Teen boys at the gym: Healthy hobby or muscle dysmorphia? Experts help parents spot the difference.

When Mike was 13, he became intrigued with the weight room at his upstate New York school and started working out there regularly. He noticed it helped him “feel good” about himself.

It also highlighted what he saw as his physical flaws.

“I hated the fact that I was so skinny and wanted to improve myself,” Mike (not his real name), now 14, tells Yahoo Life. He eventually joined a gym along with several friends, turning mainly to YouTube for effective ways to bulk up.

Mike “would do benches and all sorts of machines and figure it out online.” There, he found a seemingly endless loop of buff, weight-lifting influencers sharing hard-core workouts. “I like how much willpower you have to have, and determination, to keep working out day after day after day. It’s really helped my discipline,” he says.

His story is not uncommon among teen boys across the country — almost a third of whom (29.2%) are trying to bulk up, according to a recent study. And it resonated with parents who spoke to Yahoo Life about their own sons.

“He decided he was too skinny, too scrawny, and needed to bulk up,” a New York City mom says about her 14-year-old, who, at 13, “made the shift from coming home and just wanting to play video games to going to a local gym with his friends — which is great, as I would much rather him do that than sit at home.”

But she soon became concerned, particularly when several moms noticed their sons were sending shirtless selfies to each other to compare muscles, constantly watching bodybuilders on TikTok and wanting money to buy merch and protein powders from influencers. “There were a couple of times when he overexerted himself and came home really sore or injured,” she adds, “and my concern is that he’s not following routines necessarily set up for teenagers.”

Now on the football team, her son still “definitely thinks he’s too skinny and too wiry.” He follows a healthy eating regimen, which she sees as an upside. “But do I want my 14-year-old to be obsessed with that?” she asks. “No, I want him to be a kid who’s not thinking about what his body is like at all times.”

That may be a tall order: Experts have been noticing a rise in such behaviors among adolescent boys that, in extreme cases, can lead to a distorted sense of body image — known in such cases as muscle dysmorphia, a subset of the mental-health diagnosis body dysmorphic disorder.

Known colloquially by some as “bigorexia,” there are ongoing discussions as to whether muscle dysmorphia should be considered an eating disorder, a behavioral addiction or a form of obsessive-compulsive disorder. But it occurs when an individual “becomes obsessed with becoming muscular,” explains Dr. Jason Nagata, associate professor of pediatrics at the University of California, San Francisco, where he is an expert in male eating disorders. “They may view themselves as puny even if they are objectively muscular” and “may use anabolic steroids or other appearance- and performance-enhancing drugs to become more muscular.”

Disordered eating is common — with 22% of male adolescents taking supplements, using steroids or eating more or differently to bulk up, Nagata found in 2019. And those actions, he notes, “are not what people will typically think of as eating disorder behaviors,” largely recognized in girls, particularly around attempts to eat less and lose weight. It’s why boys with eating disorders and/or muscle dysmorphia — often aiming to gain weight — may be overlooked or even viewed as exhibiting healthy behavior.

“In moderation, physical activity and exercise has a lot of health benefits, and in general, boys and men should engage in exercise — as long as it’s fun and can be sustained,” Nagata says. “But I do think that with eating disorders and muscle dysmorphia, exercise can be taken to an extreme that can cause more worry than joy.”

Muscle dysmorphia is often fueled by the pressures of social media.

“More Instagram use in boys or men leads to meal skipping, use of steroids and muscle dissatisfaction,” says Nagata. “In the past, even if you were watching a movie or TV with a muscular guy, you were kind of living in a read-only environment — you were consuming it, which has some impact, but an average guy would never expect to be featured [anywhere], so there wasn’t pressure for them to necessarily perform,” he tells Yahoo Life. “But now there is more pressure ... for you to display your own body.”

At its worst, muscle dysmorphia can lead to suicidal ideation and planning, found a study released just last week. In those cases, a young person’s “appearance intolerance” was so extreme, study author Kyle Ganson, a University of Toronto professor of social work and an adolescent researcher, tells Yahoo Life, that the idea of suicide was “the only way to stop the negative thinking about one’s body.”

Here, experts discuss the differences between healthy exercise and dangerous obsession.

