vandello and Bosson (2013) term “threatened masculinity,” in which men's gender identity becomes precarious and must be actively defended. They further argued that responses to these threats are not uniform and should not be treated as such. Some men in this situation retreat into silence, whereas others resist emasculation by redefining the meaning of masculinity. Connell's (1995) theory of hegemonic masculinity provides a framework for understanding masculine ideals such as men as providers, protectors, and stoic figures. These ideals are not only sustained but also actively renegotiated within gender hierarchies, as men attempt to re-secure alignment with hegemonic norms in the face of threatened masculinity.
Furthermore, this framework was expanded to introduce different concepts such as reproductive masculinity emergent masculinities (Inhorn, 2012), liquid masculinity (Hanna & Gough, 2019), and masculine capital. Together, these concepts highlighted that men actively renegotiate their identity under conditions of disruption. However, much of this work was grounded in Euro-American contexts and pays limited attention to how masculinity is negotiated within societies where structures are influenced by kinship, religion, and collective moral obligations. In such settings, masculinity is not negotiated solely at the individual level but through relational and moral frameworks, which shape expectations, responses, and outcomes in this crisis (Amjad, 2025). The article extends these frameworks by showing that men do not simply compensate for or hybridize masculinity but actively inflate it through the simultaneous reinforcement and expansion of dominant masculine ideals.
This article introduces the concept of inflating masculinity as an analytical lens to capture these processes. Inflating masculinity refers to the ways infertile men actively intensify and expand normative masculine ideals to maintain legitimacy in the face of reproductive disruption. By centering the lived experiences of infertile men, this article demonstrates that masculinity is not simply eroded by reproductive disruption but actively reconstructed through culturally and religiously embedded practices. In doing so, it challenges the assumption that infertility leads to an uncontested loss of masculinity. Rather, it shows that men strategically negotiate their identities to remain socially recognizable as men. The article proceeds by situating itself within existing scholarships, outlining the methodological approach, and presenting findings on men's enactment of inflating masculinity through endurance, financial sacrifices, alternative fatherhood, and religious interpretations.
Theoretical Framework
Masculinity is neither static nor biologically predetermined; rather, it is a fluid, performative identity shaped primarily by social and cultural factors (Connell, 1995). In patriarchal societies such as Pakistan, where virility and reproductive success are central to masculinity, the inability to father a child can disrupt a man's position within the hegemonic gender order. Connell's (1995) framework of hegemonic masculinity explains that dominant masculinities maintain their privileged position by subordinating alternative masculinities, often relegating men who do not conform to dominant gender norms to positions of marginality. Since male infertility challenges the association between masculinity and biological reproduction, infertile men are at risk of falling into a subordinated category.
Prior research shows that men manage threats to masculinity by drawing on dominant ideals and adapting them to new circumstances. Studies on masculinity also suggest that men who faced reproductive disruption resisted marginalization by emphasizing endurance, provision, moral worth, or alternative forms of fatherhood. Some of these men compensate by resorting to hypermasculine behaviors such as aggression, control, and dominance to reaffirm their gender status (Connell, 2005; Hanna & Gough, 2019; Inhorn, 2012; Vandello & Bosson, 2013).
These are classic examples of “compensatory masculinity” (Connell, 2005), which refers to the exaggerated enactment of traditionally dominant masculine behaviors, often as a reaction to perceived threats. Hybrid masculinities (Bridges & Pascoe, 2014) describe men's incorporation of elements of subordinated or marginalized masculinities into their identity while maintaining hegemonic privilege. Vandello and Bosson's (2013) theory of masculinity threat further explains men's reactions when their masculinity is questioned. Infertility poses both biological and social threats, challenging men's adherence to traditional gender expectations. In response, masculinity threat literature highlights that some men often respond to challenges to manhood through performances of resilience, economic provision, moral responsibility, or spiritual endurance (Hanna & Gough, 2019; Vandello & Bosson, 2013).
Together, these theoretical perspectives provide a framework to examine how men negotiate masculinity under conditions of reproductive disruption, without presuming uniform responses or outcomes. “Inflating masculinity” is not advanced here as a new masculine typology or as a claim that hegemonic masculinity itself is substantively transformed. Rather, it is employed as an empirically grounded analytic descriptor of how men draw more heavily on already recognized hegemonic masculine scripts in order to remain socially legible as men. In this sense, the practices documented in this study resonate with scholarship on the masculinization of feminized or stigmatized domains. This literature shows that men draw on culturally dominant masculine narratives to resist subordination without fundamentally challenging the gender order.
