Anorexia in Males: What It's Like to Have an Eating Disorder

What is male anorexia?

Like people of all genders, males face a great deal of external pressure to look certain ways. Movie stars, musicians and social media influencers promote lean and muscular male physiques, often (but not always) with very low body fat. You can even see this in today’s toy and cartoon superheroes -- far more muscular than those from generations past.

These influences, combined with other factors, lead some boys and men to take extreme measures to change their physical appearance. This might mean restricting their food intake, exercising excessively, bingeing or purging. These dangerous eating disorder behaviors can lead to numerous mental and physical health complications that fall under the diagnosis anorexia nervosa, as outlined below.

If you are a friend or a family member, you may feel helpless as anorexia nervosa takes over your loved one’s life. Knowing the signs and how to get help can be the first step to healing.

How does anorexia affect males?

Anorexia nervosa is a potentially fatal eating disorder that can cause men and boys to become fixated on their body weight, shape or size. Delia Aldridge, MD, medical director at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight), explains:

“Male anorexia can often be about becoming leaner and more muscular rather than achieving a certain physical look. To achieve what they perceive as an ideal male body, males may start a rigid diet, restrict food, exercise excessively and use appearance- and performance-enhancing drugs. While some adolescent boys and men with anorexia care about very specific physical features, like having muscles, broad shoulders, a small waist and a broad back, others don’t.”

Male anorexia symptoms

One of the telltale signs of anorexia in males is that even with a dramatically reduced food intake and weight loss, the individual still struggles with negative body image or body dysmorphia. They may obsess about their body being too large or having too much body fat, even when health complications arise and others express concern about weight loss or behavior changes. 

Signs of anorexia in males that you can watch for include:

• Intense fear of gaining weight 
• Frequent thoughts about body fat percentage or body size 
• Frequent thoughts about consuming or avoiding certain foods or entire food groups
• Checking nutritional information before eating any food items
• Driven to lose weight through extreme measures, e.g., restricting food intake or purging through laxative use, excessive exercise or other means
• Body image concerns

Anorexia includes two subtypes: restricting type and binge/purge type. Learn more about the two anorexia subtypes in males here.

Signs to watch for

You cannot tell if someone has an eating disorder just by looking at them. Regardless of their appearance, males with anorexia nervosa are not consuming enough nutrients to maintain their health and well-being. This nutrient depletion can cause numerous physical and mental health consequences and signs of malnutrition, including:

• Brittle nails and hair
• Pale, thick and dry skin
• Easy bruising
• Skin rashes or changes in skin pigmentation
• Gums that bleed easily
• Yellow skin, especially the palms of the hands
• Lanugo and/or hair loss
• Decreased strength and stamina
• Lower sex drive
• Preoccupation with food; ritualized eating
• Increased irritability, anxiety, fatigue and self-harm
• Poor sleep
• Social withdrawal and isolation

One of the hallmark features of anorexia is anosognosia, which is a lack of insight or lack of awareness that the eating disorder is a problem. If you know someone who has suffered with anorexia, you may notice that they do not take your concerns seriously and will struggle to stop the eating disorder behaviors -- even if you repeatedly express concern and point out related health complications.

Learn more about the symptoms of male anorexia with our brief anorexia self-assessment test.

Long-term effects of anorexia in males

Anorexia may also cause serious physical health complications in males that are more likely to be spotted during a medical exam. These long-term effects, listed below, are signs that an individual is malnourished. When these symptoms appear, the individual needs prompt medical attention. Signs to be greatly concerned about include:

• Stunted growth
• Osteoporosis/low bone density
• Low testosterone; decreased sperm count and quality; male infertility
• Bradycardia/low heart rate
• Orthostatic heart rate increases
• GI symptoms, including constipation
• Thyroid issues
• Elevated creatinine from high protein intake and poor hydration
• Low testicular volume
• Lower percentage of extremity fat

Even if the individual’s weight seems to be “normal” or unconcerning, we know that eating disorder complications may be as severe or even more severe than those of other disorders and that medical treatment may be necessary [1].

Causes of male anorexia

Anorexia has multiple causes, including genetic (family history of disordered eating), sociocultural (media influence) and psychological (personality type). Many adolescent males who develop eating disorders have experienced one or more of the following at a young age:

• Considered to have a larger body for their age and height
• Teased or criticized for their weight
• Asked to change weight or shape for sports

Males who have experienced body shaming, anti-fat bias, weight stigma or bullying face increased risks of eating disorders, depression, anxiety and other consequences. When it comes to males of different ages developing eating disorders, experts have noted the following patterns:

• Young boys: The eating disorder tends to develop in younger males following family conflict or a major transition (moving, divorce).
• Adolescent males: The eating disorder develops more often in teen boys as they search for an identity; they may be seeking confidence or recognition.
• Older males: The eating disorder develops as a man seeks to move up in the workplace, meet armed services criteria or attract a sexual partner [1].

