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Rationales for Anti-aging Activities in Middle Age: Aging, Health, or

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 The Gerontologist
cite as: Gerontologist, 2016, Vol. 00, No. 00, 1–9
doi:10.1093/geront/gnw111
Advance Access publication August 9, 2016

Research Article

Rationales for Anti-aging Activities in Middle Age: Aging,

Health, or Appearance?
Toni Calasanti, PhD,*,1 Neal King, PhD,2 Ilkka Pietilä, PhD,3 and Hanna Ojala, PhD4
1
Department of Sociology, Virginia Tech, Blacksburg. 2Department of Sociology, Program in Women’s & Gender Studies,
Virginia Tech, Blacksburg. 3Gerontology Research Center and School of Health Sciences, University of Tampere, Finland.
4
School of Social Sciences and Humanities, University of Tampere, Finland.
*Address correspondence to Toni Calasanti, PhD, Department of Sociology, Virginia Tech, 648 McBryde Hall, 225 Stanger St Blacksburg, VA
24061. E-mail: toni@vt.edu

Received November 11, 2015; Accepted May 17, 2016

Decision Editor: Barbara J. Bowers, PhD

Abstract
Purpose: We explore the motivations of middle-aged consumers of anti-aging products and services in relation to aging,
health, and appearance. Admission of use of anti-aging products and services could align a respondent with a stigmatized
group, old people, and also connotes a feminine concern with aesthetics. For these reasons, people, particularly men, will
be unlikely to report using them for this purpose.
Design and Methods: Semi-structured, in-depth interviews were conducted among 19 men and women aged 42–61 years.
Topics included their perceptions of bodily changes and their responses to these. We analyzed data qualitatively.
Results: Respondents frame their uses of anti-aging products in terms of health and appearance, not anti-aging per se. Both
men and women see anti-aging as related to beautiful appearance and thus as a feminized activity. Both are concerned about
appearance, but in gendered ways. Overall, respondents conflate bodily appearance, health, and aging in their constructions
of anti-aging.
Implications: This conflation maintains inequality by stigmatizing old age as unhealthy and unseemly. Our results point
to the limits of studying the consumption of anti-aging products and services if researchers ask only about anti-aging uses
per se. They also point to the ways that discourses of health and appearance naturalize ageism, as they suggest that old age
inheres in bodies that “naturally” decline and thus should be excluded.
Keywords: Ageism, Healthism, Aging bodies, Gender

Critical gerontologists have revealed ways that age inter-
sects with gender to produce unequal outcomes for men and
women in employment, as others assume that women age
more quickly than men do (Hurd Clarke, 2011; McMullin
and Berger, 2006). This paradigm focuses on how bodies
serve as markers of this differential aging, just as they sig-
nify subordinate status in other inequalities (e.g., female,
and non-White in a Western context). Partly due to demand
for the eradication of such signs of change and fears of such
loss of age status, the “anti-aging industry” has burgeoned.
The American Academy of Anti-Aging Medicine (A4M)
claims 26,000 members from 120 countries (WorldHealth.
net, 2015); and estimates of the entire industry places its
worth at $292 billion worldwide (Consumer Reports on
Health, 2015).
Despite the massive profits generated by this industry,
however, we know little about consumers, reported to
number at over 90 million (NewYou, 2015). We do not
even know what they consider to be anti-aging products
and services. What comprises the anti-aging industry is nei-
ther straightforward nor simple; the products and services
that fall under this heading are wide ranging, reflecting the

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 2 The Gerontologist, 2016, Vol. 00, No. 00
complexity and breadth of cultural constructs of aging:
physical changes, ranging from functional limitations to
wrinkles; and how these are construed.
In this paper, we draw on the insights of critical, cul-
tural gerontology and ask, who uses anti-aging products
and services, and how do they describe coming to do so?
Do they see them as responses to aging, and how might
their paths toward such consumption vary by gender?
We perform qualitative analysis of data collected from in-
depth interviews among 19 middle-aged men and women
in the United States, concerning their feelings about, and
responses to, their aging bodies. Analysis of their responses
can reveal patterns in the construction of aging bodies
and how people may resist such signs in a postmodern era
of body modification. In particular, the possible range of
responses to bodily changes—related to issues of—may not
be clearly differentiated. To the extent that consumer con-
cerns with aging, health, and/or appearance blur together,
they can naturalize age relations, likening old age to poor
health and unattractive appearance, and thus justify age-
based exclusion.
Background
Several factors can influence both the use of anti-aging
products and services and the acknowledgment of their use.
We begin with a brief discussion about pressures to engage
in anti-aging strategies and then turn to stated motivations
for so doing.
