Low Testosterone and Irritable Male Syndrome (IMS)

There appears to be correlation (relationship) between declining testosterone levels and irritable male syndrome (IMS), but testosterone levels should not be clinically examined apart from this condition’s related symptoms among which are depression, mood swings, anxiety, anger, etc.  From time to time everyone becomes justifiably irritable, and/or has bad days.   However, what distinguishes irritable male syndrome from such instances is its depth, frequently, and persistence.   This article examines what IMS is, its relationship to low testosterone, and ways in which it can be best treated.

What is Irritable Male Syndrome?

IMS is often characterized by its associated biochemical changes, hormonal fluctuations, stress, and loss of male identity.  Just as andropause is the male counterpart to female menopause, IMS can be likened to the male equivalent of premenstrual syndrome (PMS), a generally monthly occurring female-based condition with a wide variety of symptoms among which the most commonly associated behavioral and emotional PMS symptoms include the following.

  • Mood swings, which can include despair, irritability, and anger
  • Withdrawal from social circles
  • Difficulty concentrating
  • Food cravings, and changes in appetite
  • Anxiety and/or tension
  • Depression or a depressed mood
  • Bouts of crying
  • Difficulty falling asleep (insomnia)
  • Emotional stress that can be severe enough to affect daily routines and activities
  • Feelings of hopelessness
  • Low self-esteem

PMS also has a physical component, which doesn’t really apply here and won’t be discussed, but from an emotional/behavioral standpoint many similarities between IMS and PMS abound.  A good and fairly comprehensive definition for irritable male syndrome is:  a behavioral state characterized by two or more significant and persistent varieties of altered moods such as irritability, nervousness, lethargy, depression, hypersensitivity, frustration, anxiety, and anger that often occurs in adult male mammals experiencing diminished testosterone levels.  This negative mood state has been well documented and described in men during andropause, i.e., the natural decline in testosterone levels which accompanies aging, and following withdrawal of exogenous (synthetic, man/made testosterone) therapy.  The reason the above definition says “mammals” instead of men is because irritable male syndrome also bears a striking resemblance to what happens to several other male mammals following seasonal breeding that is at the end of the mating season.  For example, GA Lincoln of the MRC Human Reproductive Sciences Unit, Centre for Reproductive Biology, Edinburgh, UK, published a work in the Journal of Reproduction, Fertility, and Development in 2001 entitled, ‘The irritable male syndrome’.  In it, Lincoln discusses his research on the Soay ram, which provides an animal model for IMS.  By exposing rams to alternating 16-week periods of long and short days, he was able to deactivate the reproductive axis in response to the switch to long days.  This rapid decrease in testosterone secretion provokes the symptoms of IMS, wherein the animals appear agitated and fearful, and the incidence of physical wounding owing to inter-male fighting peaks at this time.  Lincoln believes that IMS is a transition state associated with changes in the normally higher hormonal levels triggered by the hypothalamus (two sections of the brain responsible producing testosterone).

Many of the symptoms from both conditions can be readily compared to, and possibly confused with, specific psychological disorders. However, the difference in both cases has a lot to with timing, and a couple of other variables as well.  TIMING – usually recurring monthly in women, regardless of their severity, the signs and symptoms of PMS typically disappear (for most women) as the menstrual period begins; in men, IMS usually develops around the time that testosterone levels either start to decline (faster for some men), or once they’ve significantly declined.  Although frequency is less an issue in IMS, persistence is characteristic of both conditions, as PMS is most often chronic IMS persists and may worsen as testosterone levels continue to decline.

Depression as Part of IMS

There are a variety of common psychological or psychopathological conditions which are related to IMS, but one of the most significant (and one on which others pivot) seems be depression.  Research has conclusively demonstrated that depression itself (aside from the other symptoms of actual IMS) can be influenced by both biological (hormone deficiencies, illnesses, genetic conditions, etc.) and environmental factors like job problems, legal hassles, financial difficulties, sickness or loss of a loved one, etc.

In March of 2012 M. Khera, et al of the Scott Department of Urology, Baylor College of Medicine, Houston, TX published a study in Aging Male ­­­­­­­­­­(the official journal for the International Society of the Aging Male) entitled, ‘The effect of testosterone supplementation on depression symptoms in hypogonadal men from the Testim Registry in the US (TRiUS)’.  The expressed aim of this study was to determine the effect of long-term testosterone replacement therapy on depression symptoms in hypogonadal (low testosterone possessing) men.  Although multiple subgroups were broken out for greater detailed analyses, this study was comprised of 849 over the age of 60 hypogonadal men for whom 1% testosterone gel had been recently prescribed.  The study data spanned a total of 12 months, and was taken from an observational multicenter registry known as the Testim Registry in the United States (TRiUS).  Total testosterone measures were assessed at baseline and months 3, 6, and 12, while depression symptoms were gauged using a validated self-report questionnaire called the Patient Health Questionnaire-9 (PHQ-9), wherein a decrease of ≥5 represents clinical improvement.  Based on the significantly improved PHQ-9 scores at 3 months (p < 0.01), and clinically meaningful (actual real world impact on depression) mean improvement of 5.62 points on the PHQ-9 at 12 months M. Khera, et al provided sufficient evidence to verify testosterone replacement therapy’s ability to reduce depression symptoms in hypogonadal men.