Learn more about the causes of anorexia here.

Who is at risk for male anorexia?

Researchers have noticed a pattern in the personality types of males with anorexia nervosa who restrict their food intake. Males with AN are more likely to have the following personality traits:

• Self-critical
• Anxious
• Persevering
• Perfectionistic
• Obsessive-compulsive

Certain sports, hobbies and careers that require appearance or weight standards are more likely to be linked with eating disorders in males. Males involved in the following activities may be more at risk for anorexia than other males [1]:

• Wrestling
• Gymnastics
• Swimming
• Track
• Horse racing
• Football
• Weightlifting

Gay, bisexual and transgender males may be more at risk for developing body image concerns and eating disorder behaviors. Please see the last section of this piece for more information about eating disorders and body image issues in LGBTQIA+ males.

Do males experience anorexia differently?

People of all genders can struggle with eating disorders, including those who identify as non-binary. However, a commonly asked question is: Do males and females experience anorexia nervosa differently? Here we get to the bottom of it.

According to Arnold E. Andersen, MD, FAED, DLFAPA, “starved male and female patients are similar medically” [1]. However, since males often start off with lower body fat than females, they may experience a decline in health more rapidly because less weight loss is needed before ketosis sets in.

Additionally, research has found that males with anorexia nervosa:

• May be less likely to be diagnosed by providers due to stigma and misconceptions about eating disorders
• Have more trouble finding treatment in programs because they are male
• May be less likely to talk about their eating disorder due to perceived stigma
• Are more concerned with their appearance above the waist: chest, shoulders, arms and abdomen 
• Experience different hormonal changes from eating disorders
• May suffer more vitamin deficiencies
• Desire a different ideal body weight and shape than females
• Have different goals for athletic performance and dieting
• May experience osteoporosis at greater rates than females

Challenges faced by males with anorexia

Some people, even medical providers, assume that it is rare for males to have eating disorders. This can lead to stigma and, as a result, males may be less likely to be diagnosed or treated for anorexia. Males diagnosed with an eating disorder may find it harder to locate a treatment center that supports males. This can be due to housing issues and the challenge of trying to house males and females separately. The difficulty in finding treatment may lead to an increase of internalized stigma and a feeling of marginalization. Additionally, those with anorexia nervosa may feel a sense of shame about their eating disorder, and this can delay the start of life-saving treatment.

It is important not to minimize the challenges faced by males with anorexia nervosa, but to help them find the treatment and support they need.

Treatment of male anorexia

Food is medicine for all individuals with anorexia nervosa. Family involvement is also key to eating disorder recovery for children, adolescents and adults. Family-based therapy (FBT) is an integral part of treatment for individuals under 18. The goals of treatment for males with anorexia are similar to those for all persons with an eating disorder. These include:

• Addressing underlying causes, including any co-occurring medical conditions 
• Addressing co-occurring mental health conditions, including depression and anxiety
• Getting nutritional counseling to lay the foundation for a peaceful relationship with food
• Challenging harmful thought patterns and behaviors
• Building resilience and coping skills to maintain recovery
• If needed, implementing weight restoration and nutritional rehabilitation

Weight restoration may be necessary when a male with anorexia nervosa is malnourished or at a very low body weight. This is a process known as refeeding. Refeeding and weight restoration can help the individual return to optimal nourishment and well-being. Since there are risks involved, refeeding requires medical supervision.

Help for males with anorexia

The good news is that males with anorexia have an excellent chance of lasting recovery. If you or someone you care about has eating disorder symptoms, we encourage you to seek help from experienced eating disorder treatment providers. If you are interested in learning more about eating disorder treatment for males here at Eating Recovery Center (ERC), please call our admissions team at (866) 622-5914 or fill out a form to contact us.

A free online support group for men with anorexia

We also invite you to check out our free, virtual monthly support group for males with eating disorders. The monthly men’s eating disorder support group occurs every second Monday of the month and is open to all who identify as men who are seeking eating disorder recovery support. The group is open to alumni and community members who are adults (18+) and it is not meant for caregivers. The group is run by a male facilitator.

Register for our men’s support group here.