As a broad approach to aging, critical gerontology encom-
passes feminist, Marxist, and other critical perspectives on
later life (Bass, 2009). These approaches share the belief
that aging processes and experiences of old age are socially
constructed (Phillipson, 2009). They explore the ways that
intersecting relations of inequality, including various forms
of ageism, shape those experiences (Calasanti, 2009). Foci
include structured dependency, cumulative disadvantage;
the medicalization of aging; naturalization of age inequality;
and metaphors for aging that construct it as disease, death,
and disability (Estes, Biggs, & Phillipson 2003: 3).
Since Butler (1969, p. 243) first described ageism
as “the discrimination against people because they are
old,” research has documented its pervasive and consist-
ent nature. Inequality based in age relations means that,
once deemed “old,” people lose power and status such that
they are excluded from social institutions, denied citizen-
ship rights, and lost control over their bodies and other
resources (Bytheway, 1995; Calasanti, 2003; King, 2006).
As a result, people often avoid identifying themselves as old,
even to the extent of not interacting with others deemed to
be old (Minichiello, Browne, & Kendig, 2000; Townsend,
Godfrey, & Denby, 2006).
In this regard, critical, cultural gerontologists note that
bodies serve as principal markers of age, such that changes
to them alter status within age relations (Calasanti, 2005;
Laz, 2003). Unlike such other inequalities as gender or race,
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status within age is temporal, such that the passage of time
moves people from privileged categories—youth adulthood
and middle age—to the disadvantaged status of old age
(Calasanti, 2003).
Current constructions of old age present that process
as malleable and under personal control (Estes et al.,
2003). In this increasingly neoliberal context, with its
admonitions that individuals take responsibility for their
lives, science and technology promise to liberate us, and
merchants, among others, pressure us to resist bodily
aging. Although we cannot avoid aging entirely, the pitch
goes consumers can and should buy anti-aging products
and services to minimize its effects. As Jones & Pugh
(2005, p. 254) note, such signs of aging as “sagging, wrin-
kling, and graying … are … symbols of a lack of con-
trol, which is unacceptable in contemporary society.” We
may take such bodily signs of old age to indicate disease
and decline; and many equate health with goodness and
moral virtue. Attractiveness and health are thus linked in
anti-aging advertisement, in which both men and women
should strive to have bodies that appear good-looking and
healthy as they age (Calasanti, 2005).
With its focus on old age as a subordinated, stigmatized
social location, critical cultural gerontology researches the
maintenance of inequality via the mundane social distanc-
ing from old age. In that context, we expect aging people
to distinguish themselves from “old” people when they are
able to do so. We study how aging people relate themselves
to that subordinate group, as in the open consumption of
products geared toward forestalling aging.
Whether, when, and why consumers use anti-aging prod-
ucts and services remains largely undocumented. Overt
use of “anti-aging” products and services requires admit-
ting concern about aging and acknowledging movement
toward membership in a stigmatized group. Furthermore,
Fishman, Settersten, and Flatt (2010) argue that the gen-
eral public perceives the term “anti-aging” to focus on aes-
thetics and thus predominantly the realm of women. By
contrast, people tend to see health as a higher ideal, even
a duty (Hurd Clarke, 2011), in which the body is “a site
for moral action” (Conrad, 1994, p. 385). Lay understand-
ings of health are broad and include aspects ranging from
absence of disease to functional ability, energy, and healthy
lifestyles (e.g., Herzlich 1973, Jylhä, 2009) and thus might
subsume anti-aging practices as well.
Anti-aging practitioners contribute to the conflation of
aging and health as they distance themselves from both aging
and aesthetics, adopting new labels for their services and
practices that stress health and the lifelong nature of their
endeavors. Employing such names as “preventative medi-
cine,” “functional medicine,” and “age management medi-
cine,” these providers emphasize health and aging as a process
that can be managed. Thus, clients are not old people but are
middle aged; middle age brings awareness of bodily changes
and should inspire us to “manage” our aging (Fishman et al.,
2010). As Fishman et al. (2010) and Mykytyn (2008) show,
 The Gerontologist, 2016, Vol. 00, No. 00
anti-aging practitioners present themselves not as “curing”
aging (as if it were a disease), but instead as “optimizing”:
aiming for health that is not just “excellent health ‘for his
age’” but at its peak, “the best-a-body-can-be-and-has-ever-
been, generally denoting a 25–30 year old body” (Mykytyn,
2008, p. 317). Mykytyn argues that, as a result, anti-aging “is
the ultimate form of medicalization. Effectively everyone is/
will become a patient because a diagnosis need not precede
intervention. [Anti-aging] … is focused as much on health
preservation as it is on health restoration” (2008, p. 317).
