Background Men experiencing psychotic phenomena may struggle with adherence to masculinity norms, but the evidence base has received little attention.

Aim To review systematically the available evidence of adherence to masculinity in men with psychosis.

Method A systematic search of quantitative studies was undertaken using four databases. A total of 294 articles was identified. After the selection process, nine studies met the full text criteria for the review.

Results Seven studies reported males either choosing less masculine roles or scoring lower on traditional masculine descriptive measures compared to controls. One study showed that participants held a masculine disposition, and one study found no significant difference of role preference between the experimental or control groups.

Conclusion The review indicated that men with psychosis may be more likely to have a feminine gender identity, but the overall evidence lacked quality, particularly in study design and statistical rigour. New studies using more rigorous empirical methods are needed to revisit questions concerning gender identity.