The contribution of this study lies in empirically illustrating infertility as a site through which masculine labor, moral worth, and self-legitimation are articulated in everyday narratives. Framed this way, inflating masculinity functions as a heuristic device to analyze situated identity work rather than as a claim about broader transformations in hegemonic masculinity.
Methods
This study draws on qualitative, interpretive research conducted over nine months at a private hospital in Lahore, Pakistan. This approach is well suited to examining the ways men narrate experiences of their gendered disruptions (Morrow, 2005). Thirty men diagnosed with infertility were recruited through fertility clinics. Clinicians briefly informed patients about the study and, with their permission, shared their contact details with the researcher. Participants’ ages ranged between 30 and 45 years, with a clear concentration in the mid- to late-thirties. All participants were married, with marriage durations varying between approximately 2 and 15 years. The sample included individuals employed across a range of occupations, including business, education, banking, engineering, and service-sector and manual labor roles, indicating variation in socioeconomic positioning while remaining anchored in provider-oriented masculine expectations. At the time of interview, participants were at different stages of their reproductive journeys, including initial diagnosis, ongoing assisted reproductive treatment (ART), and consideration of alternative pathways such as adoption. This allowed accounts to be grounded in ongoing rather than retrospective experience.
Data collection involved semi-structured interviews with 30 participants to ensure consistency across key domains, including marital expectations, treatment experiences, financial pressures, and experiences of social stigma. A subset of participants (n = 18) took part in extended in-depth interviews that explored personal histories and everyday coping strategies in greater detail. Participants for in-depth interviews were purposively selected based on their willingness to engage in extended discussions and the richness of their initial accounts. This distinction follows qualitative methodological conventions, where semi-structured interviews allow comparability across cases, while in-depth interviews enable deeper exploration of meaning-making and lived experience (Kvale & Brinkmann, 2009). These interviews provided richer narrative accounts because they allowed participants to reflect more deeply on their experiences. In practice, many conversations moved fluidly between the semi-structured guide and open-ended exploration. This enabled the participants to elaborate, revisit, and reinterpret their accounts across the interview.
Although ethnographic observation within clinics and households was initially planned, restrictions on access and sensitivities surrounding infertility limited this component. Instead, an ethnographic sensibility informed the interview process, with attention to cultural practices, language use, metaphors, and embodied expressions, rather than producing systematic observational fieldnotes. During interviews, attention was given to participants as they narrated their experiences, including the metaphors and emotional registers they employed, in addition to what they said. This reflexive attention to discourse and affect was central to the analysis. For example, when men described infertility as a ‘test,’ ‘battle,’ or ‘trial from God,’ these metaphors were analyzed not simply as linguistic choices. They were treated as affective strategies through which men framed suffering as endurance and moral strength. Similarly, moments of hesitation, laughter, or emotional restraint during interviews were treated as meaningful indicators of how masculinity was being managed in interaction, rather than as incidental features of speech.
All interviews were conducted in Urdu, audio-recorded with consent, transcribed verbatim, and translated into English by the researcher. Translations aimed to preserve cultural nuance, including key idioms (e.g. mard ko dard nahin hota—“a man does not feel pain”), which were retained in both Urdu and English. Analysis followed an interpretive thematic approach that combined inductive coding with engagement with sociological theories of masculinity. Initial open codes were developed through close reading of the transcripts which were followed by focused coding to refine patterns across cases. Codes and themes were iteratively revised through repeated engagement with the data and analytic memo-writing. This study is based on the doctoral research conducted at Monash University, Australia, with ethical approval granted by Monash University Human Research Ethics Committee (Approval number 16782). Participants provided written informed consent, and pseudonyms are used throughout to protect confidentiality.
