The following is an excerpt from my book, Finally Out: Letting Go of Living Straight, a Psychiatrist’s Own Story, due for release January 12, 2011.

Joan Collins once famously said, “After a certain age, you get the face you deserve.”

The majority of negatives about aging come from attitudes about changes in the body. Men who are most deeply invested in their physical appearance seem to encounter the greatest difficulty.

As gay men age, fear of the loss of their external, youthful sexual attractiveness is often central to their fear of middle age. As Rebecca Mead wrote in The New Yorker, “The new idea offered by the contemporary culture of cosmetic surgery, is that it is the vessel itself that we must value, rather than the soul or spirit that it contains.”

Because this physically attractive body is the person they presented themselves to be, some have lived behind this façade with little concern about learning how to relate to others in ways beyond the physical. Others may not really have known them. They may become afraid to ditch that previous social persona and be left with nothing.

Stereotypes describe gay men as either limp-wristed and effeminate or obsessed with attaining the masculine body beautiful. The extremes of body image are captured by the exaggerated femininity in the form of drag and the exaggerated musculature of the “gym rat.”

Between these extremes there are an infinite variety of identities and lifestyles, but the unifying element remains the presentation of an attractive, attention-grabbing body.

Some gay men consider their bodies their most significant asset, and they seek affirmation of that through admiration and envy from others. Because of their anxiety about appearing feminine, they attempt to master it by exaggeration of the opposite. Their bodies are their ticket to power and success, and the goal is perfection, however unrealistic that may be.

Continual fixation on body image sometimes means attempting to radically alter the way we look by “having a little work done,” including the use of pectoral implants, steroids and penile enlargers. The enemy isn’t their body, it is their unrealistic expectations of what their body can be, must be.

Showering in a gym is surely as oppressing for a stocky, skinny or an aging gay man as it is for a woman trying on a new swim suit. Chiseled good looks are achieved by very few and remain only a dream for the majority. Not being able to achieve those good looks is sometimes perceived as a lack of commitment to body maintenance, and those who don’t achieve it may be accused of being slothful.

Age is seen as a disease that suggests a person lacks an unacceptable degree of self-control. The body becomes a project, perpetually in need of work and development to prevent it from reverting to its natural ugly state.

If the thin and muscular body beautiful is not attainable, a physically toned body is the next best thing. Our body image is the result of the difference between the perfect body and the way we see our body.

We are satisfied with our body image when we have a realistic expectation about what our body can be and seeing it as it actually is. The saddest and angriest gay men are those who have failed, feeling as intimidated by beautiful gay men as they are by straight men.

When gay men become overly concerned with physical attractiveness, too preoccupied with fashion, they may appear superficial or even threatening to heterosexual men. The American masculine ideal dictates that real men must not be concerned about matters of style and taste, all the while being blasted by images of men re-shaped by computers and wearing Armani.

The advertising industry created the word “metro-sexual” to describe a man who blends an interest in style, fashion and culture while not letting go of ball-scratching and beer-guzzling. These men have always been a part of the lives of wealthy men, but frosted hair and manicures are now more accessible to the average man. In Europe, they exist without a need to create a special category to describe them, but this cross-over is something we’re not yet comfortable with in the United States; it is just too queer.

Knowing someone’s age tells us little about them, but because of the importance of physical attractiveness in the gay community, middle age comes sooner to gay men than to heterosexual men. The work of every day life for a midlife gay male is maintaining the appearance of youth, but the fact that it is work must also be hidden so no one knows how difficult it is.

Harold Kooden wrote in Golden Men: The Power of Gay Midlife that the concept of a linear aging process is misleading. He suggested that gay men have four ages: chronological (clock age), biological (body age), experiential (heart age) and sexual (gay age.)

Kooden proposed that we age in each are of these four areas at different rates and times; chronological age represents only one portion of our authentic age. Another age might be added to Kooden’s list: geographical age. Age functions quite differently in urban and rural communities.

Portrait of the Sculptor Friedrich

Because men who have sex with men are conflicted about their sexuality, their sexual age may lag behind their clock age, body age and heart age. Geographical age may add an additional incongruity; men who grew up in the city may arrive at a homosexual identity at somewhat younger ages.

Men who are struggling with their sexual attraction to other men, may put their sexuality on hold; their sexual age and their chronological age are disparate.