Muscle dysmorphia is a condition characterized by an intense preoccupation with muscularity, significant dissatisfaction with one’s body or perceived lack of muscle mass, and impairment in social, psychological, or everyday functioning. Often described informally as a belief that one is never muscular enough, it has traditionally been studied in the context of body dissatisfaction, compulsive exercise, restrictive eating, and the pursuit of muscularity through training and, in some cases, performance-enhancing substances. The new study broadens that frame considerably. Its authors report that the condition’s symptoms were linked with difficulties including anxiety during sex, lack of sexual interest or enjoyment, lack of arousal, difficulty reaching climax, physical pain during sex, and difficulty getting or maintaining an erection. Only one of the eight sexual difficulties measured in the study was not associated with muscle dysmorphia symptoms, underscoring how pervasive the relationship appears to be across multiple dimensions of sexual functioning.

The study’s most striking finding concerns appearance-related distress. Within the cluster of muscle dysmorphia symptoms, greater dissatisfaction with appearance and greater discomfort with one’s own body were consistently linked with a wide range of sexual difficulties. The single strongest association observed was with feeling anxious during sex. This pattern makes conceptual sense within existing models of sexual response, which emphasize that attention, comfort, and a sense of safety are central to arousal and enjoyment. When cognitive resources are consumed by self-monitoring and evaluation of one’s body, the capacity to remain psychologically present during intimacy can be compromised, a phenomenon researchers often describe in terms of spectatoring, or mentally observing oneself from the outside rather than participating in the experience.

“One possible explanation is that intense body dissatisfaction and self-consciousness make it more difficult to be present and comfortable during sexual experiences,” said Ganson. “If someone is highly focused on how their body looks or worried about being seen by a partner, those thoughts may interfere with sexual interest, arousal, enjoyment, and functioning.” This mechanism, in which appearance anxiety disrupts the attentional and emotional conditions required for satisfying sexual experiences, aligns with a growing body of evidence connecting body image with sexual well-being more generally. Persistent body dissatisfaction, shame, self-consciousness, and preoccupation with appearance have all been shown in prior research to make it more difficult for individuals to feel comfortable, engaged, and emotionally available during sexual encounters.

The implications of the study reach beyond psychological mechanisms alone. The behaviors that frequently accompany the pursuit of muscularity may themselves contribute to sexual difficulties. Excessive exercise can produce physical fatigue and, when combined with restrictive eating, may leave the body without the energy reserves needed for healthy physiological functioning, including sexual response. More concerning still is the use of anabolic-androgenic steroids and other muscle-enhancing substances, which are known to disrupt the endocrine system. Exogenous steroid use can suppress natural testosterone production, and discontinuation can produce hormonal disturbances that affect libido, erectile function, and mood. The study’s authors note that such behaviors associated with muscularity pursuit may play a role in the sexual difficulties observed among those with greater muscle dysmorphia symptoms, although the cross-sectional nature of the data means the precise pathways require further investigation.

“Muscle dysmorphia is often understood in terms of body dissatisfaction, compulsive exercise, or the pursuit of muscularity, but our findings suggest that its impacts may extend into intimate and sexual experiences as well,” Ganson said. “Sexual health should be part of the conversation when clinicians are assessing boys and men with significant muscle dysmorphia symptoms.” This recommendation carries practical weight for clinicians working in eating disorder services, student health centers, sports medicine, and general mental health care, populations in which muscle dysmorphia and related muscularity-oriented behaviors are increasingly recognized. Sexual health assessments are not routinely incorporated into body-image treatment, and the study suggests that this omission may leave an important dimension of patient suffering unaddressed.

The demographic scope of the research is notable. By including sexually active participants as young as 15 and as old as 35, the study captures a developmental window that spans adolescence, emerging adulthood, and established adulthood, periods during which sexual identity, romantic relationships, and body image are all in active formation. Adolescence in particular is a time when appearance concerns can be especially acute, and when early sexual experiences may shape long-term patterns of sexual confidence and comfort. The finding that body dissatisfaction and appearance anxiety related to muscle dysmorphia may be especially important to the sexual health of boys and young men suggests that interventions delivered early could have benefits that extend across multiple domains of health and well-being.

