Across all studies, recruiting male participants proved challenging with only 10-20% of those recruited identifying as male. Working behind the scenes of recruitment highlighted several factors that may have contributed to underrepresentation. Talking therapies and mental health are often socially associated with emotional openness, which can conflict with dominant norms of masculinity. As a result, interventions centred on discussing feelings may feel less accessible or appealing to some men. Existing research supports this, with Seidler et al (2016) suggesting that men may perceive engagement with mental health research as threatening to masculine norms. Having worked alongside crisis team to identify eligible participants, it became clear that the way male distress is interpreted within clinical settings can significantly shape access to research. In some services, male distress was more likely to be understood and recorded as physical or behavioural rather than emotional. This reflects evidence that self-harm is not always consistently identified or coded in emergency settings, with presentations sometimes recorded as aggression or behavioural disturbance rather than self-harm, contributing to under-recognition, particularly in men ^6,7. As a result, male participants were often escalated to higher intensity services such as specialist community mental health teams or crisis services, which automatically excluded them from the study. In addition, the categorisation of self-harm appeared to differ by gender. While both studies adopted a broad understanding of self-harm, recognising that it can present in many forms, this definition was not always reflected in clinical decision-making. Behaviours such as punching walls or other forms of physical injury were frequently interpreted as expressions of anger or violence rather than self-harm or attempts to injure oneself. This mismatch between research definitions and clinical interpretations meant that some males who may have been eligible in principle were excluded in practice. This is consistent with research distinguishing between externalising and internalising expressions of distress, where externalising behaviours are more likely to be recognised clinically, potentially leading to under-identification of self-harm when it presents in less overt forms ^6,8. Together these observations highlight how structural and interpretative processes within services can unintentionally limit male participation in research, even when studies aim to be inclusive. To address these challenges, we introduced several practical strategies. Clinical teams were reminded of the study’s inclusive definition of self-harm, though bias in interpretation remained. Where possible, male participants recruited were paired with male researchers and therapists to make engagement more approachable and relatable. We were also keen to interview male participants about their experience and motivations for taking part, to better understand and improve recruitment for future studies.