Men who were sexually abused during childhood (MSAC) represent a highly stigmatized, marginalized population at risk for a variety of psychological problems across the lifespan. Little research has been conducted to understand why some MSAC incur mental health problems and others do not. The purpose of this study was to identify which factors are related to mental distress among MSAC using a psychosocial trauma processing model: account-making. Using a cross-sectional design, the researcher collected data on 487 MSAC through an anonymous, online survey. Multivariate analyses for the final direct effects model revealed that high conformity to masculine norms, account-making stage, and two disclosure variables (told after one year, overall response to disclosure) were related to higher levels of mental distress. Three control variables were also related to mental distress: older age, childhood stressors, and current stressors. Posttraumatic growth moderated the relationship between abuse severity (force, penetration) and mental distress. The results of this study strengthened the knowledge base of MSAC, further developed account-making theory, and provided useful recommendations for clinical practice with this population. Future areas of research were identified.