When he released his medical records this month, Donald Trump appeared on the Dr. Oz show to reveal his health information. After doing a blase rundown of results, noting many of them "good" or "normal" or "low," Oz made one number stand out.

"Your testosterone is 441, which is actually --" Oz said, then paused. "It's good," he finished with a chuckle.

Trump gave a faint smile and a meaningful eyebrow raise. The crowd cheered.

This sort of exchange would have been unthinkable in any prior presidential campaign (a sentence we could repeat about essentially every other aspect of the 2016 election). It's true that Trump isn't unique in branding himself as manly; many past candidates have touted their guyness as a positive trait. However, Trump has created his own uniquely aggressive, tough-guy image on the trail, and he is wielding it in an unsubtle, uncoded manner unlike anything seen in recent elections.

Gender was always bound to play a major role in the 2016 campaign, with Hillary Clinton poised to become the first female major-party nominee. As it turns out, Trump's gender has likewise become a major focus of this election cycle.

Weaponizing masculinity

On the Republican side, packed with 16 men and one woman, Trump weaponized his masculinity. He belittled Texas Gov. Rick Perry, saying he didn't have the "toughness" or "energy" to be on the debate stage. (Perry responded by challenging Trump to a pull-up contest.) After that, fellow candidates were given emasculating nicknames: Low-Energy Jeb, Little Marco.

Trump has also touted his association with male sports stars — and a particular type of sports star at that. These athletes have often stood out themselves for being aggressive, and even transgressive — Bobby Knight, Mike Tyson and John Rocker, for example. Those men helped him cement his identity; Knight may have been foul-mouthed and abusive toward players, but to Trump, he was "not just tough" but "smart, tactical. He was a winner."

Trump has painted himself as a particularly strong, healthy man, in contrast to Clinton, whom he has said doesn't have a "presidential look" or enough "stamina." In his Dr. Oz interview, Trump compared himself to football player Tom Brady (whom Trump also considers a friend).

And campaign Co-Chairman Sam Clovis, likewise, recently drew the Trump-NFL comparison, portraying the candidate as a formidable debate opponent because of his size: "You know, he's big enough to play tight end for the Jets, you know, for the Patriots," Clovis said, "and so, he's a big, robust fellow and again, Mrs. Clinton will be up on the stage as well. I think it'll be a great contrast physically, but I also think it'll be a great contrast in style."

Trump's running mate, Mike Pence, has likewise referred to Trump's "broad shoulders" multiple times.

The businessman has put a decidedly straight streak in his masculine presentation by commenting on women's looks, deeming Heidi Klum "no longer a 10," insulting fellow contender Carly Fiorina's looks ("Look at that face! Would anyone vote for that? Can you imagine that, the face of our next president?"), and responding to a Washington Post journalist's question by calling her "beautiful." And then there is, of course, the latest controversy over former Miss Universe Alicia Machado's weight.

And he also brought a toughness-versus-cowardice attitude to political rhetoric. Trump appeals to voters with his anti-political-correctness message, implying that every politician but him is a coward who won't suck it up and be honest.

The most blatant example of Trump's manliness as a focal point was the debate over his hand size in this election — and that because of that, he became the first presidential candidate to, in a debate, bring up the size of his penis.

Manliness has always played a part in presidential politics

Perhaps all of 2016's manly rhetoric shouldn't be a surprise. After all, gender politics has long been a fixture on the campaign trail for candidates of both parties, even when all of the major-party candidates have been of the same sex.

"It's always been there," said Michael Kimmel, a sociologist at Stony Brook University who has done extensive research on masculinity. "In 1840, we had probably the most gendered election in our history."

That year, William Henry Harrison defeated incumbent Martin Van Buren by casting himself as rugged and tough — the Whig party emphasized Harrison's victory over the Shawnee Indians at the Battle of Tippecanoe and referred to him as the "log cabin and hard cider candidate." In contrast, the Whigs cast Van Buren as an aristocratic sissy. One campaign song referred to Van Buren as "Little Vanny."

It's even possible that Harrison's toughness contributed to the shortest presidency ever. Despite a cold Inauguration Day, he gave a nearly two-hour speech with no coat or hat, then attended parties in his wet clothes. He died 32 days later, of what doctors said was pneumonia. (However, that diagnosis has recently come into question.)

An array of other presidents have benefited from the manliness factor, according to Kimmel: Teddy Roosevelt, with his outdoorsmanship and talk of speaking softly but carrying a big stick. John Kennedy's "young manly vigor," Kimmel said, arguably helped boost him over a "shady" Richard Nixon.

