Vasectomy is a long-acting male-centred family planning method that is accepted globally as a safe, low-cost procedure. However, the vasectomy uptake remains low in Africa and birth rates remain high, particularly in rural areas. In Tanzania, family planning education and service delivery are currently women-centred. Vasectomies to date have not been positively perceived in African societies including urban Tanzania, owing to the adherence to strong patriarchal belief systems and the social role of men. This study aimed to explore rural men's perceptions and beliefs regarding barriers to vasectomy uptake. Significant barriers to vasectomy uptake were the lack of knowledge, expectations around men's gendered role, religious beliefs, and social stigma. The participants were 51 purposively selected married men aged 35 to 61 years. Four focus group discussions and 20 in-depth interviews were conducted. Five main themes were extracted, namely men as the kings of their families; multiple sources of knowledge causing confusion; gender roles in family planning; cultural and religious beliefs; and stigma related to failure to produce children after vasectomy. Overall, men expressed the view that vasectomy was a challenge to their role as "king of their family". Engaging in targeted media releases, using community billboards, and providing grassroots-based health education delivered by male "elimisha rika"(peer educators) at community level are recommended as awareness raising strategies in communities.