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The State of Male Body Image

Men are more obsessed with their physical appearance than ever before, but their awareness can be just as problematic as it is productive

Traditionally, popular narratives about the male body hardly seem urgent — for three main reasons: The male body hasn’t been politicized. The male body hasn’t been legislated against. The male body hasn’t been held to an impossible standard of perfection.

Nor have men historically given much of a shit about their bodies — or their health. So much so that the Cleveland Clinic created an entire “MENtion It” campaign after its research found 60 percent of men don’t go to the doctor when they fear something is wrong with them. And even when they do, they have a tendency to play the strong, silent type, refusing to articulate what brought them there in the first place. (That might help explain why, on average, men die five years earlier than women.)

The operative words here, though, are “traditionally” and “historically.” As with most things related to modern masculinity, the past is hardly the determining factor in what’s going through the mind of the contemporary male when he looks at himself in the mirror. Or more aptly, when he sees himself tagged in a photo on Facebook or Instagram. It’s this constant digital reflection that has men headed to the plastic surgeon in record numbers — for beefier chins, for less puffy nipples, for rock-hard abs, for Harry Styles-esque dimples, for tighter assholes.

The quest for the perfect body, however, has ushered in the kind of body dysmorphia we typically equate with women. Not to mention, strict dieting and chemical shortcuts that result in as many consequences as benefits. Of course, most men are only looking for a single benefit: For their self-confidence to grow at the same rate as their muscle. The idea being that a better body will make them feel better inside, too. The two, though, aren’t nearly as symbiotic as many men hope — leading to a host of other issues (e.g., “bigorexia,” a condition where men can never be big enough, no matter the amount of time they spend at the gym or the number of steroids they inject).

Speaking of big enough, one thing that hasn’t changed is how much men think about their dicks. And yet, for all the talk of smelly dicks, whiskey dicks, bags of dicks, frankendicks, limp dicks, cartoon dicks and small dicks, giant dicks and bionic dicks, men really don’t know dick about their own sexual health — it probably doesn’t help that they don’t go to the doctor — or what a normal dick actually looks like. “I’ve chatted with girls who said I was the smallest they’ve ever seen (possibly to be hurtful), and I’ve chatted with girls who believed I was hung like a horse,” one guy told us earlier this year when we reported on the women who men were paying to critique their dick pics. “In the case of sellers, especially the more popular ones, you know they’ve seen a wide variety of cocks in all shapes, sizes and colors. Asking one of them to rate me seemed like a surefire way to get an unbiased perspective.”

All of which is to say that despite the sitcom trope of the manly man who doesn’t go to the doctor or who takes pride in his ever-mounting beer belly, it’s probably more fair to say that men are in the throes of a crisis of confidence about how they look — and that many men are attempting to avert that crisis in counterproductive ways that are detrimental to their health.

To help make sense of this, we’ve enlisted a number of health professionals who have made it their life’s work to better understand the male mind-body connection. Their methods are varied — from analyzing why men binge-eat their stress and anxiety to evangelizing the power of the prostate massage — but their mission is the same: Get men to feel better about living in their own skin.

Dr. Roberto Olivardia is a clinical psychologist at Harvard Medical School, co-author of The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys and a longtime expert on Body Dysmorphic Disorder among men and boys. He asserts that many men use their eating and fitness habits to ground themselves — whether that’s by paying meticulous attention to their fitness plans or binge-eating until they fall asleep.

More often than not, eating disorders are the physical manifestation of repressed emotions, and since we know that throughout history, men have been expected to ignore their feelings in favor of fulfilling more socially acceptable needs (food! fucking! football!), it makes sense that eating disorders among men are common — binge-eating and orthorexia chief among them.

Olivardia: These days, I treat a lot of men with eating disorders where they adhere to strict diet and fitness standards. But while they may drink spirulina shakes all day, some of them either buckle under their own pressure or just plain hate eating that way and binge-eat at night on chocolate cake and ice cream. Generally speaking, the most common eating disorder among men is binge-eating. The gender distribution here is about 50/50 between men and women. Basically, these individuals have bulimia but don’t compensate for their binging with purging, so it’s out of control.

