Men’s Health Can Be Awkward. Does Humor Help in Testicular Cancer?

When comedian Tom Green received a diagnosis of testicular cancer, he decided to keep the cameras rolling on his eponymous MTV series.

Green, who was 28 years old at the time and engaged to actress Drew Barrymore, released “The Tom Green Cancer Special,” a special installment of “The Tom Green Show,” in 2000 because, as he told Entertainment Weekly at the time, he and his cohorts “decided it might be a way of getting off the depressing tip” after his diagnosis had left Green, in his words, “feeling really sorry for myself.”

“We were just trying to make a … weird TV show, and all of a sudden people were coming up to us with somber and teary, thankful, handshaking sort of things,” Green told Entertainment Weekly. “And we started to realize that maybe this was actually good, what we were doing.”

Green tweeted in 2022 that he was still experiencing the ripples of positivity in that special’s aftermath.

“I really do hear from young testicular cancer survivors all the time who saw the cancer special on MTV and went to the doctor because of it,” Green wrote on the platform now known as X. “I’ve met and corresponded with hundreds of them! Survivors!”

Among those who remember “The Tom Green Cancer Special” is Michael J. Rovito, who was in college at the time. Rovito is now an associate professor in the department of health sciences at the University of Central Florida as well as the founder and chairman of the Male Wellness Collective.

“It's supposed to be humor, but you could tell in the eye that there's something — obviously he has cancer — (and) there's something really deep and vulnerable there,” Rovito told CURE®. “And so I thought, hindsight is 20/20, and I do think it was a nice little blend of using humor to break the ice on something very important like that.”

When Justin Birckbichler received his diagnosis of stage 2 testicular cancer at the age of 25 in November 2016, the former teacher — who is now a survivor, health advocate and founder of the blog A Ballsy Sense of Tumor — utilized humor as part of his cancer journey.

“I found, in my personal experience, that humor was a way for me to cope with what I was going through. And then also to facilitate conversation with my friends, even people I just randomly met on the street, I found that opening with some sort of joke, or some sort of witty remark, was more apt to have conversation than if I were to just lead right in with the testicular cancer information,” said Birckbichler, who also served as a contributor for CURE® from 2018 to 2019.

Birkbichler’s blog, as well as works such as “The Tom Green Cancer Special” and the 2016 YouTube short “Gentlemen, Touch Yourself Tonight” starring Ryan Reynolds as comic book character Deadpool — the later of which, as detailed in The Lancet, was produced in collaboration with the organizations Ball Boys and the Testicular Cancer Awareness Foundation — are cited in a recent study co-authored by Rovito examining the effectiveness of humor-based messaging in testicular cancer awareness campaigns, published in the American Journal of Men’s Health.

“Men's health, it can be awkward. And it's because (of) how we were raised, how society expects men to be, we don't talk about testicles without the snicker or the weird bug-eyed look of like, ‘What?’” Rovito said. “No one really talks about these things out in the open, and so it becomes uncomfortable. And how do we break an uncomfortable situation? Either you continue to be uncomfortable, or you kind of crack a joke and that kind of breaks the ice a bit.”

Rovito and his colleagues determined that “humor may be useful in reducing uncomfortable feelings surrounding TSE (testicular self-examination), increasing awareness of TC (testicular cancer) and promoting TSE. When using humor-based messaging, however, the audience and type of humor implemented must be considered,” they wrote in the study.

Researchers reviewed the findings from six previously published studies and determined that “one would be extremely hard-pressed to find a TC awareness-raising program without the use of comedy. This fact alone is not a significant issue. However, a concern is that messages rooted in off-color humor about penises and/or testes may only speak to a certain type of male, not all. … We acknowledge that not every message is meant to affect everyone similarly. However, we hypothesize that the existing humor-based TSE and TC promotion speaks to only a very narrow audience, which may alter its overall effectiveness.”

“If you're going to use humor, it's got to be audience-appropriate, context-appropriate,” said Rovito. “There's a bunch of different things that factor in; age, where you were raised, all these things factor into, like, what people find funny and what they don't. I mean, that's a hard thing to do. … Using humor can really make some good lasting change. But it is something that you really need to kind of look into, and like, figure out what the best approach is. It's not just something that you pick up off the street and start using, you got to really know what you're doing and like talking (about) because it could be something very, very effective.”

Testicular cancer, according to the National Caner Institute, is the most common cancer among men ages 20 to 35. Given that demographic, Birckbichler said irreverent, humorous messaging can be appropriate.

“I understand that (this) was also part of his study, stereotypically those are the guys who are going to be into things like Deadpool or Tom Green, or kind of crude humor, if you will,” Birckbichler said. “And so, it's playing to your audience. Again, I recognize not everybody's in the same audience. And so that's where I think humor cannot be the only way that we approach testicular cancer. But I know in my personal experience, it was it was also something that helped me cope with it as I was going through it. “It's a scary thing (and) I would never make light of cancer — but if I could add a little levity to my situation, it made things a lot better.”

Of the six studied messaging campaigns Rovito and company evaluated, demonstrable efficacy results were mixed. There were instances where, as researchers noted, “humor-based messaging had significant improvements in health knowledge, both immediately and postintervention,” or “participants’ knowledge of testicular cancer and the likelihood of conducting a testicular self-exam increased significantly.” Conversely, other studies found that “in the context of TSE, humorous messaging was not as effective as informational messaging” and, in the case of “The Tom Green Cancer Special,” “perceived humor … was not significantly associated with self-examination intention.”

“We need to use humor as an effective, cheeky tool where it could be really effective in not just raising awareness — and that's different than increasing knowledge,” Rovito said. “So, making people aware, fine, (but) making people more knowledgeable, that's a bit harder. But then, actually changing behavior, that's a way different thing.”

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