“Body image and sexual health are often treated as separate areas of health, but they may be deeply interconnected,” Ganson said. “For some boys and men, addressing distress about their bodies may also be important for understanding difficulties they are experiencing in their sexual lives.” This framing challenges the conventional siloing of sexual medicine, mental health, and body-image treatment. A young man presenting with erectile difficulties or low sexual desire might, in many clinical settings, be evaluated for vascular, hormonal, or pharmacological causes without any assessment of muscularity dissatisfaction or compulsive exercise. Conversely, a patient in treatment for muscle dysmorphia might never be asked about sexual functioning. The study suggests that each of these one-sided approaches risks missing connections that could be central to recovery.

For researchers, the findings open several avenues for future work. Longitudinal designs would help establish whether muscle dysmorphia symptoms precede sexual difficulties, follow from them, or reinforce one another in a reciprocal cycle. Studies that measure physiological indicators alongside self-reported difficulties could clarify how much of the association is psychological, how much is behavioral, and how much may be attributable to substance use. Research examining whether treatments that reduce body-image distress also improve sexual functioning would test the clinical significance of the association directly. The study’s publication in Body Image, a leading peer-reviewed journal in the field, reflects growing scientific interest in muscularity-oriented disordered eating and body-image concerns among males, populations that have historically been underrepresented in research that focused predominantly on thinness-oriented concerns among girls and women.

Overall, the study positions sexual functioning as a potentially important dimension of health for researchers and clinicians working with boys and young men experiencing muscle dysmorphia symptoms. Its message is straightforward but consequential: the distress produced by feeling insufficiently muscular does not remain confined to thoughts about appearance. It can follow young men into their most intimate moments, dampening interest, interfering with arousal, and generating anxiety precisely where comfort is most needed. Recognizing that connection, the authors argue, is a necessary step toward care that treats body image and sexual health not as separate territories, but as intertwined aspects of the same person’s well-being.

Subject of Research: Associations between muscle dysmorphia symptoms and sexual functioning among sexually active boys and young men

Article Title: Muscle dysmorphia symptoms linked with sexual difficulties among boys and young men

Article References: Muscle dysmorphia symptoms linked with sexual difficulties among boys and young men. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: muscle dysmorphia, body image, sexual health, sexual functioning, boys and young men, appearance anxiety, body dissatisfaction, anabolic steroids, compulsive exercise, University of Toronto, Body Image journal, adolescent health

The study, conducted by a Brazilian research team using exclusively public data, evaluated all 42 athletes who competed across three modalities: track sprinting, swimming, and weightlifting. These athletes brought impressive credentials, including Olympic and world championship medals, yet their historical personal bests sat on average about 6 percent below the existing world records at the time of competition. That gap matters because the typical difference between two sequential world records in these sports is usually less than 1 percent. In other words, the field entered the event far from record-breaking territory, and the pharmacological protocols on offer would have needed to produce extraordinary gains to close it.

They did not. Across 60 analyzed performances by enhanced athletes, only a single world record fell, set by a male swimmer in the 50-meter freestyle. Crucially, that swim was aided by a polyurethane suit of the kind banned in World Aquatics competition, a piece of equipment notorious for its buoyancy and hydrodynamic advantages rather than any biological effect. The same 50-meter freestyle record had already been broken under full World Anti-Doping Agency compliance just weeks earlier, in March 2026, without such a suit, which the authors note suggests the promised gains from the drug protocols were not as effective as advertised. In track and field, not a single athlete surpassed a personal best, and performances drifted further from world-record pace after the Games than before them.

The physiological rationale behind the event’s protocols was not baseless. Anabolic-androgenic steroids and growth hormone reliably stimulate muscle protein synthesis, producing chronic gains in lean mass and maximal strength, while recombinant erythropoietin elevates hemoglobin mass and oxygen-carrying capacity, improving maximal aerobic capacity in laboratory settings. Historical precedent appeared to support the enterprise: the state-sponsored doping program of the German Democratic Republic between the 1970s and 1980s yielded roughly 150 Olympic medals, and high-profile scandals from BALCO to the Russian scheme in Sochi reinforced the perception that pharmacology delivers results worth the risk. Yet an umbrella review cited by the researchers found insufficient evidence directly linking these substances to improved on-field competitive performance, a distinction between laboratory adaptation and real-world outcome that proved decisive in Las Vegas.