A lot of men I work with experience a high degree of stress and emotional suppression. Again, generally speaking, men are more likely to suppress their emotions than women are, and food becomes a legal, accessible way to cope with these emotions — either to numb oneself or to ground oneself.

That’s not to say I don’t treat men with anorexia nervosa or with bulimia nervosa. These disorders are prevalent, too. I also see a lot of men who engage in what we call subclinical eating disorders. They may eat healthy, but then go to the gym and work out for four hours. In those cases, their exercise functions the same as a purge.

A lot of men are obsessed with certain supplements to enhance their muscularity as well. That’s a trend I’ve seen more and more of the last couple years. Years ago, I’d see plenty of outright anabolic steroid users; while these guys still exist, it’s much more popular today to mathematically try to figure out the best formulas to achieve certain visible cuts, like a six-pack.

It’s easy to assume this is a positive thing, but I encourage my patients to think about their ultimate goals and values. A lot of men with disorders like this push away other important parts of their life. They put in this incredible effort to strategically get the perfect body and lose out on their leisure time and creativity. I try to get them to consider, “If I’m at the gym four hours a day but miserable because I weigh five pounds more than I want or don’t have sharp enough muscle tone — nor am I present for my wife/girlfriend/boyfriend/son/daughter — what’s the point of all this? What’s the value of having a perfect body if it damages your relationships?

I’ll often ask patients who behave in this way what they expect to happen when they reach their body goals, and they tell me things like, “I’ll always feel confident. I’ll always feel great.” There’s this myth that if you look a certain way, you’ll be immune to anxieties, stressors and criticism. So for most of my patients, it’s not about attaining the perfect body, it’s about what they feel they’re going to get by having the perfect body.

At least they’re willing to admit it — and talk about it. Something that wasn’t necessarily the case even 25 years ago.

Olivardia: My thesis at Tufts University in 1993 was on eating disorders in college men. I’d placed ads in various college newspapers in the Boston area, and I remember my committee telling me that I should have a plan B, because I might not have enough men respond. Plenty of men called, however. But what was striking was that very few had ever disclosed their eating disorder to anyone. Some of these men were in therapy for depression and drug addiction, and yet, they’d never disclosed even to their therapist that they were anorexic or bulimic. There was an incredible amount of shame around what it meant to even pay attention to their bodies.

The millennials and adolescents I treat are much more open about their feelings in this way. They’re also much more open to talking to their friends about it, which is a great thing and has led to less shame among men. That said, the way they talk about it is a little different. Body image isn’t a phrase a lot of my male patients will use. They’ll say, “I have an eating disorder.” Or: “I want to look bigger, and I’m frustrated by how I look and it creates unhealthy patterns for me.”

Unfortunately, though, my older male patients still have problems talking about it. For them, there continues to be shame around struggling with something that’s traditionally seen as a female condition.

Similarly, while plastic surgery used to only be thought of as a woman’s pursuit, it’s very much becoming a male “condition” as well. Per Jezebel earlier this month, “According to the American Society for Aesthetic Plastic Surgery [ASAPS], the number of men undergoing plastic surgery has increased 53 percent from 2011 to 2015.” The five most common procedures they undergo: Liposuction, breast reduction, eyelid surgery, nose surgery and facelifts.

Dr. Michael Salzhauer is better known as Dr. Miami, the viral plastic surgeon known for posting his procedures in real time on Snapchat and Instagram. (I watched him do so in person a couple of years ago.) Social media also birthed his reality show, Dr. Miami (“Dr. Miami land is a never-ending soap opera of over-the-top patients, wild antics and salacious moments with his staff”). Along with his staff of marketing-savvy Floridians, Dr. Miami’s online presence aims to eliminate any barriers between his followers and his operating room.

He echoes a lot of what Olivardia had to say about the rise of men’s preoccupation with their bodies, but contends plastic surgery isn’t all that different from more traditional methods men have used to look good — namely, grooming and clothing.

