Middle-aged African American men experience disproportionate rates of chronic disease, reduced life expectancy, and barriers to preventive and mental health care. From a public health perspective, these inequities reflect the intersection of structural racism, medical mistrust, and gendered norms of masculinity rather than individual behavior alone. This analytic essay examines how masculinity functions as both a barrier to and facilitator of self-care among African American men in midlife using a social constructionist framework. Traditional norms emphasizing self-reliance, emotional restraint, and provider roles often discourage help-seeking and preventive care, whereas racial discrimination and chronic stress further exacerbate risk. Emerging evidence suggests that reframing masculinity around responsibility, family protection, and community engagement can promote health-supportive behaviors. Findings highlight the need for culturally responsive public health interventions that address structural barriers, affirm positive reframes of masculine identity, and leverage community strengths.