If you are caring for someone with an eating disorder

It can be very difficult to watch someone you love struggle with an eating disorder. Eating disorders can increase stress levels for close family members and friends. If you are finding yourself stressed, exhausted, or if you are experiencing a variety of emotions, please know that all these feelings are very normal. As you help your loved one find the care they need, we also encourage you to practice radical self-care for yourself. Time in nature, a relaxing massage, a quiet dinner out with a good friend – all can be healing if you can offer yourself grace and be patient with the process.

Recovering from an eating disorder is a marathon, not a sprint. It takes time and it is important to pace yourself. Beth Ayn Stansfield, MEd, national family advocate at ERC Pathlight, works closely with caregivers of those in recovery. She shares her insight and advice:

“I wish I had a crystal ball to tell you the exact date that your loved one will be thriving in recovery. But recovery looks different for everyone. What I can tell you is there is hope. Educate yourself. Find a local support group. Take care of yourself -- and know that full recovery is possible.”

Find community and connection at one of our ongoing, free, online eating disorder support groups for friends, caregivers and those in recovery.

Male eating disorder facts and statistics

Boys and men have historically been underdiagnosed and underrepresented in both eating disorder research and treatment programs. Less than 1% of current peer-reviewed, published articles on anorexia nervosa specifically relate to anorexia in males [2]. Here are some facts and statistics about eating disorders in males. 

• Male anorexia is not new. Eating disorder research in England from the 1800s referenced males with anorexia [1].
• Researchers found that nearly one in three 6-year-old boys wanted to be more muscular while one in five wanted to be thinner.
• Puberty is a particularly common time for onset of an eating disorder. The body changes in young men during this developmental phase are significant; boys gain an average of 50-60 pounds and grow 12-14 inches during this time.
• One study showed that eating disorders (based on DSM-V criteria) affect 1.2% of males at 14 years old, 2.6% at 17 years old and 2.9% at 20 years old.
• Another study found that 3.6% of males on college campuses had eating disorders.
• Purposeful restriction is the most common eating disorder behavior displayed by men (96%). Other eating disorder behaviors used by males include overexercising, purging (including laxative abuse) and bingeing.
• Male anorexia is also associated with an increased risk of early death and suicide. Individuals with anorexia are 18 times more likely to take their own lives.

Facts about LGBTQIA+ males and anorexia

• Anorexia is more common in LGBTQIA+ adults compared to cisgender heterosexual adults in the U.S.
• Many males with anorexia identify as asexual [1].
• Multiple research studies have suggested that gay and bisexual adolescent males have a greater prevalence and increased likelihood of developing eating disorders. 
• Although transgender people are underrepresented in eating disorder research, a small but growing body of work indicates that transgender people may uniquely experience body image dissatisfaction and eating disorders. 
• Transgender people may be affected by gender norms and body image ideals related to masculinity (muscular/larger frame) and femininity (thin/smaller frame). 

All these factors may influence eating disorder thoughts and behaviors. Read more about our approach to treating eating disorders in transgender individuals here.

Read more articles on this topic:

• Eating Disorders in Men
• Anorexia in Teens
• Parents of Males With Eating Disorders
• Body Dysmorphic Disorder in Gay Men
• LGBTQIA+ Eating Disorder Resources
• Eating Disorders in the Trans Community

Sources

1. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.
2. Murray, S., Griffiths, S., & Mond, J. (2016). Evolving eating disorder psychopathology: Conceptualising muscularity-oriented disordered eating. The British Journal of Psychiatry, 208(5), 414-415.

Related Articles

Misra, M., Katzman, D. K., Cord, J., Manning, S. J., Mickley, D., Herzog, D. B., Miller, K. K., & Klibanski, A. (2008). Percentage extremity fat, but not percentage trunk fat, is lower in adolescent boys with anorexia nervosa than in healthy adolescents. American Journal of Clinical Nutrition, 88(6), 1478-1484.

Nagata, J.M., Domingue, B.W., Darmstadt, G.L., Weber, A.M., Meausoone, V., Cislaghi, B., et al. (2020). Gender norms and weight control behaviors in U.S. adolescents: A prospective cohort study (1994-2002). Journal of Adolescent Health, 66(1S), S34-S41.

Nagata, J.M., Ganson, K.T., & Murray, S.B. (2020). Eating disorders in adolescent boys and young men: An update. Current Opinion in Pediatrics, 2(4), 476-481.

Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating disorders in men: Underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20(5), 346-355.
 
Woodside, D.B., Garfinkel, P.E., Lin, E., et al. (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. Am J Psychiatry, 158(4), 570-574.