Dr. Miami: I definitely think men are more self-conscious and aware of their bodies today — in large part because of social media and the amount of pictures we take of each other now. I probably have 100 pictures of me growing up; my kids have thousands and thousands. That creates an astronomical change in the way people perceive themselves. Before that, all we had was the mirror. But we’ve learned how to deceive ourselves in the mirror. We know what to suck in and generally end up looking a little better and a little slimmer when we look in the mirror. And so, you can sell yourself on an image that’s different from what you actually look like. But when you have tons of videos and photos revealing what you look like from all sorts of angles, it’s harder to fool yourself.

Solving this problem with plastic surgery isn’t entirely unique, though. While the World War II generation might not have considered it, a lot of those guys did care about dressing well as a means of presenting themselves nicely. After that, the bodybuilding and gym movement took off. I’d put that, philosophically, in the same category as plastic surgery, in that these guys invest huge amounts of time and energy into making themselves attractive. You could say the benefit is about gaining strength, but that’s not usually the real goal.

Most people are having plastic surgery to feel a greater sense of comfort and security in their bodies. We all can recognize when people go too far, but there’s other questions to consider too. When one of my patients has a Mommy Makeover after giving birth, isn’t that a reconstructive procedure as opposed to a vain one? Someone is used to looking a certain way, but suddenly, there’s stretch marks and breasts in the wrong place. That’s very depersonalizing.

Dr. Miami and I went on to discuss how men haven’t been traditionally deduced to their appearance in the same way women have. Yet when talking to my male colleagues, they told me about becoming more and more aware of the utility of looking good — to my surprise. I knew men had the benefit of being unconcerned with their looks, but I didn’t know how many of them were looking to double down on that advantage with smoldering acts of hotness. Dr. Miami, however, concurred.

Dr. Miami: There’s a book called Erotic Capital that’s great. One of the chapters talks about the fact that men also have erotic capital and gain more from it than women do. I think this has to do with the Tinder generation. In my generation, growing up in the 1980s and 1990s, men weren’t selected for dating based on their looks as intensely as men are today. The fact that a man could theoretically be picked up just based on the way he looks is a newer phenomenon. Straight women have always, smartly, been more circumspect, but the ways these apps are designed is changing that — for better or for worse.

Beyond getting laid, though, there’s something to be said for men harnessing the confidence they get from their body and injecting that sense of desirability into other aspects of their life, too. To quote Tony Robbins (as one must from time to time): “Whatever you hold in your mind on a consistent basis is exactly what you will experience in your life.” That, it seems, extends even to the asshole, which some men are botoxing to enhance both its beauty and sexual compatibility.

Dr. Miami: If someone told me they’d spent a million dollars getting their anus botox look perfect, I’d agree that it seemed excessive. But if they’re getting botox anyway, and they’re like, “Where else can you put it that will make me look or feel better?” I don’t think there’s anything wrong with that. Some people are just meticulous, and they pay attention to detail in every aspect of their life. So that would simply be an expression of their personality.

On the other hand, if the person becomes obsessed with that one specific thing and it’s so out of proportion that they can’t go on because they think their anus is too wrinkled, that’s when it becomes pathological. But as a rule, I don’t think there’s anything wrong with trying to be the best you can be.

What of their dicks, though? If guys are shooting up their assholes with botox, they must be doing something similarly extreme to pump up the appearance of the one organ they stress about the most — at least in terms of what others (particularly their sexual partners) think about it.

Dr. Miami: Penis enlargement is certainly something that people always talk about. It’s not very popular, however. The mainstay approach for the last 15 years is this: There’s a small ligament at the top of the penis that retracts it a little bit. If you cut that ligament, it releases the tension, and you get maybe another inch or so of length. To get girth, people either inject fat or filler materials, just like you’d put in your lips. Although the gains aren’t that impressive — you can’t suddenly go from average to porn star — you can go from slightly below average to average, or average to slightly above average, and for some, that makes a big difference psychologically.

Dr. Miami hasn’t operated on any dicks in years, so he refers me to the real expert: Dr. Harold Reed. The 77-year-old completed his residency in 1973 and got interested in penile implants when he was finishing graduate school at SUNY Upstate Medical University. He’s been performing them regularly since 1986.