This medicalization blurs the line between anti-aging and the
promotion of health, removing it from the realm of later life
(and association with a stigmatized group) while also empha-
sizing its importance to younger ages.
What we hear from consumers about the anti-aging indus-
try may follow this trend toward conflation of anti-aging and
health. Still, appearance concerns may also be mixed in, as
bodies serve as markers of both age and health. Thus, men
and women may both concern themselves with how their
bodies look, and research indicates that they may do so
in gendered ways. For instance, aging men are focused on
musculature and the appearance of physical capacity, while
women’s concerns relate to beauty (Hurd Clarke, 2011; Hurd
Clarke and Korothchenko, 2011). Along these lines, Lodge
and Umberson (2013) find that middle-aged men focus on
how their bodies appear to function. However, they also
find that the gay men in their sample focus on appearances
in terms of youthful attractiveness. Thus, the intersections of
sexuality with gender may complicate this picture.
To summarize, motivations for using anti-aging prod-
ucts and services can reflect concerns related to age (try-
ing to avoid a negative status), health, or appearance; and
stated reasons might both conflate these and vary by gen-
der. This paper draws upon interviews among middle-aged
respondents to examine the extent to which they attribute
their use of anti-aging goods and services to shifts in age,
health, and appearance. Results indicate that respondents
use many anti-aging strategies but rarely label them as such.
Present Study
This study uses U.S. data gathered from in-depth inter-
views collected in 2006 and 2007 from middle-aged (aged
42–61 years) men and women. The sample was gathered
through a combination of convenience and snowball pro-
cedures and was diverse by gender and sexuality; of the
9 men and 10 women interviewed, 16 were heterosexual
and 3 were nonheterosexual. In other respects, the sample
was relatively privileged. All were White and fairly well-
educated: of the 6 who did not have a college degree, 2 had
high school diplomas and 4 had completed from 1–3 years
of college. The remainder of the sample (11) had completed
college and even advanced degrees. All were employed,
with 15 occupying professional and semi-professional posi-
tions; 2 held pink-collar jobs; and 1 each man and woman
worked in labor that was primarily physical in nature.
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3
These data were collected as a part of a larger study that
received institutional research board approval and sought
information on men’s and women’s experiences of and
responses to their aging bodies. A qualitative, open-ended
approach was employed as the goal was both to explore
bodily changes and the terms in which respondents made
sense of these. A semi-structured interview schedule allowed
interviewers to use questions consistently across interviews,
but flexibly, to allow for free-flowing discussion of topics as
they came up and for the emergence of issues that interview-
ees found personally relevant. Data were collected and ana-
lyzed in an iterative process, leading to the development of
new questions in later interviews (Taylor & Bogden, 1998).
Topics covered in the interview guide included respondents’
changing bodies and concerns; their ideas about age-appro-
priate behaviors and appearance; ageism; knowledge and
use of anti-aging products and services; and their thoughts
about growing older. To ascertain respondents’ use of anti-
aging products and services, respondents were asked, first,
what “anti-aging” products and services meant to them
and then whether they engaged in such anti-aging activi-
ties. Later in the interview, they were asked about their use
of different products and services that Mehlman, Binstock,
Juengst, Ponsaran, & Whitehouse, 2004, p. 305) derived
from their study of the anti-aging industry. This list that we
refer to as the anti-aging industry (AAI) list in our analy-
sis includes “cosmetic treatments and surgery; exercise and
therapy; food and beverages; vitamins, minerals, and sup-
plements; and cosmetics and cosmeceuticals.” While some
of these strategies might be more extreme, time-consuming,
or costly than others, to the extent that they are touted as
anti-aging, we sought to understand the degree to which
consumers see them as such, why, and how this might vary
by gender.
Conducted at locations chosen by respondents, interviews
averaged more than 2 hr. They were recorded digitally and
professionally transcribed, with the exception of one, in
which technological failure intervened. In this instance, the
handwritten notes taken at the time of the interview were
used for analysis. The analytic strategy involved a process
of inductive reasoning and theorizing (Taylor & Bogdan,
1998). The first author developed an initial code sheet. She
and two other researchers then read key interviews indepen-
dently. Intercoder agreement was reached through a series of
discussions wherein codes were modified and finalized. We
used QSR NUD*IST 6.0 to examine further themes already
delineated and to explore their relationship with one another.
This software did not guide the analysis per se but provided
ancillary help.
Findings
The Meaning of Anti-aging: Appearance as Beauty
All respondents, whether they believed in the efficacy of
anti-aging products and services or not, said that these
have to do with appearance, by which they meant beauty.