As a Pakistani male researcher, my positionality shaped both access to participants and the dynamics of interaction during the study. This approach aligns with methodological work on insider research, which emphasizes that shared cultural location facilitates access to sensitive narratives while shaping what participants choose to disclose (Dwyer & Buckle, 2009). On the one hand, sharing linguistic, cultural, and religious backgrounds with participants facilitated trust and enabled candid discussions about sensitive topics such as masculinity, sexuality, and infertility. On the other hand, this shared identity also influenced how men narrated their experiences, often framing their struggles in terms of endurance, provision, and religious conviction, assuming I would already understand or value these frames. I stayed attentive to these dynamics by treating interviews as co-constructed encounters and reflected on my positionality that shaped data collection and analysis (Berger, 2013).
Findings
Reframing Medical Treatment as Masculine Endurance
For many men, infertility is not merely a medical diagnosis but a profound challenge to their masculinity. In contexts where manhood is defined through virility, strength, and control, an infertility diagnosis threatens to erase selfhood. Participants in this study resisted that erasure by reframing invasive medical treatment as a site of masculine endurance. Procedures such as Intracytoplasmic Sperm Injection (ICSI) and testicular sperm extraction—technologies that could be perceived as emasculating due to their association with women's reproductive medicine—were instead reinterpreted as opportunities to demonstrate fortitude. In doing so, men converted medical pain into a resource for sustaining and inflating masculinity.
Hussain, a 33-year-old entrepreneur who was advised by his doctor to undergo ICSI, described his willingness to undergo painful procedures when asked whether he had any hesitation in undergoing them. Absolutely not! I understand that the procedure will put me through physical pain and discomfort, but I am ready to endure and will take it like a real man.
His insistence that he would “take it like a real man” demonstrates that the meaning of treatment extended beyond reproduction. Enduring pain became a public performance of masculinity, allowing him to reclaim control in the face of infertility. This reflects what Daniels (2006) calls reproductive masculinity, where men's worth is tied to fatherhood. Yet Hussain's narrative illustrates the extension of this model: even without successful reproduction, bodily endurance itself became a marker of manhood. Cultural scripts reinforced this expectation. Adnan, a 32-year-old zonal bank manager who had already undergone ICSI, explained: Haven’t you heard the phrase “مرد کو درد نہیں ہوتا” [A man doesn’t feel pain]? Jokes apart, it was a painful experience, but I had to undergo it at any cost and will do it again if I have to. The pain can’t keep me away from taking my chance.
Here, the popular saying “a man doesn’t feel pain” provided a framework for interpreting invasive treatment not as emasculating but as a masculine necessity. His readiness to “undergo it at any cost” shows that pain was redefined as proof of commitment to both fatherhood and manhood. This resonates with Connell's (1995) notion that masculinity is an ongoing performance requiring continual reinforcement, but it also suggests something more: the inflation of masculinity. Endurance was not simply compensatory; it was exaggerated into sacrificial extremes, so that medical suffering itself became a badge of strength.
By reframing treatment as masculine endurance, men resisted infertility's potential to feminize or marginalize them. Their suffering was not narrated as weakness but as deliberate proof of resilience. In this way, medical intervention—ordinarily coded as a feminized space—is recast as a stage for asserting hegemonic masculinity. Endurance functioned as a masculine currency, allowing men to remain firmly positioned within gendered hierarchies despite reproductive failure.
Embracing Infertility: Reworking Masculinity Beyond Biological Fatherhood
In many societies, and particularly in South Asia, masculinity is closely tied to fertility and the ability to continue the family line (Daniels, 2006; Inhorn, 2012). An infertility diagnosis therefore often stigmatizes men, casting them outside the boundaries of dominant masculinity. Yet participants in this study resist such exclusion by drawing on and intensifying existing masculine ideals in ways that allow them to remain recognizably masculine despite reproductive failure.
Ali, a 36-year-old businessman who had undergone multiple unsuccessful fertility treatments, embodied this stance when reflecting on his experience of infertility: Sure, I have fertility issues, but does that make me any less of a man? Not at all. I know who I am, and I don’t need children to prove it. People need to understand that masculinity is more than just fathering a child.
Ali's declaration illustrates a refusal to accept reproductive capacity as the sole criterion for manhood. His words resonate with Daniels’ (2006) concept of reproductive masculinity, which links masculine worth to fatherhood, but they simultaneously challenge it. Rather than abandoning masculinity altogether, Ali enlarges it—insisting that manhood must extend beyond biology. Rather than straightforward compensation for loss, this framing reflects an attempt to narrate vulnerability in ways that preserve self-affirmation.
