To sculpt his physique, the 25-year-old worked hard.

He had begun bodybuilding four years ago. He visited the gym three days a week. He ate so much protein that his diet inflamed the blood vessels within his kidneys. Perhaps he thought the injections — of vitamin B12, anabolic steroids and a thyroid hormone — were a fair price to pay for impressive muscles. The man used insulin, which no doctor had prescribed, because he believed it would melt away body fat.

Instead, the insulin triggered seizures and weakened a tendon his arm. While he waited to heal, he turned to coconut oil. In recent years, after all, the food had accrued a reputation — though somewhat overblown — as an enriching, healthy fat. The oil, the bodybuilder believed, would plump up his muscles, as doctors wrote on Dec. 1 in the journal BMJ Case Reports.

It did not work as he intended.

The man arrived to his clinical exam agitated and sweating copiously, Maria Johnson, a musculoskeletal radiologist and study author at Ealing Hospital in London, told The Washington Post by phone on Monday. The pain in his right arm lasted for months, and he had trouble moving his elbow.

Johnson performed an ultrasound. The scan revealed damaged muscle fibers and “pockets of fluid within the muscles,” she said. It was a bizarre find, unlike anything she had seen. “I had no appreciation of this.” One possible diagnosis, she said, was that he had acquired some kind of infection while on a recent trip to Saudi Arabia.

The doctors conducted an MRI, and once the more detailed scan confirmed the cysts in his arm, the man confessed: He injected coconut oil into the belly of his right arm muscle. There, he hoped the fatty globules would improve the size and definition of his muscles as he waited on the ruptured tendon.

Instead, the oil congealed into what the physicians described as “proteinaceous lesions.”

Injections of natural compounds, unlike anabolic steroid abuse, are rare, the doctors wrote. It was popular on a few Internet forums and within Arab and Middle Eastern communities, the doctors wrote in the study. But it was the first time Johnson had encountered anything of this sort in her work.

The bodybuilder was lucky. “It is extremely dangerous for anyone to be injecting substances” like coconut oil, Johnson said. Had the man missed the muscle and injected the oil into a vein, it could have formed a lethal embolism in his vital organs.

For years, experts considered body dysmorphia and disorders like anorexia to be problems that mainly affected women. For the most part, men were left unscathed.

That is no longer the case — as it is becoming increasingly clear. “Men feel much greater pressure now than in the past to achieve a visibly muscular and lean physique, which is leading to higher rates of muscle dysmorphia and eating disorders in men,” wrote Linda Lin, a psychologist at Emmanuel College in Boston, in an email to The Washington Post.

The drive to pack on muscle can be extreme. “I started off at 12 stone [168 pounds], my goal was 15, I got to 15, then it was 17, then it was 19 [266 pounds], and you’re always striving for something else, the goal post is constantly moving,” one amateur male bodybuilder told the BBC in 2015.

In the way that women’s bodies have been idealized, Lin cited toys, action stars and “Playgirl” centerfolds as the increasing “hypermuscularization” of the male body. A 2005 review in the Journal of Athletic Training argued that rates of muscle dysmorphia are increasing in United States and elsewhere, a surge in what the researchers called “reverse anorexia or bigorexia.” It is not well known how many men are affected by muscle dysmorphia, though one estimate put the figure as high as one in 10 bodybuilders; there is a consensus among those who study the disorder that rates are underreported — reflecting a lack of awareness among physicians and the public at large.

Both Lin and Johnson were clear to The Post that neither expert was in a position to diagnose the injured bodybuilder with body dysmorphia. Lin said there were some warning signs, however: his preoccupation with building muscle, the muscle impairment and his distress. Likewise, the fact that he was injecting natural oils — which would have enhanced the appearance, but not the performance of his muscles — was a red flag.

Both experts agreed that muscle dysmorphia was a disorder that deserved more attention. “I think this is more common,” Johnson told The Post, “than we might think.”

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