What Is Irritable Male Syndrome and What Can You Do About It?

If you are a man who has begun to experience escalating tension combined with a diminishing sense of wellbeing and reduced optimism, these may be the precursors to an unhappy but avoidable condition known as Irritable Male Syndrome, (IMS).

As we age, men sometimes feel that mounting pressures from career, marriage, kids, and interests can accumulate and threaten the quality of life those things are meant to provide. This loss of meaning feels like a trap and can weigh heavily on middle-aged guys and produce immense anxiety and conflict in even our best relationships.

So in this article, we take a look at IMS and what can be done about it. If you have experienced irritability or mood swings, keep reading.

RELATED: Can Dads Get Postpartum Depression?

What Is Irritable Male Syndrome?

Irritable Male Syndrome is an ongoing mental state of hypersensitivity, anxiety, frustration, and anger in men thought to stem from changes in biochemistry and hormones that relate to a loss of masculine identity. The name is borrowed from a similar condition that occurs in animals reaching the end of their breeding time – a primary example of loss of male identity.

In humans, the primary symptoms of Irritable Male Syndrome are:

• Hypersensitivity
• Anxiety
• Frustration
• Anger

1. Hypersensitivity

Hypersensitivity is the tendency to focus on problems and to react to them in a disproportionate manner. The person being hypersensitive never thinks they’re hypersensitive; instead, they think that pressures are mounting, and annoyance and frustration are natural responses.

To the man with IMS, it feels like people are bothering you. It seems as if nothing has changed in you, but the world is getting more and more annoying, ineffective, two-faced, incompetent, needy, disorganized, dishonest, … etc. etc. etc.

For the partner of the man with IMS, you might find yourself feeling like you walk on eggshells. You may notice that small, unexpected things “set him off”. You may struggle often to find something to cheer him up only to be pushed away again and again. It can be very much like unknowingly giving a bear hug to someone with a sunburn. You’re trying to be loving but it causes your partner pain or frustration.

2. Anxiety

People experience anxiety as apprehension or fear stemming from perceived danger or pitfall (whether real or imagined). As hunting animals, we still have instincts – instincts that have the capacity to exaggerate. For example, not getting the corner office isn’t really a threat to your life. But among modern men, career has replaced hunting and our animal instincts may be overactive in sizing up threats to our wellbeing.

If you find yourself inventorying an exhausting (and frightening) list of “WHAT IF” scenarios in your head, that is anxiety. What if my partner leaves me? What if my employer replaces me? What if I lost my hair? What if – what if – what if ?!

RELATED: How To Get Over Performance Anxiety and Intimacy Issues

3. Frustration

Psychologists define frustration as the feeling you get when you believe you have been blocked or undermined from achieving something important to you. For men suffering IMS, many things become frustrating as perceptions of failure and negativity seem to be all around.

This feeling of inability to get what you want or achieve what you wish can be intensified by anxiety and uncertainty about the first step toward a goal. With societal and cultural pressure for men to be in control and great protectors, shortfalls in this area can be mentally excruciating for men.

4. Anger

Anger – that feeling of extreme displeasure or hostility – is complex and intricate. Turned outward, anger can lead to violence and aggression. Turned inward, it can lead to depression and thoughts of self-harm.

For some men, anger becomes their primary method of expression and their primary defense against perceived threats to wellbeing. Since so many men rely on anger as their go-to emotion, it is often the first symptom spotted in diagnosing IMS.

All of these feelings – hypersensitivity, anxiety, frustration, and anger – are usually passing emotions that come and go. But when these feelings become almost ever-present, they can turn into a long-lasting mood that is difficult to escape. That condition is known as IMS, Irritable Male Syndrome.

How To Avoid Irritable Male Syndrome

For treatment of IMS, speak with a doctor since these symptoms can be signs of multiple various causes. Your doctor can help test the conditions that lead to IMS and can recommend treatments based on that diagnosis.

Hormonal fluctuations are one cause of IMS so your doctor may test your levels of testosterone and other hormones.