Sohaib, a 39-year-old school principal who had undergone multiple unsuccessful assisted reproductive treatments, offered a similar redefinition of masculinity in the context of infertility: People assume that infertility makes a man weak, as if not having children takes away who we are. But that's their definition, not mine. I refuse to let biology dictate my masculinity. I know I am a man, and I don’t need anyone's permission to claim that.
Here, Sohaib directly contests the cultural narrative that equates infertility with emasculation. His refusal to “let biology dictate masculinity” underscores a shift away from reproduction as the exclusive basis of manhood. This contrasts with Hanna and Gough's (2019) notion of liquid masculinity, which emphasizes fluid renegotiation through relational or emotional practices. Rather than rejecting dominant masculine boundaries, Sohaib insists on remaining within them, while arguing that biological reproduction should not be their sole criterion.
These narratives demonstrate that infertile men in Pakistan are not merely coping with stigma; they are engaged in individual narrative work through which masculinity is reinterpreted and defended in everyday life. By insisting that manhood cannot be reduced to biological fatherhood, they reframe infertility not as a private failure but as a legitimate masculine experience. This aligns with Connell's (1995) argument that masculinity is an ongoing social performance and extends it by showing that hegemonic norms can be strategically expanded to preserve men's inclusion. Inflating masculinity here functions as a personal and relational strategy through which men seek recognition without directly challenging dominant gender norms.
Support-Seeking and the Reconfiguration of Masculinity
Masculinity has long been associated with self-reliance, emotional restraint, and facing hardship without recourse to external help (Addis & Mahalik, 2003). Within this framework, seeking social support for infertility appears to contradict dominant masculine ideals. Yet participants in this study reframed support-seeking as a masculine practice. Rather than reading their openness as weakness, they positioned it as a deliberate strategy to assert visibility and expand the boundaries of manhood.
Hassan, a participant running his own business and undergoing repeat fertility testing following a diagnosis of infertility, captured this tension: “There is a will, but there aren’t many ways to express it.” His words underscore that these men are not inherently reluctant to seek support. Instead, their silence is structured by the absence of male-centered spaces in a reproductive health landscape dominated by women (Barnes, 2011). Support-seeking thus became a way of contesting not just personal isolation but also structural erasure. By voicing a desire for connection, men sought to reclaim agency over their narratives and resist the invisibility imposed by cultural norms.
Sohaib elaborated on the cultural prohibition against disclosure: Unlike women, we can’t speak out! Men can talk about anything but infertility. Having said that, I sometimes feel like talking to someone with similar issues, but then there is no one, so I shut myself up.
Here, infertility emerges as both a private burden and a public silence. Sohaib highlights the paradox whereby men are culturally forbidden to discuss reproductive struggles, yet deeply desire solidarity. This reflects Connell's (1995) observation that hegemonic masculinity enforces emotional detachment. However, rather than abandoning masculinity, Sohaib attempted to inflate it by carving out space for disclosure. Speaking out became an act of defiance against silence, positioning visibility itself as a form of masculine resilience.
Adil, a real estate agent undergoing repeat fertility testing following a diagnosis of infertility, reflected on the isolating effects of this silence: Sometimes you think you are the only one with this problem. It is hard to find and talk to another [infertile] man in our country even if one wants to.
His statement highlights the structural absence of male infertility discourse in Pakistan. Unlike contexts where men have been documented adopting hybrid or liquid masculinities by emphasizing relationality and openness (Hanna & Gough, 2019), Pakistani men framed their desire for support differently. They sought connection not as a retreat from hegemonic norms but as a way to expand them, asserting that true masculinity included the right to speak openly about reproductive struggles.
This redefinition of support-seeking as a masculine act was also future-oriented. As Adil added further, “As long as my story is beneficial to someone, I am happy to share it.” For men like him, talking about infertility was not only a way to cope with their situation, but also a means of presenting themselves as responsible and socially useful. Rather than signaling an attempt to reshape broader cultural narratives, this openness demonstrates that men often make disclosure acceptable within existing masculine expectations by framing it as purposeful rather than weak. In this sense, speaking about infertility served to sustain masculine respectability, allowing vulnerability to be expressed without undermining men’s moral standing or self-worth as men.
