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A 5-year-old sat in the back of the car, struggling to get his words out. “I can’t say it,” he told his dad.

With gentle coaxing, he finally let it out — through tears, slowly, and pausing after each word: “I’m too skinny.”

No one at school, and none of his friends, had ever said this to him. And to an onlooker he would seem to be about the same size and shape as any other boy in his pre-K class.

But he’s not alone in having these worries at a very young age. “I had a 6-year-old patient who was constantly picking his body apart, saying he was too fat, too skinny, not muscular,” says Roberto Olivardia, psychologist at Harvard Medical School who specializes in body image issues. “My patients are getting younger.”

Why is this happening? Sadly, given the ridiculous images of masculinity that boys are exposed to from birth, the more apt question is: How could it not?

Warping Boys’ Minds

“Here’s a picture of my superheroes when I was a boy,” says researcher Michael Kaufman. He’s speaking at U.N. headquarters in New York. Behind him on a large screen are two photographs: the 1960s TV versions of Superman and Batman, played by George Reeves and Adam West.

“If I show this picture now in a school, the boys go absolutely hysterical. They say, ‘Those flabby, middle-aged men are superheroes? Are you nuts?’”

“I had a 6-year-old patient who was constantly picking his body apart, saying he was too fat, too skinny, not muscular.”

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“But when I was a kid, those were our images of invincible masculinity. We could only imagine, we could only fantasize about being that powerful, that superheroic. We couldn’t pull it off.

“If we couldn’t pull off that, imagine a boy now trying to pull this off,” Kaufman says, switching to an image of a current Batman cartoon. It shows a figure more massive, bulging, and chiseled than any actor, even Schwarzenegger or Stallone, has ever looked.

Kaufman then shows how G.I. Joe toys have changed similarly, and how Luke Skywalker action figures now look like they’re “on steroids.”

Pictures of idealized physical perfection have “saturated” the culture, says Dr. Alison Field, who chairs the Department of Epidemiology at the Brown University School of Public Health. “We’ve been doing it a long time to girls. And unfortunately we’re now doing the exact same thing with boys.”

The Rise of Disorders Among Teens

Most 5- and 6-year-olds aren’t yet self-aware or self-conscious enough to worry about how they compare, says Field. But among preteens and teenagers, the prevalence of this problem is alarming.

Field was the lead researcher on a study published in JAMA Pediatrics. Examining more than 5,500 boys nationwide, the study found that 18% had become “extremely concerned with their weight and physique.” More than 7% of older teens are using creatine supplements, growth hormone derivatives, or anabolic steroids – a figure that is “absolutely huge,” says Field. The use of those products among boys is at least as common as purging is among girls, the study said.

And it could be much more widespread. This problem among boys often goes undiagnosed, Field says. “We have a pretty gender biased view of eating disorders,” with clinicians generally focusing on female patients. “They didn’t think maybe it just looks different in males.”

If a girl is underweight, her parents and doctor might notice and take it seriously. A girl who is purging might show telltale signs. But to many adults and doctors, a boy working out and wanting to be bigger seems relatively harmless. They might not know he’s become preoccupied and obsessed. And short of blood work, they might not know he’s using chemicals.

These chemicals are easily accessible, with very little regulation. “It’s the wild, wild west. You can order anything you want,” says Field.

To be clear, these substances don’t all necessarily damage health. “Creatine is likely safe when used long term,” the Mayo Clinic says, noting that there are also potential health dangers. But the point is that boys, like girls, are trying to alter their physiques beyond what comes naturally.

Field’s study found that boys with acute body image struggles are more likely to experience depression and abuse drugs. And those using products to bulk up are more likely to start binge drinking.

Body Dysmorphic Disorder

The problem doesn’t end with youth. Many men are struggling as well.

Harrison Pope, co-author of the book The Adonis Complex, sent me his latest research estimating that up to four million Americans have used steroids, and about a million “may have experienced dependence.” About 98% of steroid users are men. (Anabolic steroids can cause infertility, impotence, liver abnormalities and tumors, among a list of other problems.)

More than 2% of men are estimated to have Body Dysmorphic Disorder (BDD), which the Mayo Clinic defines as a “chronic mental illness in which you can’t stop thinking about a flaw in your appearance — a flaw that is either minor or imagined.” And again, researchers say the real number is probably higher because many men are undiagnosed.

The tales of guys suffering with BDD are heartbreaking. “I always feel small,” a 25-year-old super-pumped bodybuilder told the BBC for a story on “Bigorexia.” Staring endlessly at himself in front of the mirror, he said he wonders, “How can anyone love or enjoy what is here? It boggles my mind because I myself don’t like what I’m seeing.”

Research has found that about a quarter of people with BDD at some point at least consider suicide. And among guys with BDD who specifically have “muscle dysmorphia” — which Merriam-Webster describes as “pathological preoccupation with the perceived smallness or weakness of one’s body and musculature” — suicide and suicidal attempts are even more common. In one study of 14 men with muscle dysmorphia, half admitted to having attempted suicide.

