The continuing confrontation with the thoughts and feelings surrounding an unfulfilled wish for a child makes coping very difficult. There is empirical evidence that, in medical illnesses associated with stress and loss of quality of life, patients react with alexithymia, which means a difficulty to communicate emotions. In this study we compared 84 infertile men with a group of 96 healthy men and 43 male psychosomatic outpatients concerning their ability to communicate feelings, measured by the Twenty-Item Toronto Alexithymia Scale and the amount of psychopathologically relevant symptoms, especially somatization, measured by the Symptom Checklist 90-R and a List of Complaints (Beschwerden-Liste). The results showed a significantly higher alexithymia in infertile men compared with healthy men (P < 0.05), but a significantly lower alexithymia compared with psychosomatic outpatients (P < 0.05). Furthermore the study group showed significantly more somatic complaints in the List of Complaints compared with healthy men (P < 0.05). The importance of alexithymia in male infertility is discussed on the basis of empirical results that it might play a defensive role as far as depression is concerned but on the other hand increases the possibility of somatic complaints. The need for prospective studies in further research is emphasized.