Support-seeking, therefore, was not a rejection of masculinity but a renegotiation of its terms. By framing openness as strength and visibility as resilience, participants challenged the expectation that male infertility must remain hidden. Their insistence on recognition demonstrates that men work within hegemonic norms, reinterpreting them to accommodate practices such as openness and disclosure. Speaking about infertility was not an abdication of masculinity but an assertion of it.
Flexing Financial Muscle as Masculine Act
Assisted reproductive technologies (ARTs) impose immense financial strain in Pakistan, where multiple IVF or ICSI cycles can cost several years’ worth of savings. For participants, these costs are not perceived as threats to masculinity but as opportunities to demonstrate endurance, provision, and sacrifice. In patriarchal cultures where economic strength is a cornerstone of hegemonic masculinity (Kimmel, 1996), financial commitment became a performative act through which men inflated their masculinity. Provision is reframed as sacrifice, and expenditure was narrated as proof of paternal legitimacy.
Arshad, a 37-year-old branch manager at a private bank had undergone previous unsuccessful fertility treatment at other clinics and was currently undergoing treatment following a diagnosis of infertility, emphasized determination over cost: It's not just about becoming a father rather it's about proving that I will do whatever it takes. A man does not give up just because it is difficult or expensive. I will keep trying until we succeed.
His insistence on “doing whatever it takes” demonstrates that economic endurance became a proving ground for masculinity. This resonates with De Visser and McDonnell's (2013) notion of masculine capital, where men compensate for vulnerabilities by excelling in other domains. Arshad's words illustrate that financial sacrifice becomes a key site for reaffirming masculine worth. By treating financial sacrifice as evidence of endurance and responsibility, he mobilized established masculine ideals to sustain his recognition as a man.
Similarly, Azlan, a 34-year-old businessman undergoing ART following previous unsuccessful fertility treatment at other clinics, frames financial labor as central to both fatherhood and manhood: People say fertility treatments are expensive, but what is money if I can’t use it to build my family? If I stop trying because of money, what does that say about me as a man? I have worked hard for this, and I will keep working hard.
By contrasting money with fatherhood, Azlan reframed financial provision as a test of masculine worth. His question— “what does that say about me as a man?”—acknowledges the cultural expectation that true men endure financial hardship for their families. This aligns with capitalist ideals of masculinity (Messner, 1993), where work and persistence define manhood. Yet in this context, financial commitment also intersects with Islamic and cultural ideals of qurbani (sacrifice), which valorize endurance and provision as moral strengths. Azlan thus demonstrates that inflationary masculinity emerges at the intersection of patriarchal and religious scripts. Imran, a 40-year-old engineer undergoing ART and at the final stage of repeated ART attempts, highlighted the social visibility of financial sacrifice: People talk, they whisper, but at the end of the day, they see that I am doing everything a real man should do like protecting, providing, making sure my family's future is secure. No one can say I failed as a man.
His statement demonstrates that economic investment served to counter stigma. By asserting that he was “doing everything a real man should do,” Imran redirected masculine recognition from biological fatherhood toward financial provision. This mirrors Connell's (1995) insight that hegemonic masculinity adapts by absorbing vulnerabilities into reaffirmed performances of dominance. Here, provision was inflated into an exaggerated display of sacrifice, silencing doubts about reproductive failure.
For these men, infertility was not a marker of inadequacy but a stage on which to dramatize resilience. By investing heavily in ARTs, they engaged in inflating masculinity, converting financial burden into evidence of strength and responsibility. Their masculinity was reconstructed not in spite of infertility but through it—expanded to include sacrifice as proof of manhood. This demonstrates hegemonic masculine ideals’ endurance of crisis, as financial provision is intensified to compensate for threatened reproductive capacity.
Alternative Pathways to Fatherhood: Non-Biological and Adopted Children
Fatherhood has long been central to masculine legitimacy, securing lineage and reinforcing a man's social authority. In contexts where biological reproduction is equated with manhood, infertility threatens not only reproductive ability but masculine identity itself. Yet participants in this study resist exclusion by inflating masculinity to encompass non-biological fatherhood as a legitimate masculine achievement. Adoption was reframed not as a lesser option but as an active strategy to claim paternal authority and, by extension, manhood. In doing so, men did not abandon hegemonic ideals of fatherhood; they expand them to accommodate reproductive disruption.