 4 The Gerontologist, 2016, Vol. 00, No. 00
For example, Carrie said that anti-aging products and ser-
vices were about “Appearance….[They are fighting] look-
ing old, appearance of skin, skin, hair, weight, cellulite….
[Y]ou lose your smoothness, wrinkles, … sagging, the skin
sags. Ah, elasticity. … Hair loss …Cellulite … Lumpy …
Not smooth anymore.” Even though Shelly doesn’t believe
anti-aging products work, she sees them as linked to appear-
ance conceived in terms of the attractiveness of smooth skin
rather than the visual spectacle of some sort of activity or
performance: “It’s a joke to me … it’s just silly, the concept
that you think this moisturizer is going to work that much
better for you than that moisturizer, when you should have
been drinking water and not smoking and limiting your
alcohol intake as well as exercising the whole way through
and then you won’t have all of those wrinkles.” Likewise,
Dreama depicts anti-aging in terms of beauty, as a product
for women: “Anti-aging means … Botox or some laser or
some skin stretching, whatever. … [Trying to fight] wrinkles
mostly and sagging skin…. And … women with the breast
jobs, you know they don’t like sagging breasts and they
want to have that youthful look so they have the implants.”
Given this equation of appearance as beauty, respond-
ents regarded products for aging men not as “anti-aging”
but in terms of activity and performance. When John was
asked about what he thought it meant if a product or ser-
vice calls itself “anti-aging”, he responded, “That would
mean to me that they will focus on your appearance and
help you to achieve particular qualities that are seen as
youthful. That might mean hair color; that might mean
skin treatment. I see those as definitely the two big things.
…When I hear about anti-aging products, I primarily think
of them focusing in my mind as appearance. I mean, do
I consider Viagra an anti-aging product? Not in that sense.”
For John, equating Viagra with performance rendered it
not an anti-aging product. Aligning anti-aging with beauty,
he defined Viagra out of the realm of anti-aging altogether.
Finally, Carl related anti-aging activities to appearance
in the gay community as well. When asked if some gay men
take part in anti-aging activities, he spoke of men in a city
with a relatively large gay population, and said, “Oh, sure.
I mean I think if they had the money I am sure they would.
… And if, well, … man, if you look at the [dating] ads from
[the city]…. [The guys are] … either much older or early
20s, and the older guys are doing things to make them-
selves look younger. … They all either seem to be physically
fit and have had some sort of cosmetic surgery (laughter!)
or they are very wealthy and don’t seem to care.”
Conflation of Aging and Health
That respondents identified anti-aging products and services
so readily with beauty and with women (and, apparently, a
heterosexual context) may have deterred them from admit-
ting their use, as we have shown earlier. However, examina-
tion of their responses to the AAI list reveals that they also
avoided acknowledging their consumption because they
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had conflated aging with health. Any respondent may see
that what she or he does as an individual is about health, a
legitimate focus for bodily practices that does not align the
respondent with those who are growing old. Respondents
sometimes spoke of health and aging as if they are the
same, that one indicates the other, as is apparent in Carl’s
allusion to physical fitness, above. Either way, ill-health and
advancing age remained entwined in their minds.
For example, in talking about why she uses anti-aging
products and services, Elizabeth said, “It’s hard for me
to separate health from aging right now.” Nora said that
she exercises for about 20 min in the mornings, “both for
health and anti-aging, but again, anti-aging means main-
taining health.” Finally, when discussing impotence with
aging, Mike said that, “if you live a healthy lifestyle and do
what you are supposed to do, you aren’t going to have any
problem. Statistically, most people are not going to have
any problems.”
Jake’s interview exemplifies the conflation of anti-aging
and health motivations, one that fits well with anti-aging
practitioners’ views. Jake is aware that human growth hor-
mone (hGH) is promoted as an “anti-aging” product, but
claimed his interest in it—and in the endurance drink he
imbibed during the interview—bears on optimizing health
and performance: “I don’t think of [those products] … as
slowing down [aging]…. I think of them as enhancing your
performance …. And to be honest with you, if they were
legal, I would use those things … [M]y opinion on hGH is,
if it makes you faster, stronger, you have to tell me what’s
wrong with it, you know. … I would have no problem if
those were legal [to] use them. … I never used … steroids
because they are harsh on the body, and I know that. Never
have, never will, but the hGH product is not that hard on
the body and it helps you heal, you know... [B]asically the
things that I’ve used are … performance enhancing, not,
definitely not anti-aging. It’s more like getting stronger,
faster.”