Reed: When patients see me, I tell them, much to their surprise, that my first responsibility is to keep their hard-earned money in their pocket. Many guys don’t know what normal penis size is, so it’s my job to say, “Hey, you’re normal.” Of course, normal isn’t a precise number, it’s a range, but for the most part, guys don’t need penis enlargement surgery. I’ll even go so far as to say we go out of our way to discourage patients from having this done, which may be why the rate of these procedures is static.

I had a woman who worked in my office for about 20 years tell me she was going to write a book called Me and My 3,000 Penises. She came to the conclusion that most of these prospective patients weren’t lacking penile size, they were lacking love — either self-love or love from a partner. After all, penile enlargement won’t turn an introvert into an extrovert. It will turn an introvert into an introvert with a big penis.

Now, when we talk about penis surgery, we’ve got to break it down into two categories: lengthening procedures and girth-enhancing procedures. To avoid complications, these operations should never be performed simultaneously. As far as lengthening goes, men can get a longer penis with the use of traction. They don’t have to have surgery; they just have to follow the instructions of a doctor who knows about traction, and they’ll get a longer penis. Different companies sell different forms of traction devices, which get attached to the head of the penis and pull on it. If someone wants to use traction, they need to use it for a minimum of eight hours a day in 24 divided sessions for it to work.

As for girth enhancement, there are different techniques, including the injection of silicon, the injection of tissue fillers and the injection of fat. My office offers AlloDerm sheets. AlloDerm is an allograft, which means it comes from another person, and we implant it under the skin to a fairly uniform thickness. Generally, it produces a nice result. The problem with fat injections is that they go into the tissue planes of least resistance, so even though you put the fat in what you feel was the right areas, your fat injection may wind up in the pubis, the scrotum and/or a portion of the foreskin, forming nodules like cottage cheese at each stop.

The other procedure I’ll mention is testicular implants. A lot of guys who seek out this procedure want to look symmetrical after losing a testicle to a tumor or torsion (the twisting of a testicle). They want to regain that sense of balance. This procedure is also popular among weightlifters, because steroids cause atrophy in the testicles.

From one Florida-based urologist to another: Dr. Jamin Brahmbhatt specializes in the penis, too. Though less versed in elective surgery than Reed, he is excited to see how the new generic Viagra affects the pharmaceutical market and men’s libidos alike. In particular, he hopes the generic version of the ED elixir minimizes the popularity of those “horny goat weed” supplement scams once and for all.

Brahmbhatt: Currently in the U.K., there’s a big push to make Viagra over-the-counter. In the next year, we’re going to see that become their full-fledged policy. But Viagra isn’t over-the-counter in America yet. The only thing that’s changed is that it’s officially going generic. Of course, there already are unofficial compounds similar to Viagra and Cialis that specialty pharmacies create and sell, but we’re approaching the first time in the history of Viagra in the U.S. where a legitimate generic version of the patent will be officially released. It’s not going to be much cheaper than the name-brand stuff at first, but it’ll still make the medication much more accessible.

Overall, I’m hoping generic Viagra will encourage guys to stop buying stuff from the gas station and select something that’s more science-based. That stuff isn’t regulated and neither are the unofficial Viagra copies. Also, when you look at clinical studies, a lot of it only offers a placebo effect. And while some of them do help with erections and blood flow, it’s usually because they’ve packaged 10 or so different things into one pill, with each ingredient proving to benefit erections or blood flow by one or two percent, culminating in a larger overall benefit.

I’d be lying, though, if I said I wasn’t a little nervous about something like Viagra going over-the-counter in the U.S. because there’s definitely side effects to it. The biggest being a decrease in blood pressure; the second being cross reactivity with other medications. For instance, there are men who are on certain blood pressure medications that shouldn’t be taking Viagra. They’re really putting their bodies at risk if they do. Hopefully if Viagra ever does go over-the-counter here, we’ll be able to fine-tune things to protect these kind of men.