Isn’t working out good for teen boys?

It absolutely can be, says Brett Klika, youth fitness expert, former Olympic trainer and co-founder/CEO of Spiderfit Kids. “It is an unbelievably positive thing for them, from both a mental and physical health standpoint, to get into any form of exercise,” he tells Yahoo Life. But as with any type of workout, he cautions, there are safety guidelines.

“The No. 1 thing for teen boys, or anyone getting into something new, is to get some sort of experienced, credentialed, professional guidance,” Klika says. “Because in this information age, they can go to the internet and a supplement company is going to sell them a lifting program,” or a bodybuilding influencer will share his routine while having “no idea how old the kid is” who’s watching.

As for worrying that a not-fully-developed teen could stunt his growth by lifting weights, Klika calls that an “urban legend,” stressing that strength training, when done correctly, is an excellent form of exercise for both tweens and teens — something backed for many years by the American Academy of Pediatrics.

“If your child wants to get into weight training,” says Klika, “that’s an unbelievably positive thing, considering every other thing they can be getting into.”

When should parents worry?

“Overall, the red flag, for me, is when exercise or food leads to preoccupations that lead them to withdraw from their usual activities or friends because of concerns with appearance,” Nagata says.

Klika adds to look for “drastic behavior changes” around socializing and food. “It’s one thing for them to say, ‘I don’t want the fried chicken, I want it grilled,’ which is positive. But when they’re weighing food and they don’t want to go to Thanksgiving dinner and it disrupts their lifestyle, then it becomes a concern,” he says. “All of a sudden the kid is a different kid — and not necessarily for the better.”

Both experts caution that using legal muscle-building supplements can be a gateway to use of anabolic steroids (at an increase, found a recent Nagata study, of up to 3.18 times as much). And “if your kid’s in high school,” warns Klika, steroids — which can lead to heart disease, kidney problems and liver damage — “are available.”

Sometimes, the clearest clue of trouble is in the way teens talk about themselves — such as focusing on a need for willpower, or a desire to “better” oneself, says Michael Reichert, psychologist and author of How to Raise a Boy. “It’s definitely easy for that to slip over into a harsh personal critique that’s not grounded in any concept of self-care or self-love,” he tells Yahoo Life.

If a teen boy’s approach to himself is “mean-spirited and chronically dissatisfied,” he explains, it can lead to a “compulsive drive to exercise and eat carefully and lift weights.” And that not only gets endorphins going, but prompts “a sense of progress when looking in the mirror. But that way of generating self-acceptance and positive self-esteem is problematic,” Reichert explains, “because it’s totally contingent on the imagined outsider gaze. ... It’s not really a substitute for self-acceptance and being OK with who we are.”

How to help your teen

Nagata advises any concerned parent to take the initial step of “talking openly with your child about the behaviors that are concerning you,” and if there is significant concern, to take the extra step of seeking professional help. Raising concerns with a primary care physician or pediatrician could lead to helpful referrals for a therapist, eating-disorder specialist or nutritionist, he says.

Klika recommends that parents get involved with guiding their kids’ workouts — looking to the International Youth Conditioning Association or his own Spiderfit Kids for free resources, or experts such as Mark Rippetoe and Mike Boyle. “You’re not going to see muscles bulging out of his head, and [your kid] might not get excited, but ... in all honesty,” he says, “most of the people posting good stuff for beginners are not the people ’roided out of their skulls.”

On that note, it’s vital to talk to your teen about how to critically consume media — pointing out realities from how some fitness influencers heavily filter their images to the fact that toy action figures have gotten more muscular over the years, much to the delight of fans.

“It’s about media literacy — teaching young people, especially boys, how to talk about their body, their relationship with their body and their relationship with food, and how to be aware of social media’s impact and pressure,” says Ganson, who recommends limiting social media use as much as possible.

Finally, Reichert advises parents to lay a strong foundation of support, openness and involvement — one in which boys will “invest themselves in a relationship where they feel known and cared for and want to be honest and open and themselves,” he says.

“It’s never too late to begin,” he stresses. “Even though pretty thick walls may have gone up, the fact of the matter is that the boy longs to be connected to someone who knows him and cares about him, and the first person they look to for that is their parents.”