According to the publicly available clinical trial registration associated with the Games, the protocol involved 25 weeks of various testosterone esters and derivatives, with most participants using testosterone, more than half using stimulants, and a minority using erythropoietin or additional anabolic steroids. The authors caution that actual doses and exact substances were never disclosed, leaving open the possibility that administration fell within clinically recommended ranges insufficient for meaningful performance enhancement. They also note that gains in muscle mass and force do not always transfer to sport-specific outcomes, where hydrodynamics, aerodynamics, technique, and neuromuscular timing impose demands that hypertrophy alone cannot satisfy.

On the individual level, the picture was mixed but underwhelming. Nineteen new personal bests were achieved out of 60 enhanced-athlete performances, all in swimming or weightlifting, representing a genuine if modest accomplishment given that most competitors were past their athletic prime. Athletes who set new personal bests improved by roughly 3 percent on average, while the remaining 41 performances declined by about 5.6 percent relative to prior marks. Weightlifting showed the greatest variability, with three athletes achieving new bests while eight regressed, some by double-digit margins. Swimming was the only modality in which the overall gap to world records remained comparable to the historical pre-Games gap, a result the authors suggest may have been confounded by the permitted use of banned polyurethane suits rather than the drug protocols themselves.

Age emerged as a more plausible explanation for the few successes than pharmacology. Athletes who set new personal bests were, on average, closer in age to the point at which they had previously peaked, roughly five years removed from their best performances compared with seven years for those who regressed. Peak performance in sprinting, swimming, and weightlifting generally occurs in the early to mid-twenties, and the researchers argue that a smaller age gap, combined with the enhancement protocol, likely drove the improved marks rather than any dramatic drug effect. If the protocols had been as powerful as claimed, they contend, performances should have exceeded expectations across the board, which was not the case for the majority of competitors.

The event’s third core promise, that enhancement could offset age-related decline and even support longevity, fared worst of all. Using a linear mixed-effects model with athlete identity as a random intercept, the team examined the relationship between the number of years elapsed since each athlete’s personal best and the percentage change in performance at the Games. The slope was negative, meaning performance tended to worsen as time since peak increased, and while the association did not reach statistical significance at the conventional threshold, the authors note that this direction of effect directly contradicts the claim that drug protocols could counteract aging. Physical capacities such as maximal strength, power, and aerobic function are well documented to decline after the third decade of life, and nothing in the Las Vegas data suggested pharmacology had reversed that trajectory.

Perhaps the most pointed observation concerns the handful of athletes who competed without any enhancement at all. Four athletes self-declared as non-enhanced, and their six performances were on average closer to their personal bests, about 1 percent below, than the enhanced athletes’ aggregate 3 percent deficit. One non-enhanced swimmer achieved two new personal bests, and a non-enhanced sprinter came closest among track competitors to surpassing his own record. The sample is far too small for definitive conclusions, and self-declared status was never independently verified, but the pattern reinforces a conclusion the authors emphasize throughout: elite athletic performance is multifactorial, shaped by training quality, injury history, technique, and psychology, and not determined by pharmacology alone. The study has clear limitations, including the absence of dose information, no age-matched control group, and the inherent constraints of retrospective observational analysis of publicly available data. Even so, the collective evidence indicates that the Enhanced Games failed to deliver on all three of its central promises, generating one suit-assisted world record, a minority of new personal bests concentrated in swimmers and lifters, and no detectable attenuation of age-related decline. The human body, it turns out, may indeed be an incomplete project, but the pharmaceutical toolkit on display in Las Vegas was not the shortcut its promoters promised.

Subject of Research: Performance outcomes of doping-permitted competition at the inaugural Enhanced Games

Article Title: Enhanced but not superior: Performance outcomes from the inaugural enhanced games

Article References: Azevedo, R. A., Coutinho, L. F., Gonçalves, M. C., Oliveira, H. A., Gonçalves, G. J., Campos, M., Roschel, H., & Gualano, B. (2026). Enhanced but not superior: Performance outcomes from the inaugural enhanced games. Physiological Reports, 14(19), Article e71123. https://doi.org/10.14814/phy2.71123

Image Credits: AI Generated

DOI: 10.14814/phy2.71123

Keywords: Enhanced Games, performance-enhancing drugs, anabolic steroids, erythropoietin, world records, athletic performance, aging, anti-doping, physiology, swimming, weightlifting, track and field