Irritable Male Syndrome not something to scoff at, Hormonal condition can affect men over 45 years of age - Dr Deepak Janardhanan, specialist urologist

Published on August 9 2015


Furious at his wife, 47-year-old Mark stomps out of the house for work because the toast wasn’t the exact shade of cinnamon he wanted. Normally, a shade or two off would not be a big deal, but lately, every small matter seems to be raising his hackles. He wonders what is happening to him. His wife wonders too.

He decides to see a doctor and, after undergoing a few tests, he is informed that his testosterone levels are decreasing. His recurrent bouts of irritation and anger, the doctor tells him, are due to a hormonal imbalance and the syndrome is called the Irritable Male Syndrome (IMS). It affects large numbers of men entering middle age.

The general assumption that only women suffer hormonal fluctuations that lead to mood swings while men stay grounded by logic is not true, says Dr Deepak Janardhanan, specialist urologist at Medeor Hospital.

Dr Janardhanan said the larger problem is that men in this region are either unaware of the problem or in denial that they too can experience hormonal imbalances.

“I have had about 150 patients seeking medical advice in the last five years. The problem though is much larger than the number suggests, as most men do not seek medical advice. Men only decide to see a doctor when they face problems at work or when their sexual relationship is suffering,” he said.

Unlike menopause in women, when hormone production stops completely, in men, testosterone levels decline over time, explained Dr Janardhan. “In some men, this leads to what is termed as Andropause, though the term is not a precise one since hormone production in men does not stop. In men over 60, it is termed as Adam [Androgen deficiency in ageing men].”

IMS is part of Adam, explained Dr Janardhanan, and it is not only due to decreased levels of testosterone; sometimes, it’s also due to increased levels of oestrogen.

Unlike women, who experience premenstrual Syndrome (PMS) every month and have mood swings, there are no definite cycles for hormonal changes in men. Studies have shown that testosterone levels in men vary; they go up and down every hour. “Testosterone is usually the highest in the early morning and lower at night,” Dr Janardhanan said.

However, not every man with a low testosterone level is symptomatic. “About 20 per cent of men above the age of 60 have testosterone below the normal levels, but not all have IMS. So the demographics remain unclear,” said Dr Janardhanan.

“Men suffering from IMS get moody, tense, depressed and frustrated at different hours of the day. The symptoms can vary in individuals. They can feel less energetic, hostile, lethargic and have problems with sleep and [their] sex life. These symptoms can last for a few days to weeks and even months,” he explained.

A dip in testosterone is linked to many reasons, the most common being ageing. The decline sets in usually after the age of 45.

“In males, their behaviour and characteristics are due to the male hormone, testosterone. About 98 per cent of the testosterone in the body is bound to a protein called sex hormone binding globulin [SHBG]. Only the remaining 2 per cent of testosterone — called free testosterone — is responsible for male characteristics,” he explained.

Due to the ageing process, the amount of SHGB in the blood increases, which means there is less free testosterone in the body.

Stress, certain medicines, chronic diseases, tumours and alcohol can also lead to a decline in testosterone, “even in young men”, Dr Janardhanan said.

“Stress increases the production of corticosteroids in the body, which have a direct impact on the production of testosterone. Medicines like steroids, diseases of the liver and kidney, and tumours of the brain also contribute to a drop in testosterone.”