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It’s the flip side of the obesity epidemic. And in some ways the two are intertwined, says Olivardia, who is also a co-author of The Adonis Complex. “We’re a very all-or-nothing, dichotomous kind of culture,” with little focus on moderation, he says. Some people become obsessed with fitness because they’re afraid of becoming obese. Others decide not to bother to exercise or eat healthy at all because they’ll never have the “ideal” body anyway.

These are the extreme cases. The body image crisis affects millions more men who don’t suffer from disorders, but still wrestle with feelings of physical inadequacy because of these imaginary ideals. Just as women are impacted by images of beauty, so are men. It’s something I’ve even learned to watch out for in myself.

My Health Journey

When I was growing up in the 80s, there wasn’t the kind of pressure there is now. I don’t remember feeling worried about being thin.

In my mid-20s, I suddenly started getting intestinal blockages and having emergency surgeries. I’d spend weeks in the hospital and weeks more recovering. I could barely eat. Physically, I was wasting away. At one point, I weighed in at 137 pounds. Friends would later tell me that I had looked like a concentration camp survivor during this time.

Finally, research led me to a good team of specialists. On my fourth surgery, they fixed the underlying problem. I entered the best health of my life. I started working out to build up my body. Steadily, I packed on muscle. Looking in the mirror one day, I was stunned at how I had transformed.

So for me, working out is about health and power. It’s my way of trying to take back control of my body. And, yes, there’s vanity involved.

But a couple of years after I started lifting weights, two women I trusted told me they thought I had bulked up a bit too much. I was at 195 pounds. I didn’t see what they saw — didn’t really see myself as any bigger than how I had looked at 180. I was still in the mindset that I needed to grow to be in control of my body. But after they pointed this out, I looked at myself differently, and decided that they were probably right. So I dropped down steadily into the 180s, and generally stay there.

I work out three times a week with one of two trainers, both of whom are my friends. It’s 90 minutes total — one hour of weights and 30 minutes of cardio. And I happen to like healthy food, but still have my indulgences.

Magazines, Hollywood, and Social Media

This experience helped me see pop culture in a new way. I saw how, amid the growing and crucial movement for healthy female body image, there is no similar movement for men.

Instead, when actors undergo extreme body makeovers to be shirtless in movies, they’re praised for it. The stories of twice-daily workouts and crazy eating regimens become legendary. And the use of chemicals by these actors remains unspoken. It’s a similar story for many TV shows that seem to recruit exclusively at bodybuilding competitions.

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Men’s magazines, meanwhile, promise to lay out the steps every guy can take to look just like whichever muscle man is on the cover. “I can tell you honestly, based on personal experience and friends in that industry, those models are some of the most unhealthy people,” fitness trainer Dai Manuel told me for my book, All In. “To get photo-ready, they go through diuretics, calorie reduction.”

Even then, they sometimes get Photoshopped into biologically impossible shapes. Increasing numbers of female celebrities have called out magazines for altering their bodies, but male stars virtually never admit it. A prominent exception was tennis player Andy Roddick, who appeared on a cover and then quipped, “Little did I know I have 22-inch guns and a disappearing birthmark on my right arm.”

All these problems are compounded by social media. “You have to look like a celebrity every minute of the day now because you could be snapped on the Internet and all your friends could see it,” Olivardia says. This is especially true of teens and younger adults who more often use social media in these ways. Today’s culture for young people is “much more aggressive, and the pressure is more intense,” he says.

The Real Me

It’s time for a national conversation to change this. Time for us all to be as aware of the dangers facing boys and men as we are of those facing girls and women. That’s why we’re taking this on with the cover. I’m no juiced up, Photoshopped beast. This is what I actually look like – 6’1”, 180 pounds, with a healthy amount of body fat. Having eaten breakfast. And drinking water.

When I look at these pictures of me, my first thought is not that I look fine or normal or healthy. And it’s certainly not that any part of me looks good. My first thought is that I have no business showing this much skin in a magazine. Because we all, including me, have been trained to expect only Herculean physiques in media.

But that’s just my first thought. I quickly crush it. I tell myself that it’s crucial that we, men included, get real about the body. I tell myself that I’m healthy, that this is me, that I should feel good in my skin.

We all should. “Having a healthy body image doesn’t mean loving everything about the way you look,” says Olivardia. “You’re going to love some aspects, like some, and feel neutral about most. Then there will be a couple parts of your body that you probably hate. That’s OK – you can still function and see yourself as a worthwhile person. Where it becomes problematic is it becomes more negative, and when you base your worth as a person on it.”

Let’s focus on being healthy. And real. And show children that men come in lots of equally good shapes and sizes. Together, let’s take a stand against this crisis.

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By: Josh Levs

– a dad of three and the author of the widely acclaimed book All In: How Our Work-First Culture Fails Dads, Families, and Businesses–And How We Can Fix It Together. A former reporter for NPR and CNN, he now focuses on issues of gender equality and fatherhood full time. The U.N. has named him a global gender champion, the New York Times called him a “pioneer,” and the Financial Times named him one of the top 10 male feminists. Learn more at joshlevs.com.

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PhotoImage GettyImages

Previously published on STAND Magazine