Irritable Male Syndrome

WebMD Live Events Transcript

Stressed out? Grumpy? Moody? If you're a guy and these words describe your mental state, you may be suffering from what psychotherapist Jed Diamond calls "irritable male syndrome" in his book of the same name. Yes, ladies, even men can fall victim to hormone fluctuations. We discussed IMS and its effects on men when Diamond joined us on Nov. 10, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD Live, Jed. Thank you for joining us today. What is irritable male syndrome? Is this a new problem or a newly recognized problem?

This is really based on 40 years of my own clinical research as well as responses from 10,000 men. We've discovered why millions of men are becoming angry and depressed, and why they so often vent their frustration on the women they love the most.

Irritable male syndrome (IMS) can be defined as a state of hypersensitivity, frustration, anxiety, and anger that occurs in males and is associated with biochemical changes, hormonal fluctuations, stress, and loss of male identity.

How are depression and aggression linked in men?

What we've found was that most of the professional research and, in some ways, common experience have assumed women suffered from depression at twice the rate as males. We've found in our research that men often experience depression in different ways than women. And often, irritability and anger and hypersensitivity are male aspects of depression that often go unrecognized.

What is the role of stress in IMS?

What we found is that stress is destroying marriages and destroying relationships. There are a number of reasons for this. There are more new and more deadly stresses that we face today than ever before. In the past, stress came from physical sources. A wild animal would run into the camp or there would be physical danger. And men knew how to respond to that, the fight or flight response.

But now, stress comes from many other sources. From too much traffic, stress from where our country is going, and the direction we're going, fears about unknown attacks from outside or stresses from inside our country. The traditional male responses don't work. We can't fight it if we don't know what it is. As a result, male stress tends to be taken out on the partners that we are in relationship with.

Some men turn inward and harm themselves; others become aggressive. What determines which way a man will go?

As I described IMS as having two types or directions, we can say it's either acted in -- reflecting in depression, and if not treated even suicide. Or it's acted out in terms of anger, aggression and violence. What determines which one has to do with often our upbringing, in some cases our genetic heritage and biochemistry. But quite often, we see men going from one extreme to the other. These are the men that seem to hold it inside and then, out of the blue, tend to explode.

Are there hormonal factors in IMS? We so easily throw around the idea that hormones affect women's moods, but for men it never seems to come up.

Again, there is the assumption that women are hormonal but men are moved more by logic. But the truth is men are as hormonally driven as women. In fact, men have a number of hormonal cycles:

1) Men's testosterone, for instance, varies and goes up and down four or five times an hour.
2) There are daily cycles with testosterone being higher in the morning and lower at night.
3) Men have a monthly hormonal cycle that is unique to each man, but men can actually track their moods and recognize they are related to hormonal changes through the month.
4) We know that there are seasonal cycles with testosterone higher in November and lower in April.
5) We know about hormonal cycles with males during adolescence, but also the years between 40 and 55 have what we call male menopause or andropause.
6) Finally, we know there are hormonal changes in men going through IMS, related to stress in a man's life.

"What we've found is that one of the primary symptoms is denial. That is, men think the problem is anywhere other than in themselves."

What causes hormones to go out of whack in a man?

There are a lot of things that can make hormones go out of whack. Let's start with something we all do, and that is eating food. If we gain weight, we run the potential of increasing IMS.

Here is how it works: In the body, a certain amount of testosterone gets converted to estrogen. Males and females have estrogen and testosterone in our bodies. When we put on weight, our fat cells are more active in converting testosterone into estrogen. The more estrogen we have and the less testosterone we have, the more irritable we become and the less sense of our own manly strength that we have. That's one way they get out of whack.

A second way is that we know when we are under a great deal of stress our testosterone levels drop. The third way they get out of whack is when we use various medications that can have in impact on hormonal levels. Many people are using multiple medications, not always with the knowledge of their doctors. And when I say medication, I include herbal remedies that many people think that because they're natural, they're safe, or that they're not real medications.

What I tell people is that all of these things are important to be explored by your health care provider to be sure you're not causing reactions between the various things you may be taking that can make your condition worse rather than better.

What are the signs of irritable male syndrome? My husband is depressed and stressed. Sometimes I have no idea what sets him off. How is IMS different from just regular depression?

We've set up a specific web site for you, at On that site, you can take a quiz that will score your answers and give you an idea of whether you are suffering from IMS or the man that you may be concerned about is suffering. The quiz will also tell you which of nine types of IMS a man may have.

What we've found is that one of the primary symptoms is denial. That is, men think the problem is anywhere other than in themselves. They think it's their wives, their boss, people on the highway, the people in the White House, anybody but what's going on with themselves. So one of the primary things we help couples do is help men break through the denial.

What we know is that depression obviously can be present in people, male or female, who are not experiencing IMS. But we do think depression is a very significant aspect of IMS, and it is often unrecognized in males, because we tend to see irritability and anger and aggression as something that is acted-out behavior or negative behavior. We rarely see how sad and unhappy the men are.

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