Men who are considered the most physically attractive in American pop culture tend to be lean and muscular. They have body proportions that bear little resemblance to the average American guy, who tends to be a bit overweight.

But what are the implications of this discrepancy for male body image? Does the media pressure to be fit and strong have an effect on how men feel about their appearance? And do the effects differ for men depending on their sexual orientation? A recent article published in the journal Psychology of Men & Masculinity offers some insight.

In the article, researchers reviewed the results of five studies of male body image that, combined, included more than 116,000 participants, of whom a little more than 4,000 identified as gay.

They found that a significant number of men reported dissatisfaction with their physical appearance, ranging from one-fifth to one-half, depending on the specific aspect of their appearance considered.

The things men were most likely to be dissatisfied with were their weight as well as their muscle size and tone. Notably, 44 percent of gay men and 39 percent of straight men were unhappy with their weight, while 45 percent of gay men and 30 percent of straight men were unhappy with their muscularity.

Overall, gay men expressed more appearance-related concerns than straight men, and they were more likely to say that this results, in large part, from media pressure to look a certain way. In response to the statement “I feel pressure to have a more attractive body from magazines and television,” 58 percent of gay men agreed compared to just 29 percent of straight men. This means that gay men are twice as likely to feel that they need to live up to the body standards established by the media.

Consistent with this finding, gay men were also more likely to feel that other people will judge them based on their looks, to spend more time thinking about their appearance during the day, and to compare their appearance to other men. Interestingly, though, gay and straight men didn’t differ when it came to how much pressure they felt from their dating partners to look a certain way.

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Gay men’s greater dissatisfaction with their bodies appears to have important implications for both their overall health and their sex lives.

First and foremost, gay men are more likely than straight men to try and modify their bodies. For example, 7 percent of gay men reported undergoing cosmetic surgery in the past year, compared to just 1 percent of straight guys. In addition, 37 percent of gay men went on a weight loss diet and 12 percent had taken diet pills in the last 12 months (for straight men, the numbers were 29 percent and 5 percent, respectively).

The higher prevalence of diet pill use among gay men is especially concerning given the well-documented dangers associated with weight-loss supplements. Given that supplements aren’t regulated as strictly as pharmaceuticals, people who take them often don’t know what they’re getting and there isn’t always safety data available.

Related to this, other research has found that gay men are at a heightened risk of developing eating disorders, such as anorexia and bulimia. For example, in a study that assessed eating disorder symptoms, just 1 percent of heterosexual men met disorder criteria, compared to 10 percent of gay men. By contrast, 13 percent of heterosexual women and 9 percent of lesbians were categorized as having an eating disorder. It would seem, then, that gay men’s risk of eating disorders is similarly high to that of women.

Eating disorders pose a serious health risk in that they have the potential to negatively affect functioning of the heart and other major organ systems throughout the body. As a result, they can potentially be life-threatening.

Beyond eating disorders, body dissatisfaction among gay men also appears to contribute to higher rates of anabolic steroid use, which are often used to address concerns about muscularity. Usage of anabolic steroids can have a detrimental impact on the cardiovascular, endocrine, and nervous systems; it's also linked to an increased risk of death.

A recent study of nearly 3,000 gay and bisexual men in Australia and New Zealand found that 5 percent had used steroids and 25 percent were thinking about doing so. Eating disorder symptoms were the strongest predictor of gay men’s steroid use.

It’s worth noting that gay men’s body image issues don’t just pose a risk to their health—they may also have a detrimental impact on their sex lives and relationships. Though the review article discussed above didn’t find a difference between gay and straight men in perceived partner pressure to lose weight, gay men reported more concern about showing their body to a partner.

Specifically, gay men felt more uncomfortable undressing in their partner’s presence. They were also more likely to hide certain parts of their body during sex, including their chest, stomach, and genitals.

Most telling, when asked whether their feelings about their body have caused them to avoid sex, 20 percent of gay men said yes, compared to 5 percent of straight men. In other words, gay men are four times as likely to avoid having sex with a partner because they are dissatisfied with their looks.

All in all, what these data tell us is that a lot of men have body image concerns stemming from media pressure to be fit and muscular. However, these concerns disproportionately affect gay men, increasing their susceptibility to eating disorders and risky health practices. There also appear to be detrimental implications for gay men’s sex lives and relationships.

More research and public awareness of these important health disparities is needed so that we might encourage prevention and intervention efforts.

Justin Lehmiller is the director of the social psychology program at Ball State University, a faculty affiliate of The Kinsey Institute, and author of the blog Sex and Psychology. Follow him on Twitter @JustinLehmiller__.