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 online survey. Multivariate analyses revealed that four abuse severity factors (clergy abuser, force, penetration, injury), disclosure variables (told after one year, response to first disclosure, overall response to disclosure, in-depth discussion), account-making, and high conformity to masculine norms were related to higher levels of mental distress. Furthermore, posttraumatic growth moderated the relationship between abuse severity variables (force, penetration) and mental distress. This study strengthened the knowledge base of MSAC, further developed account-making theory, and provided useful recommendations for clinical practice with this population. Future research areas were identified.