New standards for masculinity are stacked against men’s health
A cultural shift toward 'looksmaxxing' and biohacking has many men using prescription and gray-market drugs — from low-dose tadalafil to testosterone and experimental peptides — to pursue enhanced appearance, performance, and longevity. Medical experts warn these practices often lack scientific justification and can carry unknown physical and psychological risks, especially when multiple substances are combined.
Why It Matters
The trend maps a widening gap between influencer-led enhancement culture and clinical medicine: prominent figures and online communities are promoting off-label and unapproved treatments as routine male self-improvement, while clinicians caution that benefits, interactions, and harms are not well established.
Key Facts
- newsletter: Optimizer, written by Verge senior reviewer Victoria Song
- example drug promoted by biohackers: tadalafil (Cialis) — a vasodilator commonly prescribed for erectile dysfunction
- notable endorsers: Bryan Johnson (biohacker/entrepreneur), Andrew Huberman (podcaster), Clavicular (looksmaxxer)
- tadalafil uses: treats erectile dysfunction, urinary issues from enlarged prostate, and pulmonary arterial hypertension
- enhanced-games stat: 91% of athletes at the inaugural Enhanced Games used testosterone
What began as a comedic contrast in a 2009 sketch — men portrayed as already ‘brilliant’ while women were urged to buy products to fix themselves — now reads differently as a new male-focused optimization culture takes hold. Online communities and influencers are increasingly promoting a regimen of pharmaceuticals and experimental compounds aimed at improving looks, strength, sexual performance, or longevity. These practices, often grouped under terms like looksmaxxing and biohacking, include sharing before-and-after photos and recommending specific drug 'stacks' and dosing protocols.
One widely discussed example is tadalafil, a vasodilator known primarily as a treatment for erectile dysfunction. Biohackers and some public figures tout low daily doses for cardiovascular and cognitive benefits or as a preworkout to enhance muscle pumps. While tadalafil is an approved therapy for certain medical conditions — including enlarged prostate-related urinary symptoms and pulmonary arterial hypertension — proponents recommend use in populations and for purposes that fall outside typical prescribing patterns.
Beyond tadalafil, the movement frequently involves testosterone and a range of peptides. Data cited from the Enhanced Games indicates 91 percent of athletes at its first event used testosterone; other enthusiasts reference unapproved or gray-market peptides such as retatrutide (in phase three trials), TB-500, and BPC-157, the latter two nicknamed the 'Wolverine stack' for purported recovery properties. Participants and influencers argue these regimens boost masculinity, but stacking multiple agents raises concerns about unpredictable interactions and long-term effects, which may remain unknown even to treating clinicians.
Medical experts emphasize the divide between enhancement-minded users and standard clinical practice. Dr. Arthur Burnett, a Johns Hopkins urologist whose research contributed to erectile dysfunction therapies, says the current 'maxxing' trend lacks solid scientific grounding and could be psychologically and physically harmful. He notes clinicians generally view drugs as tools to correct deficiencies and return patients to normal function, not as routinely appropriate instruments for pushing physiology beyond established baselines.