Respondents asserted that the route to both health and
the fight against aging required remaining active, being
energetic, performing. Mike says, “It’s the adage, ‘if you
don’t use it, you lose it.’ So, the less active you are, the
quicker the aging process is gonna come up on you … You
never stop [working on your body]. That goes on forever.”
Similarly, Shelley spoke of the importance of being a “par-
ticipant in life” for aging well: “you aren’t sedentary ….
you are moving around and you are an active participant in
life versus a couch potato … and I think that makes a dif-
ference.” In Jim’s depiction, old age is the opposite of being
active, a stance that again conflates aging with health/phys-
icality. He says, “I do associate aging with sedentary exist-
ence, and so if one appears more youthful, then one is less
likely to be sedentary. And I view sedentary as decline ….”
These excerpts show that respondents often equated
their attempts to avoid aging with maintaining their health.
At the same time, their conceptions of health remained
vague. They spoke of health less as absence of disease and
 The Gerontologist, 2016, Vol. 00, No. 00
more as physical capacity and performance. Their accounts
also include normative expressions (“what you are sup-
posed to do”) that exemplify the moral dimension of main-
taining health.
Conflation of Aging and Health With Appearance
Sometimes, respondents conflated aging, health, and appear-
ance. For example, Maggie noted that anti-aging products
are for “wrinkles. … It’s a big one obviously. It’s skin stuff
you know. Vaginal dryness. Ah, sagginess. Memory loss.
Just health stuff.” Later in the interview, she noted that
anti-aging products were meant to avoid “being labelled as
unattractive. A lot of those products are aimed at that. All
the stereotypes about being forgetful and hmm, what else?
I guess just generally not as capable.” Here the equation of
appearance with age and health was even more apparent.
To be unattractive meant to be deemed old and incapable.
Indeed, when describing what they saw as an attractive
person for their age, overwhelmingly, respondents spoke
both of health, judged on the basis of appearance, and of
aging. Shelley mentioned people who look good for their
age as those who “have taken care of themselves up until
now and so they look healthy; you can tell they have main-
tained more of a healthy lifestyle; that they continue to take
care of their appearance rather than … letting things go …
you still try to put an outward appearance. I think it’s how
you dress and how you carry yourself, too. … [Y]ou can
tell they have to have a healthy lifestyle or they wouldn’t
look that good.” Likewise, Dreama noted that, in judging if
someone looked good for their age, “I would be looking at
their overall appearance, how they took care of themselves
and their energy level, their vitality …”.
Mike followed suit, speaking of apparent health and
age. “I evaluate on how I think they can act. I can look
at their body and evaluate their body and pretty much
figure out what they have done to be able to maintain
where they are at with respect to their age. I’d go yeah,
that’s pretty good, this person’s led a pretty good life, …
they probably have good eating habits….Looking good
doesn’t mean that you are at an ideal weight … but you
can tell a person that is proactive with respect to trying
to maintain themselves.” Carl also maintains that, in later
life, to be attractive, one need not be model-thin but can
look active instead. Speaking of a middle-aged man whom
he finds good-looking, Carl, says, “He’s certainly in good
shape. Not you know like hyper-good shape … but you
know, fit, active. Well dressed. Not jelly. … I mean he’s fit,
but he’s older so it’s not that trim sort of sinewy look any-
more. It’s a much fuller look that I associate with a sort of
healthy middle age that I think is really attractive.” Shelley
also says it isn’t so much about being the perfect weight per
se, but activity: “[M]y brother who is very gray looks great.
… [H]e looks healthy and he looks active and he looks
like he participates …I think that’s really what makes the
difference.” The alternative to participation is exclusion.
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5
Respondents’ focus on activity allows them to relate this
concern to health rather than aging per se and thus avoid
aligning with a stigmatized group.
The links between good health, attractive appearance, and
responses to their aging is typified in Shelly’s discussion of
the AAI list. She acknowledged engaging in diet modification
(which included taking supplements and vitamins and being
careful about what she eats) and when asked whether she was
doing so based on concerns for health, appearance or aging,
she said, “I think all of the above, because I think the appear-
ance piece of it is, if you don’t watch it, it gets out of hand and
then you snowball, and then it’s so hard to go backwards, so
yeah.” Particularly when considering exercise or diet, others
responded in similar ways, regardless of gender. For instance,
when asked about his motivations for his dietary regimen,
John included health, aging, and appearance among them. He
explained, “So, you know, health, in terms of my heart and
cholesterol especially. Appearance, to be thinner. And, I guess
age, in the sense of just keeping my joints younger in that they
are not carrying on as much weight, I guess. … [I]t’s hard for
me to [separate], I mean do I look younger because I am eat-
ing a lot of fiber or whatever? I guess in a sense that if older
equals fatter, I guess that’s true.” Similarly, Mike, who took
vitamins, minerals, supplements and herbal extracts, and
who also worked out 6 days a week, was asked whether this
regimen was based on health, appearance, or aging concerns.