Ali, a 36-year-old businessman, emphasized responsibility over biology: Being a father isn’t just about biology; it's about responsibility. If I raise a child, provide for them, and shape their future, who can say I am not a man?
Ali's framing reflects Connell's (1995) account of fatherhood as a key dimension of hegemonic masculinity. His words challenge Daniels’ (2006) idea of reproductive masculinity—that men's worth is judged by their sperm lineage—by redefining fatherhood through provision and authority. This reflects a process through which masculine legitimacy is reasserted by foregrounding responsibility and authority over biological connection. Adil similarly framed adoption as an act of courage: People think adoption is an easy way out, but it's not. It takes courage to take responsibility for a child who isn’t yours by blood. A man is known by what he does, not by whose blood runs in the child.
Here, adoption is not feminized as care but masculinized as strength and resilience. This statement makes explicit that adoption is framed not merely as caregiving but as a moral and masculine accomplishment, reinforcing men's claims to authority and respectability. Also, by positioning adoption as a test of endurance, Adil reasserted traditional masculine ideals of toughness while also expanding them. This resonates with De Visser and McDonnell's (2013) notion of masculine capital: men accumulate legitimacy by excelling in other domains when vulnerable in one. Rather than shifting to an alternative domain of masculine recognition, participants framed non-biological fatherhood through already valued masculine qualities such as courage, responsibility, and endurance. At the same time, adoption in Pakistan is entangled with Islamic norms. While raising non-biological children is encouraged as a charitable act (kafala), legal adoption that severs lineage ties is often contested. Men's accounts reflected this tension. For example, Salman, a 41-year-old taxi driver, noted: Islam allows you to raise a child and take care of them, but people still say it is not your real child. They ask about bloodline. So even if you adopt, society does not always accept it easily.
Salman points out that fatherhood is valued as responsibility and provision, yet cultural and religious restrictions complicate adoption's legitimacy. By insisting nonetheless that adoption affirmed their manhood, these men articulated fatherhood in ways that allowed them to remain aligned with hegemonic masculine expectations, despite tensions with prevailing cultural scripts. Another participant, Bilal, a 39-year-old salesman at a well-reputed grocery store stated: Even if people talk, I do not care. If I am raising a child properly, then I know I am doing my duty as a man.
This inflationary strategy also overlapped with financial sacrifice. Participants emphasized that fatherhood—whether biological or adoptive—demanded economic provision. Willingness to invest in costly ARTs or to shoulder the financial responsibility of adoption became a stage upon which masculinity was performed. Financial outlay was narrated as evidence of dedication, transforming economic sacrifice into masculine legitimacy.
Thus, by embracing the practice of child adoption, participants inflate masculinity rather than rejecting it. They reframed fatherhood as a matter of will, action, and responsibility, ensuring that infertility did not exclude them from masculine recognition. In a patriarchal context where lineage and genetics remain paramount, this inflation of masculinity demonstrates that hegemonic ideals can be stretched to preserve masculine legitimacy during a reproductive crisis.
Invoking Religious Justification
In Pakistan, masculinity is deeply entangled with religious and cultural ideals that valorize endurance, perseverance, and divine will (Mushtaq & de Visser, 2024). For infertile men, religious repertoires offered powerful resources not only for coping but for reasserting masculine worth. Rather than interpreting infertility as biological failure, participants reframed it as a spiritual test. By invoking faith, they redefined themselves not as emasculated but as resilient believers whose masculinity was validated through patience (sabr) and moral strength. Across interviews, men repeatedly invoke religious language to frame infertility as divine testing rather than personal failure
Aamir, a 35-year-old academician, articulated this perspective: Allah tests those He loves the most. This is my test, and I must face it with strength. A man does not break when challenged—he stands firm. I know that if I keep trying, Allah will grant me what is written for me.
Aamir's account demonstrates that infertility was reframed as a divine trial rather than personal inadequacy. His insistence that “a man does not break” reflects Islamic notions of endurance that were folded into masculine identity. This resonates with Connell's (1995) view of masculinity as a performance requiring constant reinforcement: here, religious faith itself became a stage for masculine assertion. Infertility was not emasculating but an opportunity to prove resilience before both God and society.