In a March 2008 study from the Archives of General Psychiatry was conducted with the intention of determining whether the association between serum testosterone concentration and mood in older men is independent of physical comorbidity (the presence of two or more different diseases or conditions).  This cross-sectional study at the WA Centre for Health and Ageing, University of Western Australia, Perth, Australia, was comprised of a Perth community sample of men between 71 and 89 years age, and used the 15-item Geriatric Depression Scale (GDS-15) to assess depressed mood while defining clinically significant depression as a score of 7 or greater.  OP Almeida, et al (and conducting researchers) found that of the 3987 men included in the study (203 of which had depression), those participants with depression had significantly lower total and free testosterone concentrations than those without depression.  After adjusting for variables such as age, smoking, low educational attainment, obesity, prior antidepressant drug usage, etc., men with depression were 1.55 and 2.71 times more likely to have total and free testosterone concentrations, respectively, in the lowest quintile.  Their findings along with those of the above study and countless others clearly illustrate a definite link between depression ( a major IMS symptom) and low testosterone.

Anxiety as Part of IMS

As cited earlier, IMS is a condition which consists of variety of mood-based symptoms among which are rapid changes in mood (usually for the worse), a quicker tendency, towards anger, persistent depression, and otherwise unexplained anxiety.  According to the Mayo Clinic anxiety happens as a normal part of life, and can even be useful when it alerts one to danger.  However, for some people anxiety that continuously interferes with daily activities such as work, school, and sleep, or disrupts one’s relationships and enjoyment of life can lead to health concerns and other possibly very serious problems.

In some cases, when presented alone, anxiety can be a mental health condition that may require treatment.  For example, generalized anxiety disorder, is characterized by persistent worry about major or minor concerns.  Other anxiety disorders like post-traumatic stress disorder (PTSD), panic disorder, and obsessive-compulsive disorder (OCD) have more-specific triggers and symptoms.  Sometimes anxiety resolves on its own, and sometimes it results from a medical condition that calls for treatment such as lifestyle changes, counseling, medications or a combination of these approaches.  In the case of irritable male syndrome, anxiety is paired with one or more conditions which together help to form the disorder, a condition that will not resolve without medical care.

In December 2012, U. Aydogan, et al of the Department of Family Medicine, Gulhane School of Medicine, Ankara, Turkey published a study entitled, ‘Increased frequency of anxiety, depression, quality of life and sexual life in young hypogonadotropic hypogonadal males and impacts of testosterone replacement therapy on these conditions’.  The purpose of this study was to evaluate the relationship between low testosterone levels and psychopathological symptoms such as anxiety, depression, sexual function, and quality of life all of which are common conditions in young hypogonadal men.  This six month study consisted of 39 young hypogonadal male patients, and an additional 40 age-matched healthy males.  Both pre-tests and post-tests were administered to assess results before and after the 6-month treatment period using the Arizona Sexual Experiences (ASEX), the Beck Anxiety Inventory (BAI), the Short Form-36 (SF-36), and Beck Depression Inventory (BDI).  Results discovered by U. Aydogan, et al determined that compared to the control group, the (pre-treatment) experimental group had both a greater number of and a higher severity of depression, anxiety, and sexual dysfunction symptoms along with a lesser reported quality of life.  After 6 months of testosterone replacement therapy, researchers observed significant improvements in each of the above measures, and concluded that increased incidence of negative mood-related psychological symptoms are in fact associated with low testosterone levels.

Best Treatment for Low Testosterone Induced Irritable Male Syndrome

There appears to be a very sound correlation between declining low testosterone and irritable male syndrome, which includes such supporting symptoms as anger, anxiety, depression, and mood swings.  The majority of clinically research demonstrates that irritable male resulting from low testosterone can be best treated via testosterone replacement therapy (TRT).  Conclusively proven to greatly improve and often completely reverse IMS symptoms experienced by low testosterone sufferers, testosterone replacement therapy improves a variety of additional conditions as well such as decreased sexual function, and overall quality of life, muscle strength, body composition, insulin sensitivity, general well-being, etc.


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