That sensibility — that a masculine leader is a good leader — has continued into more modern campaigns, as political scientists Meredith Conroy and Caroline Heldman wrote in a recent essay. Even a single ill-advised photo-op can be damaging. Democratic candidate Michael Dukakis learned that with his infamous 1988 tank ride. When Dukakis grinned and waved from the top of a tank, wearing a massive helmet, the general consensus was that he looked weak and out of place.

Journalists picked up on the display of manliness (or lack thereof) immediately. The New York Times made it the lede of its story: "Forget John Wayne and Clint Eastwood. Forget Rambo. Meet Macho Mike Dukakis. At least that's what his image makers are struggling to convey." The George H.W. Bush campaign immediately seized on the image and made it a focal point of its advertising.

But then, Bush found himself fighting the "wimp factor" in 1988, as Newsweek described it: the fact that, for whatever reason, people saw him as too weak to be president.

The masculinity contest reached new heights in the 2004 race, when John Kerry and George W. Bush seemed locked in a constant contest of who could outdude the other, as USA Today wrote then. Both candidates prominently displayed their sporting activities and "everyman"-ness, the paper wrote. Kerry also emphasized his military background, telling the audience at the 2004 Democratic National Convention that he was "reporting for duty," in the middle of a so-called global war on terrorism.

Not that that stopped Kerry's opponents from trying to unman him: In one 2004 ad, the National Rifle Association portrayed Kerry as a sweater-wearing poodle with a pink bow in its hair — an ad that simultaneously evoked elitism and femininity. Kerry's running mate took his share of flak too; Bush officials apparently referred to then-Sen. John Edwards as the "Breck girl."

So this election isn't entirely unique, Conroy told NPR, but she added there is something special about Campaign 2016: "It does seem to be the subtlety is gone in this election, with Trump."

With Trump placing such a high emphasis on his manhood, some of the insults aimed his way have, fittingly, taken aim at that manhood. The naked Trump statues placed in parks in big U.S. cities were titled The Emperor Has No Balls, after all. (Not to be outdone by the statue-makers, the New York City Parks Department responded with its own dig: "NYC Parks stands firmly against any unpermitted erection in city parks, no matter how small.")

In August, Morning Joe played a music video called "Amnesty Don," which kicks off by calling Trump "soft and flaccid." Sen. Elizabeth Warren slammed Trump and his running mate, Indiana Gov. Mike Pence, as "two small, insecure, weak men."

It may be that those insulters thought those digs would get under the skin of a man who flaunts his macho-ness. But then again, they may also know the long-standing playbook: assuming that masculinity is a winning trait.

The American brand of manliness

It's not that Americans are opposed to a woman in the Oval Office. Fully 92 percent of Americans say they would vote for a woman for president, according to Gallup.

But then, when men have monopolized the Oval Office and dominated the other branches of government for more than two centuries — and when women nationwide have had the right to vote for less than half that time — it's understandable if the masculine template is a winning template.

It's possible that appearing less than manly can hurt a candidate on Election Day. One 1988 poll found that 1 in 4 Americans was less likely to vote for Dukakis as a result of that tank ride, Politico reported.

In another analysis, American University political scientist Jennifer Lawless used survey research to analyze Americans' attitudes about gender in the post-Sept. 11 atmosphere of fear and calls for war. She concluded that "citizens prefer men's leadership traits and characteristics, deem men more competent at legislating around issues of national security and military crises, and contend that men are superior to women" at dealing with the aftermath of Sept. 11.

So while many Americans are fine with — even enthusiastic about — electing a woman as president, that doesn't mean they have fully egalitarian attitudes about gender.

And it's clear that the Trump and Clinton supporters have distinctly different attitudes in this area. Sixty-eight percent of Trump supporters said they believe the U.S. has grown too "soft and feminine," according to an April poll from the Public Religion Research Institute, compared with 31 percent of Clinton supporters and 42 percent of Americans overall. In addition, 50 percent of Trump supporters said they believed that it "benefits society for men and women to embrace traditional gender roles." For Clinton supporters, it was 39 percent.

One of Trump's policy proposals also telegraphs traditional gender ideas — when he recently unveiled his family-friendly work policies, he announced that he was proposing six weeks of maternity leave, with no leave for dads.

The "alt-right" community has plenty of differences from more mainstream Trump voters. However, its rhetoric suggests that it prizes masculinity particularly highly. The epithet "cuckservative" (as in, "cuckold" plus "conservative") is wielded against fellow conservatives that alt-righters feel are not conservative in the right way, as Matt Lewis at the Daily Caller explained last year (this article could be considered NSFW).