Serotonin is a neurotransmitter that is sometimes associated with IMS. Serotonin is vital to brain function and communication so a reduction in available levels could easily trigger the emotions and conditions of IMS.

Finally, you must “manage your mind” by being purposeful about what you focus on. What you focus on increases so remove sources of stress and be deliberate about how you conceptualize your own goals and successes.

Origin of the Term IMS

Reproductive biologist Gerald Lincoln coined the term irritable male syndrome in a 2001 review published in Reproduction, Fertility and Development. Lincoln described Soay rams that became nervous, irritable and lethargic when their testosterone fell after the breeding season. Author and therapist Jed Diamond later adapted the idea for men, and the shorthand IMS stuck.

IMS is not a formal diagnosis in the DSM or in endocrine guidelines. The symptoms are real. Low testosterone and thyroid problems show up in bloodwork, and sleep apnea shows up in a sleep study, so your physician can test for each.

Common Causes of Mood Swings in Men

Mood swings in adult men usually trace to one of five common causes.

• Declining testosterone. The Massachusetts Male Aging Study (Feldman and colleagues, 2002) followed middle-aged men over time. Total testosterone fell about 1.6% a year, and free testosterone 2% to 3% a year.
• Depression, which in men often looks like anger. A 2013 analysis in JAMA Psychiatry by Martin and colleagues found men report more anger attacks, substance use and risk-taking than women, symptoms that standard depression criteria can miss.
• Short or broken sleep, including obstructive sleep apnea.
• Thyroid dysfunction, which can change mood and energy on its own.
• Prolonged stress.

Each cause has its own treatment, so your physician finds the cause first and treats that.

IMS Duration and the Midlife Pattern

IMS lasts as long as its cause does.

Irritability from short sleep eases once sleep is restored, and sleep apnea is diagnosed with a sleep study and treated on its own terms. Irritability from low testosterone continues while levels stay low, and depression responds to treatment. Testosterone declines from middle age and sleep apnea grows more common with age. That makes your 40s and 50s the usual time to check for both.

Note when the irritability started and how you have been sleeping. That history gives your physician a starting point to read alongside your labs.

Testosterone Testing for Irritability

Low testosterone is diagnosed from labs and symptoms together. The Endocrine Society 2018 clinical practice guideline (Bhasin and colleagues) sets the bar. Your physician diagnoses low testosterone only with characteristic symptoms and a low fasting morning total testosterone on two separate days. The morning draw matters because testosterone peaks early in the day.

Testosterone varies from day to day, which is why the guideline asks for a second test. A testosterone blood test shows whether your level is low. LH and FSH then show whether the problem starts in the testes or the pituitary. If low mood persists, see a physician or mental-health professional. If you have thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911 now.

The Opt Take on Irritable Male Syndrome

We start with measurement. Your first step is a blood panel of 55+ biomarkers taken at home or at a partner lab. An Opt Health physician reads your panel with you in a one-on-one consultation to see whether your hormones or metabolic markers explain your symptoms. Your physician also reviews your existing conditions and medications at that first consultation. We repeat the blood panel and physician consultation every three to four months, so your plan follows what your numbers do.

Get started: Begin with Opt Health, where a physician reads your labs, builds your plan, and adjusts it over the loop.

References

1. Lincoln GA. The irritable male syndrome. Reprod Fertil Dev. 2001;13(7-8):567-576.
2. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589-598.
3. Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry. 2013;70(10):1100-1106.
4. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.

There is a lot to think about – we understand. If you have questions about Irritable Male Syndrome or any of the conditions discussed here, connecting with a doctor in a discrete setting has never been easier.

Opt Health is a telehealth platform that reconnects men with wellness, fitness, strength, and sexual vitality through scientific preventive medicine. From your own home, you can schedule with a physician, meet one-on-one via video conference, receive test results, and have medications delivered to your door.

For questions, inquiries, or appointments, don’t hesitate to contact us. Get personalized support and insight from top-tier physicians available 24/7.

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