Think worrying about your appearance is a "woman's thing?" Not anymore, mental health professionals say. Increasingly, some men are as preoccupied with their looks as some women.
Psychologists say the quest for abs like the Soloflex man and shoulders like rapper-turned-actor Mark Wahlberg - plus a full head of hair and flawless, tanned skin - is creating problems in men typically associated with women: eating disorders and body obsessions.
"We live in a society that is very appearance-oriented," says Roberto Olivardia, a clinical psychologist and co-author of The Adonis Complex: The Secret Crisis of Male Body Obsession. "The message is: 'If you look perfect, you are perfect.' A lot of men feel inadequate and are very depressed because they feel they don't measure up."
For some men, anxiety over their appearance manifests itself in eating disorders such as anorexia and bulimia. Men now account for about 10 percent of the estimated seven million to 10 million Americans with eating disorders, says Mark Klug, national outreach representative for Rogers Memorial, which runs a male-only eating disorder treatment facility.
Other men develop body dysmorphic disorder, a pathological preoccupation with a particular body part they believe is flawed. In men, a common form of this disorder is what's being called "bigorexia," an obsession with being muscular and a fear of being too small, says Dr Eric Hollander, a professor of psychiatry in New York City.
Men with bigorexia are prone to depression, using anabolic steroids and forgoing social events to spend several hours a day at the gym, lifting weights. Some continue to exercise even after they've suffered a serious injury, such as a dislocated shoulder, Hollander says.
The media's powerful pull
What's driving men to become obsessed with their physiques? Doctors say a variety of causes contribute, from brain chemistry to the media.
Hollander believes bigorexia is a type of obsessive compulsive disorder, which drives people to repeat an action or a behaviour over and over. Men with bigorexia often look at themselves in the mirror frequently, eat a strange or restrictive diet and exercise until exhaustion.
But the media also play a role, he says. In men's magazines, advertisers prey on the insecurities of many men, using modern-day Adonises with washboard abs, broad shoulders, slim waists and white teeth to peddle diet aids, fitness machines, baldness remedies, vitamins and an array of other products.
"You need to have a genetic or biological predisposition to the disorder, but constant bombardment with unrealistic images can contribute," Hollander says.
Not so long ago, bodies of the manliest men in popular culture looked a bit more ordinary. Think John Wayne in the '40s or Steve McQueen in the '60s.
But in the last several decades, images of the ideal male body have grown increasingly more muscular. In one recent study, Olivardia and his colleagues compared the muscularity of action figure toys, past and present.
Scaled to human dimensions, the original 1965 GI Joe would have a biceps circumference of about 11 inches - similar to an ordinary man, they found. However, the 1995 GI Joe Extreme would have 26-inch biceps - larger than any bodybuilder in history.
Another factor fuelling men's obsessions is an emphasis on youth, Olivardia says. And he believes that's one reason increasing numbers of men are getting plastic surgery.
"Being young is very, very important, especially in today's dot.com business world," Olivardia says. "Men believe in order to stay competitive you have to look good, and that means looking young."
Lining up for liposuction
The most popular procedure among men? Liposuction. That's when a surgeon suctions out fat using a hollow tube called a cannula to slim down a so-called "problem area," such as love handles or the abdomen.
Last year, nearly 33 000 men had liposuction, about a 33 percent increase from the previous year, according to the plastic surgeons' group. Some men even are requesting abdominal "etching," which involves having the surgeon remove fat in a way that results in a "six-pack" stomach.
Liposuction is followed by eyelid surgery, nose jobs, breast reduction and facelifts on the most-popular procedures list.
And some men are requesting chest and calf implants these days.
The top two reasons men cite for getting plastic surgery: to improve self-image and enhance a career, according to a survey by the Chicago-based American Academy of Cosmetic Surgery.
But for all the men who develop full-blown body dysmorphic disorders, countless others cope quietly with insecurities about their physiques, Olivardia says.
"Regular" guys should take heart, however. While men think women dig big, bulging muscles, in fact women seem to prefer more ordinary-looking guys.
A survey of 200 college-age men in the United States, Austria and France found that men want - and believe women desire - a body with at least 27 more pounds of muscle than they actually have, according to research published in a recent issue of the American Journal of Psychiatry.
But Austrian females surveyed said they preferred a more typical, less-muscular male physique. While women in the United States and France were not surveyed, previous research has found they have similar tastes.