Similarly, Usman, a 38-year-old shopkeeper, linked cultural ideals of honor with infertility: In our culture, a man's patience and ability to endure hardships define his worth. Running away from a challenge is cowardice. My infertility is just another battle, and I will face it with dignity. This is what makes a man strong.
By framing infertility as a “battle,” Usman mobilized martial and honor-based idioms central to Pakistani masculinity (izzat). His account resonates with Daniels’ (2006) argument about reproductive masculinity and also demonstrates that men inflate masculinity by amplifying cultural ideals of endurance. Infertility became not a sign of weakness but evidence of dignity and courage. Faith also justified persistence in medical treatment. The principle that “God helps those who help themselves” was widely invoked to reconcile reliance on divine will with active pursuit of ARTs. Kamran, a 40-year-old businessman, explained: I pray, I fast, I give charity, but I also go to the best doctors. A real man does everything in his power and then leaves the rest to Allah. If I stop trying, I am failing not just my family but also my faith.
He further added that “We cannot sit and wait only. Dua [supplication or prayer] is important, but effort is also important. A man must try everything possible before leaving it to Allah.” Here, masculinity was enacted through a dual strategy: spiritual devotion and material effort. Kamran's statement highlights the inflationary process; religion does not encourage passivity but underpins proactive engagement. Being “a real man” meant demonstrating both piety and persistence, fusing faith with provision and responsibility.
By integrating religious and cultural justifications, participants ensure that infertility does not exclude them from hegemonic masculinity. They mobilized religious idioms of patience and sacrifice to reaffirm and inflate established masculine ideals of endurance and moral strength. In this way, masculinity is not diminished but amplified, anchored in faith and cultural honor. These strategies show that some men draw on religious repertoires to align their experiences of infertility with culturally valued forms of masculine endurance.
Taken together, these themes demonstrate that infertility does not simply diminish men's sense of masculinity but becomes a context in which they actively reassert masculine legitimacy through recognized cultural, economic, and religious practices. By reframing medical suffering as endurance, asserting manhood beyond biological fatherhood, breaking silences around infertility, pursuing adoption, demonstrating financial sacrifice, and invoking religious justifications, men strategically narrated and performed masculinity in ways that counteracted the stigma of reproductive failure. These practices show that masculinity in Pakistan is not reducible to biological reproduction alone, but is negotiated through culturally sanctioned forms of endurance, provision, and moral responsibility. In this process, men did not abandon hegemonic ideals of strength, provision, and faith but rather adapted and expanded them, ensuring their continued recognition as “real men” despite infertility.
These findings illustrate that infertile Pakistani men do not passively accept emasculation but actively renegotiate and inflate their masculinity through diverse strategies. What emerges is not the collapse of masculine identity but its reassertion through pain, endurance, provision, alternative fatherhood, and religious devotion. The following discussion examines these practices in light of sociological theories of hegemonic masculinity, masculinity threat, and hybrid masculinities. It highlights these men's negotiations, which largely reproduce dominant gender norms while allowing limited flexibility in their enactment.
Discussion
This article examined infertile Pakistani men's navigation of their social, cultural, and personal challenges of infertility. The findings demonstrate that infertility does not simply strip men of masculinity but becomes a site in which men seek to defensively reassert it. Across medical, financial, social, and religious domains, men are seen to inflate masculinity, drawing on cultural repertoires of endurance, provision, and faith to ensure that infertility did not render them less than “real men.” These practices illustrate Connell's (1995) conceptualization of hegemonic masculinity as a dynamic and relational structure, one that is continually reproduced through adaptation and performance rather than held as a fixed attribute.
A central contribution of this study is showing that infertility, while potentially destabilizing, does not necessarily produce emasculation. Rather, men reframed painful medical treatments as opportunities for masculine endurance, aligned with cultural scripts such as “mard ko dard nahin hota” (a man does not feel pain). In doing so, they reasserted their place within hegemonic masculinity by treating suffering as a resource for masculine display. This resonates with research on masculinity threat (Vandello & Bosson, 2013), which suggests that men actively engage in compensatory strategies when their masculinity is called into question. Yet, unlike purely compensatory acts, these men did not simply “make up” for infertility; they sought to interpret the experience of reproductive failure as a site of masculine performance.