Another reason I’m cautious about Viagra going over-the-counter is you’re going to see a lot of guys who don’t need to take it potentially start taking it recreationally. That’s not good because it’s one of those things where if you don’t need to take it, you shouldn’t. So if a lot of young guys start taking it just to have stronger erections, that may become a problem down the road. Not because it’s going to cause erectile dysfunction. It won’t. But it’ll be more like how we need caffeine to energize us. In that same way, Viagra may be something men don’t have to be dependent on, but become dependent on.

That said, more direct access to Viagra could potentially inspire men to have more frank conversations about their sexual health and give them a chance to talk about what real sex is as opposed to comparing themselves to porn stars. Guys see hour-long sexual scenarios that ends in a boatload of jizz and worry about not being able to replicate that. This gives them a lot of insecurities, which can lead to erectile dysfunction. I’d say 50 percent of erectile dysfunction is mental, so when you begin dealing with their body image issues as well as their anxiety, their sex life automatically improves.

Charlie Glickman thinks another way to automatically improve the sex lives of men is by removing the focus from their dicks and putting it on (or in) their asses — especially in the form of prostate massages. The sexuality expert and author of The Ultimate Guide to Prostate Pleasure: Erotic Exploration for Men and Their Partners attempted ass play for the first time in college after his girlfriend suggested they give it a try. “She told me what other men had said about it and I got really curious,” he tells me.

Needless to say, that night was a big success — both sexually and professionally. Today, Glickman’s work, which involves both live demos and private coaching sessions, explores the “myth of normal” and what actually gets guys off versus societal expectations, as well as what sex acts or preferences men don’t own up to among each other but enjoy in private.

Glickman: Until recently, there’s never been a time when men’s prostates as a pleasure organ has been widely understood. That’s mostly because in talking about the prostate, we’re talking about men receiving anal penetration, and there are a lot of taboos around that, many of which are rooted in homophobia, though gay and straight men have the same capacity to experience prostate pleasure. Even in sex-positive communities, people have been slow to recognize that men have a G-Spot too — the P-Spot.

In The Ultimate Guide to Prostate Pleasure, we have an entire chapter unpacking the myths and concerns that men and their partners have about male-receptive anal sex. There’s this idea that in having receptive anal sex as a guy, you’re taking on the woman’s role and giving up masculine status. This, of course, is a frightening idea when you think about what it means for the ways straight men think about their female partners. If getting fucked means you’re submissive, what does that say about our attitudes toward women? It’s ridiculous, because not only can you have penis-and-vagina intercourse without themes of domination and submission, you can also receive penetration and be in charge, no matter what orifice is involved.

We see toxic masculinity play out this way in gay men, too. “Tops,” men who penetrate their partner, have a certain amount of privilege. That’s changed some in recent decades, but still, guys who get fucked have traditionally been called “punks,” “fairies” or “maricón.” I’ve spoken with a number of gay men who have said, “I’ve been exclusively a top, and now I’m thinking about bottoming and it really freaks me out.” I hear similar things from straight men who say, “I’m contemplating prostate massaging, but I’m scared.”

This isn’t surprising when we look at the language we use. What happens when something really bad happens? We say, “I’m so fucked,” or “I’m so screwed.” There’s this way in which our language assumes that there’s something wrong with being the one who gets penetrated.

Let’s look at it at the body level as well. I’ve never met a cis man who didn’t know where his genitals were and what they looked like. But I’ve talked with far fewer men who know as much about their anatomy as women know about theirs. The reason this is relevant is because so much of the focus culturally around male sexuality is about the penis — that’s all there is. Why do so many men send dick pics? It’s because it’s the only part of our bodies that get coded as sexual, at least within heterosexual contexts. The standard model of male sexuality is that it’s all about the penis and finishing. Get it up, get it in, get it off.

This approach very much assumes, “You had an orgasm, that means that you had sexual satisfaction.” In fact, if you look at a lot of sex research, that’s what they’ll focus on: “Did you cum?” But there’s incredible pleasure potential in the body that a lot of men and their partners completely miss out on when they stick to the narrow scripts they were taught as adolescents.