"By supporting immigration reform, criminal justice reform, etc., a white conservative is therefore surrendering his honor and masculinity (and it won't be long before his women folk are compromised, as well!)," he wrote. (He also explained the racial associations that the term elicits.)

Often, the term is used against "establishment" Republicans. Unofficial alt-right leader Milo Yiannopolous explained it in a post at Breitbart (this article also is NSFW) that listed Sen. Lindsey Graham, former George W. Bush adviser Karl Rove and former presidential candidate Jeb Bush as examples.

There are particular demographic targets to the masculinity strategy. The goal of Bush and Kerry's manliness contest in 2004, as pollster Brad Coker told USA Today, was to win "white men who live in economically challenged areas of swing states." According to Celinda Lake, a Democratic pollster, this year's strategy is similar.

"You have a certain group of voters who like the masculinity, the muscularity, and it's also in Trump's case very combined with 'tell it like it is,' " she said. "Most are men, particularly older men, particularly blue-collar men, white men," she added. Those men, of course, are among Trump's most loyal supporters. (This rhetoric also usually appeals to Latino men, Lake said, but Trump's other statements and positions have cut off that source of support.)

Trump may very well be a reaction to the analytical and intellectual Obama, who beat out a war hero fighter pilot in 2008 and was preceded by a brush-clearing "decider" in George W. Bush.

If white, blue-collar men in particular like this language, it's fitting that the candidates who have often been cast as wimps — George H.W. Bush, Mitt Romney, John Kerry — have also been wealthy or powerful. The weakness they were labeled with came not only with feminine connotations but also more than a whiff of elitism.

"We've always coded the upper class as foppish and not really masculine," Kimmel said. "The American ideal of masculinity is you make it yourself. You build it. Your hands."

Trump is, of course, wealthy and powerful himself, but with his brashness and anger has successfully avoided any upper-class "foppish" associations. Furthermore, his identity as a builder was underlined at the Republican National Convention, when his son Donald Jr. described how his father "hung out with the guys on construction sites ... pouring concrete and hanging Sheetrock."

There's a parallel age-related appeal to Trump's brand of manliness, according to one Republican strategist.

"I do think that what Trump has done effectively [is] harkened back to the idea of the Marlboro Man — the opposite of metro-macho," said Sarah Isgur Flores, who served as a deputy campaign manager on Carly Fiorina's 2016 campaign. "And so I think for older voters that have seen that cultural shift there's a lot of nostalgia and comfort with that."

But beyond class and cultural norms, there are also concrete economic realities at work here — the "economic anxiety" that is always mentioned in conjunction with Trump followers.

"These guys, their fathers, their grandfathers, their great-grandfathers, they all made a bet. The bet was, 'If I take this job in heavy industry, in the steel mill, auto factory, I can buy a house. I can support a family,' " Kimmel said.

"These guys, they made the same bet that their fathers and grandfathers made, and they lost the bet" as they watched those mills and factories close, he added. That led to a deep anger in some of these men, who felt they were losing out on pieces of the pie to which they felt entitled, according to Kimmel.

The anti-PC appeal

Trump speaks to that anger, with his "tell it like it is" style and opposition to "political correctness." The distaste for political correctness burns particularly hot among the alt-right community.

"You can see the cuckservative phenemona in the campus rape hearings about to happen in the U.S. Senate," as lawyer Michael Cernovich told Yiannopolous in his Breitbart piece, citing this as an example of a subject that demanded more truth-telling. "Not a single Republican senator will speak out in favor of due process or refute the rape culture nonsense."

That blunt appeal helps Trump extend his pitch beyond economically struggling Americans, to people broadly frustrated by a "PC culture," one that many Trump followers perceive as too sensitive and unfairly advantaging some groups over others. That culture is holding men back, in the Trumpian framing.

"All of the men, we're petrified to speak to women anymore, we may raise our voice — you know what, the women get it better than we do, folks, they get it better than we do," as he told a rally in Spokane, Wash.

Many Americans may agree with Trump on that point, but it remains objectively true that women are not close to equally represented in government, whether in statehouses, governors mansions, the Supreme Court, Congress, or the White House — and women have made up a majority of the presidential electorate since 1984.

The dearth of women even as presidential candidates means that the norms still skew masculine, often with few to no women to balance out perspectives. Fiorina had dropped out of the Republican primary by the time Rubio and Trump got into their infamous hand-size discussion, but a woman on the stage would have been able to provide a valuable counterpoint, Flores said.

"Where they talked about the hand size and the, 'There's no problem down there,' and there's no woman on the stage to roll her eyes to the back of her head — I think that would have been a moment we would have wanted to be a part of," she said.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

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