{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:13:39Z","timestamp":1788286419283,"version":"build-2803163510"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Azoospermia affects 1% of men and 10\u201320% of infertile males, yet the psychosocial mechanisms underlying self-esteem impairment remain poorly characterized. Guided by Connell\u2019s Masculinity Theory and Bury\u2019s Biographical Disruption Framework, this mixed methods study examined self-esteem experiences among Chinese men with azoospermia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An explanatory sequential design was employed. Phase 1 surveyed 216 men using Rosenberg\u2019s Self-Esteem Scale, with multiple regression identifying predictors. Phase 2 involved semi-structured interviews with 16 purposively sampled participants, analyzed through thematic analysis. Integration of quantitative and qualitative findings provided comprehensive interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Quantitative analysis revealed moderate self-esteem overall (mean\u2009=\u200930.18\u2009\u00b1\u20093.99), with 10.19% exhibiting low self-esteem. Significant predictors included monthly income (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.210,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), family harmony (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.141,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), and attitudes toward childbearing discussions (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.159,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). Qualitative findings identified five themes, including economic burden, family dynamics, social stigma, treatment uncertainty, and cumulative psychological impacts. Integration demonstrated financial capacity\u2019s dual role as both practical enabler and symbolic compensation for perceived masculine failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Self-esteem in azoospermic men is shaped by interconnected economic, familial, and social factors. Clinical interventions should integrate financial counseling, family-based emotional support, and culturally tailored stigma reduction, highlighting the value of mixed methods in understanding male infertility psychosocial dimensions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338811","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:40:04Z","timestamp":1768588804000},"page":"e0338811","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Self-esteem in crisis: Psychosocial adaptation and masculine identity among Chinese men with azoospermia"],"prefix":"10.1371","volume":"21","author":[{"given":"Fangliang","family":"Zou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8799-5941","authenticated-orcid":true,"given":"Jue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiliang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8788-3659","authenticated-orcid":true,"given":"Zikai","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiyun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2266-3778","authenticated-orcid":true,"given":"Yanshan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"issue":"10271","key":"pone.0338811.ref001","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(20)32667-2","article-title":"Male 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