His response was that it was, “The whole package.”
Such statements demonstrate that, in our respondents’
thinking, health can be inferred from appearance and that
an active, slim, fit, and energetic appearance indicates good
health and relative youthfulness. A healthy appearance is
also conceived of as a sign of a proactive, responsible attitude
toward maintaining one’s body and health through lifestyle,
leading “a pretty good life”. These respondents distinguish
between healthy, active, responsible, and youthful bodies
on the one hand, and passive, careless, and old bodies—the
“unhealthy others” (Crawford, 1994)—on the other.
Gender and Motivations for Anti-aging Activities
When we consider how gender shapes stated motivations for
use of anti-aging products and services, we see that, indeed,
respondents see anti-aging as concerning beauty and thus
primarily as woman’s purview. Only women talked about
anti-aging strategies in relation to appearance defined as
beauty; they were concerned about not becoming “invisible,”
as both Elizabeth and Mary put it. However, this does not
mean that men did not care about their appearances. Instead,
men would talk about care for their appearance in terms that
focused on shaping bodies to look like they can perform.
Women: Appearance as Beauty
Earlier, we noted the ways in which respondents viewed
anti-aging as women’s activity, motivated by aesthetics.
As Shelley said, “[H]ave you ever noticed … that there’s
 6 The Gerontologist, 2016, Vol. 00, No. 00
nothing out there for men for anti-aging or very little …
except for maybe going bald? … But it’s predominately
geared towards women.” Implicit in this statement is that
anti-aging products are cosmetics.
Indeed, many women were clear that they were con-
cerned about their beauty. For instance, Maggie said, “I
think you want to look good as long as you can.” She then
discussed a long list of products and services she used,
including moisturizers, alpha-hydroxy lotions, lipstick,
and hair dye. She was also concerned to exercise, carefully
regulate her diet (including ingesting various vitamins and
supplements) and choose clothing to enhance her attrac-
tiveness (although she also discussed health and age as
motivations). Barb noted that for women, advertisements
revolves around wrinkle creams and balms to put “under
your eyes and take away the bags and all of that.” Finally,
Elizabeth said, “Oh, I buy them all. … I am always trying
something different. … One is for wrinkles, one is for age
spots … So, yeah I am always looking for something.”
Further, these products were not seen to be for men.
Sue thought for a while about what anti-aging prod-
ucts might be related to men, eventually saying, “[T]he
only thing I can think of for men … is Grecian Formula.
(laughter!) … That’s the only thing I can think of …
I don’t think of men using anti-wrinkle creams, those
kind of products.” Similarly, Mary expresses an aware-
ness that anti-aging equates to attractiveness for women,
regardless of the means to get there: “I think a woman’s
appearance is much more … there’s more things that
you have to live up to in terms of, you know, hair and
general fitness and a feminine attractiveness, all that
kind of stuff … I think men can be sexually attractive
all their lives really, but [for] women, there’s a cutoff
point. There’s more, [women have] to do a lot more to
maintain the illusion … than men do.” Nora also see
such products for women as dealing with “the possibil-
ity of being viewed as unattractive and being viewed as
irrelevant … and defined as, you know, having neither
attractiveness nor use.”
Even anti-aging products and services not touted for
aesthetics per se were seen to enhance women’s beauty as
anti-aging, health, and attractiveness become intertwined.
As Dreama said, “If you can do things that keep you from
aging that’s not gonna be putting you in debt … then
I think it would be good for you. I think … eating properly,
nutrition, nutritional supplements, and if you could have
a massage or any of the stuff that makes you feel good
inside, it’s gonna show outward, and then all that beauty
itself makes you feel good.”
Men: Appearance as the Image of Performance
Respondents also acknowledged that men also should
be concerned with their appearances but said that they do
so differently. Men need to look like they could perform.
Nora delineated gendered approaches when she said that,
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for aging men, demonstrating their value revolves around
“being able to perform, whatever [that] might be. … So, for
women it’s very much about maintaining youthful appear-
ance, skin, hair and so forth and for men as well, but for
men it’s also about keeping your abs fit and your dick hard
and all that stuff. [laughter!]”