The findings also show that men attempted to position infertility within masculinity rather than disavowing it. By declaring that manhood is not dependent on fatherhood, participants challenged the narrow conflation of virility with masculinity. Here, their narratives resonate with scholarship on hybrid masculinities (Bridges & Pascoe, 2014), which highlights men's selective incorporation of traits or practices that fall outside dominant ideals to reconfigure their identity without fully destabilizing patriarchal hierarchies. In this case, infertile men do not reject hegemonic masculinity but inflate it by reshaping it to ensure their continued inclusion. Their embrace of adoption, financial sacrifice, or religious justification illustrates men's effort to remain intelligible as men within existing cultural definitions of masculinity.
At the same time, these practices reveal important tensions. By leaning on provision, endurance, and faith as masculine currencies, men sustained rather than dismantled patriarchal ideals. Financial sacrifice, for instance, allowed men to redirect attention from reproductive incapacity to economic resilience, reinforcing the expectation that men must be providers. Religious justifications reframed infertility as divine testing, preserving men's sense of strength while also reinscribing the idea that men must endure hardship with dignity. These strategies illustrate the ambivalence of masculine renegotiation: while they stretch the symbolic limits of masculinity, they simultaneously reproduce its hegemonic foundations.
Importantly, the Pakistani cultural context shaped the ways in which masculinity was inflated. In a society where reproductive success remains central to male honor and family continuity, infertility presents an acute threat. Yet cultural scripts of endurance (“mard ko dard nahin hota”), patriarchal ideals of provision, and Islamic discourses of divine testing provided men with resources for reconfiguring their masculinity. This demonstrates that hegemonic masculinity is not only a global structure but also locally embedded, taking shape through religious, economic, and cultural idioms that give men tools to negotiate threats to their identity.
Finally, these findings highlight the silences surrounding male infertility in Pakistan. Men's expressed desire for support networks shows both the inadequacy of existing reproductive health discourses and the potential for cultural change. Their insistence that speaking out and seeking support can be framed as a masculine act suggests tentative shifts in how masculinity is negotiated in the context of infertility. However, this expansion remains fragile: it depends on men's ability to translate silence into visibility without being cast outside the boundaries of hegemonic masculinity.
Taken together, this article contributes to sociological debates on masculinity by demonstrating that infertility is not merely a site of loss but also a context in which masculinity is actively defended and reworked. Infertile Pakistani men do not abandon masculinity; they inflate it, seeking to ensure that even in the face of reproductive failure, they remain legible as men. This underscores the performative, adaptable, and context-specific nature of hegemonic masculinity, while also raising critical questions about the durability of patriarchal ideals in the face of new challenges to male identity.
Conclusion
This article has demonstrated that Pakistani men clinically diagnosed with male-factor infertility negotiate masculinity by drawing on and intensifying dominant masculine norms in ways that sustain their inclusion within hegemonic gender arrangements. Rather than accepting infertility as a loss of manhood, the men in this study reframed their suffering, financial sacrifices, pursuit of medical treatment, and even openness to adoption as acts of endurance, provision, and resilience. In doing so, they resisted the emasculating potential of infertility and transformed it into a proving ground for masculine strength.
Theoretically, this study contributes to the sociology of masculinities by empirically illustrating the ways hegemonic masculinity is sustained under conditions of reproductive disruption. Drawing on cultural scripts of endurance, religious justification, and provision, infertile men in Pakistan did not reject dominant masculine ideals but mobilized them in ways that mitigated the stigma associated with infertility. Rather than advancing a new model of masculinity, the concept of inflating masculinity is used here as an analytic descriptor to capture the ways men intensify and repurpose existing hegemonic scripts in the face of vulnerability. These findings carry important implications, for example, clinically, they suggest that infertility interventions must recognize men not as silent bystanders but as active participants who invest bodily, financially, and emotionally in treatment. Socially, they call for greater visibility of male infertility, challenging taboos that constrain men to secrecy and silence.
Future research might extend this analysis by examining how class, religion, and transnational mobility shape alternative masculinities across different cultural settings. By situating Pakistani men's narratives within broader debates on gender, reproduction, and identity, this study shows that infertility does not automatically result in emasculation but becomes a context in which masculinity is actively negotiated.
Footnotes
Author Note
This research was conducted at the
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.