It’s also important to keep in mind that regardless of one’s gender, emotional safety is a big part of being able to feel sexual pleasure. Culturally, we’ve limited the way men are encouraged to speak about their feelings. We take for granted the way men need emotional care, touch, sweetness and romance as much as anyone else. So it gets tacked onto intercourse. Most men I treat or coach say when they feel lonely, they reach out to a partner for sex. They see it as a safe space to let themselves have feelings.

In general, men don’t have many emotional management skills — it’s mostly lashing out verbally or physically. Because if they don’t, our culture considers them a wimp. So here’s this situation where men don’t have as many tools for managing their feelings, and when difficult feelings come up and they’re triggered, they go into fight or flight. And fight is especially common, because that’s the one that’s culturally sanctioned.

“We’d all be much more well-adjusted, healthy, happy human beings if we weren’t being sent messages that shame us because of something that has brought us joy,” Ryan Sallans offers. He and I are talking about child rearing today amid the slow but steady cultural revolution seeking to break the man/woman, gay/straight binaries so many of us were raised to accept as fact. Sallans is a transgender speaker, consultant and author living in Omaha, Nebraska, who appeared in our “Families in Transition” series last year with his brother Greg.

As a frequent guest lecturer at universities across the country, his most requested presentation is “Scouting the Unknown,” which recounts his experience both recovering from anorexia and physically transitioning from female-to-male.

Sallans: Some parents today freak out and say we’re going to completely confuse all these children by being more flexible in the way we enforce gender — that we’re going to completely emasculate little boys if we allow them to play with Barbies. But that’s a ridiculous, inflammatory statement. The most important thing parents can do is not freak out if their kid shows behaviors different than what they’d assume based on what genitalia the providers said they had when they were born.

While my gender identity wasn’t the root cause of me having anorexia, there were pieces of it that were linked, and thinking about where that link was is interesting. Through journaling and therapy, I’ve realized that a lot of discomfort I had around my body growing up was related to my male identity. It goes beyond masculinity and femininity, too. Because I was raised as a female, my identity was hidden underneath my skin and I was trying to find a way to bring it out.

There were some very marked positive changes in my body image after I had chest surgery — that is the removal of breasts. After I started on hormones, testosterone in this case, my body started changing in a way that felt right for my skin. The physical transition has helped alleviate one dysphoria that I had around body parts related to gender that wasn’t mine and some of the negative self-talk, too. But it didn’t completely take away the eating disorders. The thoughts I had back then are still with me daily. I do my best to stop focusing on them by working out or attempting to write. Other times, I’ll take on unhealthy behaviors like drinking too much beer. I’m still exploring the perfect balance to deal with it, because you’re never “recovered” from an eating disorder.

No matter what, it’s important for us to reflect on our bodies in ways beyond “us” — in terms of biology, genetics and heritage. I love to sit down with photo albums and look at my ancestors from the 1800s, and think about the different things that blended together over the years to create each of us.

The future, though, is messier. Not so much the destination — that’s abundantly clear — it’s how we get there that’s hazy.

Sallans: As a society, we’re going through some important growing pains. We’re on the cusp of a new form of gender liberation — for starters, women not being silenced when speaking out against sexual harassment and assault. But also, us being able to have conversations around identity that go beyond the stereotypes of how gender has been looked at in the past. The issue then becomes respecting the individuals we’re having these conversations with without putting them into categories based on our own assumptions or judgments.

I even see this with older white gay men who are being villainized as guys who’ve gained power and status while ignoring the larger queer community. These are men who went through the AIDS epidemic and were in hospital rooms where nobody would even touch them, or their food tray would be set outside their room because people didn’t want to enter it. Now they’re seen as the guys who are trying to control everything. That’s not helpful.

I’m hoping we can get to a place over the next few years where people will realize that you’re doing unto others what you didn’t want done upon yourself. You’re labeling people. You’re passing your own judgments and assumptions. And you’re using language as a way to attack and defend your own stance, instead of as a way to try to start conversations that help one another.

For trans men, because we’re now able to walk around being seen as a man thanks to testosterone, we’re also put into this category, and our experiences prior to our transition — being socially reared female — are completely ignored.

That’s the thing we need to figure out next: How are we able to express our feelings in a safe place where everyone actually listens to each other?