As we have shown in another report on this research,
men often talked about the importance of having strong
bodies—not just actual strength but also bodies that looked
like they could perform (Calasanti, Pietilä, King, & Ojala,
2013). Darryl was proud to give his chest measurements as
a sign that he was still in good shape; he also feared look-
ing like he was not physically fit: “The thought of becom-
ing the beer-belly, suffering from the ‘donelap’ disease—his
belly had done lapped over his belt buckle—bothers me.”
Likewise, Mike noted, “I enjoy being strong, therefore I do
things to make sure that my strength maintains itself.” And
Jake spoke of the importance of being physically fit, and his
subsequent ability to perform: “I’ve always worked out. …
all my life … I just remember football and running railroad
tracks to try to get in shape and understanding that some-
day you may not have a lot, but if you can just be physically
fit and healthy then you can ward off whatever…..”
Power, or at least looking powerful, is key. As Mary
noted, “I think for men the whole notion of potency is
just overwhelmingly important and dominating in adver-
tisements and consumer imaging of what men need to
counteract their aging.” And of course, as this state-
ment and Nora’s make clear, the emphasis on strength
and performance relates to the sexual arena as well.
Carl elaborated the importance of sexuality in this way:
“a lot of the products for men seem to focus on viril-
ity, sexual ability, keeping it up, getting it up, making it
up (Laughter!). …. It’s maintaining your ability to get
an erection and it’s also for maintaining muscle … it’s
all part of that potency. The more muscular you are the
more sexual you must be, I think.” In fact, most respond-
ents spoke of the centrality of sexual performance to
men’s anti-aging strategies; when they focused on per-
formance rather than beauty, Viagra emerged as a key
anti-aging product for men.
Although the focus on women’s attractiveness is also
about being sexual, the emphasis here is different: women
are to look attractive to signify they are sexually avail-
able to men. By contrast, an active, initiating sexuality is
seen as central to masculinity. Reflecting on the use of anti-
aging products and services for reasons of appearance, and
differentiating between the importance of sexuality and
virility to men versus women, Carl said it is “symbolic of
something I suppose, you know, in the sense that it’s going
to be … the way you can capture some other people ….
I really think … being a man is very tied up with virility.
So I don’t know that it is about other people. I really think
it’s about being a man. It’s about yourself. For women, it’s
about other people. It’s making that appearance impres-
sion different.”
 The Gerontologist, 2016, Vol. 00, No. 00
As well, both men and women asserted that what
men do concerning appearance generally differs from
what women do. Men cannot use “an easy fix”; it must
involve work. For example, Jake says that products for
men and women are “totally different” and that men are
“always going to be … looking for quite simply to be big
and stronger ….” He believes it is easier for women to use
products for appearance; and while he’d like to use some
of those products, he realizes it would be inappropriate.
Note in this excerpt as well how he conflates appearance,
aging, and health: “For me to color my hair would proba-
bly be, man, you probably shouldn’t do that, you know? …
I mean I don’t know too many guys … that color their hair
that I would say [it] was probably a good idea. … I tell
you right now, if I could not have gray hair, I wouldn’t
have gray hair. ... that’s one thing that would definitely
give my age away … but then I go, you know what? …
I try to work on things that I can …. I think I’ve developed
a good game plan on [being] healthy…because I don’t find
attractive a 50-year old [man] that I go, ‘God, is his hair
colored?’”
Others mentioned that some men might begin to use
such things as skin care products a bit more than before
but that this was not their main approach to anti-aging,
nor would it be something that should be acknowledged
publically. After Mike criticized those men who would
opt for “a quick fix … put a Band-aid on something
instead of taking care of what the Band-aid is covering,”
he noted that, “males are doing this Botox mess, too …
and all this kind of stuff … [But] they are not gonna
advertise it like the females would … I think the guys
still wanna hide that a little bit more … And I think the
females want to promote it a little bit more to let the
guys know that they are trying to do something to make
themselves younger, to make themselves look better for
you.”
Thus, while men may care about their aging appear-
ances, and a small number might even engage in some of
the beauty regimens mentioned by women, they would not
characterize it in the same way or want others to know.
By contrast, women (who are assumed to be heterosexual)
would want men to know that they are trying to look bet-
ter for men. As Jake said, “I think it’s presumed that … a
woman will do… whatever to try to fight these [appear-
ance] things, and … it’s not something men are proud
of ….” John concurs, “You know I think people would
look differently at a man when they know he colored his
hair than they would a woman if they know she colored
her hair.” In fact, in Darryl’s view, concern for how she
appears to men is the essence of femininity: “I can tell a
difference in women that take pride in being a woman
than the ones that don’t care and don’t have any self-pride.
I’ve seen women that are not the most attractive, but they
do the best with what they’ve got and they worry about it
and they doll themselves up—they work with what God
gave them. I’ve seen other woman that got the tools to
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7
work with and don’t care. That disturbs me. … It doesn’t
take a lot for a girl … to try to doll themselves up to look
like a woman.”
Finally, as Mike’s previous comment indicated, men
made clear that they believed that one needed to work
at their appearances. Greg talked about the importance
of “burning it off” if he ate something he should not, by
which he meant exercising. He said “you … want to stay
physically fit [and] that’s clearly anti-aging. …but I sub-
scribe to the fact it requires work. It is work.” And while
Jim says he has come to realize that “work harder doesn’t
solve everything,” he also admits that “I still work hard
to control things. [laughter!]” Women also talked about
the importance of exercising, eating well, or otherwise
monitoring their bodies, but they never talked about it
as work.
Discussion
In this study, we use a critical, cultural gerontological
approach to explore the reasons middle-aged adults
give for their use of anti-aging strategies. This paradigm
focuses us on the subordination of old people that social
distancing from old age sustains. Despite entering a time
of life where bodily changes become hard to ignore,
we suggest that middle-aged people maintain ageism
by disavowing engaging in anti-aging for two reasons:
(1) they do not align themselves with a stigmatized
group—old people and (2) in line with previous stud-
ies (Fishman et al., 2010; Hurd Clarke, 2011), the label
“anti-aging” attaches to beauty, the purview of women
only. The men are highly unlikely to say that they do (or
should) engage in anti-aging activities. To do so would
be doubly stigmatizing, associating with two marginal-
ized groups, women and old people. Where women may
focus on beauty, men disavow that pursuit and speak of
performance instead.
Given the neoliberal dictates of individual responsibility
for health (Crawford 1994; Estes et al., 2003), and the wide
range of what can fall under that, it is not surprising that
our respondents often ascribe their behaviors to health.
However, both women and men among our respondents
conflate health with aging and appearance. Not only did
they often provide two or more reasons for bodily prac-
tices but they often equate one to the other such that, for
example, using an anti-aging product might be thought to
be helpful to health and thus also prevent aging. In their
accounts, “good” and youthful appearance suggests an
active lifestyle and individual responsibility to live prop-
erly. This healthism, an individualized concept of fitness
achieved through consumption and discipline, roots bad
health in personal flaws and moral failure.
Documenting this conflation of health, appearance, and
aging helps us to understand the logic of some anti-aging
medical practitioners and to see the ageism that can under-
lie their discussions of health. Activities focused on health
 8 The Gerontologist, 2016, Vol. 00, No. 00
reaffirm both the morality of the individual and the sup-
position that we can read health on the surfaces of bod-
ies. Appearance thus becomes an issue of social assessment
and judgment (Skeggs, 2005). Those unwilling or unable to
meet expectations regarding healthy and active appearance
risk being deemed to be “aging” in the negative sense of
that word.
Few people would say that the improvement of health
posed a problem; and we do not argue that here. We point
instead to the critical issues masked by the conflations
documented above. First, the conflation makes the effects
of anti-aging difficult to measure. Because many respond-
ents define anti-aging in terms of health care, they do not
report it in “anti-aging” terms. Researchers relying on such
self-reports must be wary of what and how they measure.
Second, the neoliberal emphasis on personal responsibil-
ity implies more control over our health than individu-
als have, as well as over the outcome of social policy not
obviously amenable to personal consumer choices. Third,
discourses of health and appearance naturalize ageism,
suggesting that stigmatized old age inheres in bodies that
“naturally” decline and thus should be excluded, unless
persons can somehow reverse the process through aggres-
sive consumption.
These conflations promote the ideas that (1) the low sta-
tus imputed to old age is mere expression of nature, (2) we
can control, even reverse our bodies’ aging, and (3) others
can infer age on the basis of health and discern one’s health
from appearances. The gender differences in how men and
women judge appropriate appearances remain important,
but the ultimate message is similar: men who are healthy
and not aging look like strong, active performers; women
who are healthy and not aging are attractive and “toned”—
their bodies are smooth and without cellulite but not neces-
sarily strong. These gendered perceptions affirm that those
whose bodies do not meet these ideals may count as both
unhealthy and “old” and thus deserve exclusion.
Limitations on our research result from the small sam-
ple size and narrow geographic range from which we
have drawn; it cannot be generalized. It provides instead
a vocabulary, a set of terms that respondents use for their
discussions of anti-aging. Further research can reveal terms
used by other populations, in part by focusing on their care
for health and appearance, and provide measures of the
relative popularity of the terms and justifications that they
use. Such research may contribute to the discovery of the
mechanisms of ageism, in its intersections with gender and
other relations of inequality.
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