Irritable Male Syndrome (IMS)

irritable male

Yes, Irritable Male Syndrome is a real thing… every woman out there knew it was real.

It is now recognized as a combination of men’s health, behavioral, and mental health collection of hormonal changes around the point in life as women go through menopause.

Initially, about ten years ago or longer, I was researching and building content for a presentation at a health and nutrition conference on male hormones and insulin resistance when I came across a very interesting article on IMS.

But first, let’s look at the standard medical model regarding depression. Before researching IMS, I read an article that compared depression rates in men and women and how the same criteria for identifying risk, diagnosing, and managing depression is conventionally used and almost entirely based on a woman’s profile and experience with depression.

Women have had a very biased history with the medical system due to 72% of the doctors in 2007 improving to 67% in 2021 being men, creating an unintentional bias that results in women being misdiagnosed. According to a paper published in the New England Journal of Medicine, women also suffer delays in treatment and prescriptions. One study shows that women are seven times more likely to be misdiagnosed and discharged during a heart attack.

The signs of early to moderate depression in men are not specific and without standard male-centric assessments. The only consensus I could identify was the agreement that men do not present in the same way as women.

The default for men then is the one-size-fits-all (in this case, a women’s one-size-fitting-all-men) approach in healthcare can cause significant harm. As I mentioned earlier, this gender bias is unintentional, yet when we consider how different the hormonal or behavioral profiles are between men and women, I’m surprised there isn’t a more obvious solution. (9)

Culturally, we have come to approach depression as more of a woman thing, and many feel it’s not masculine to feel depressed or talk about being depressed.

Considering mental illness is the number one cause of disability worldwide, and depression is the number condition of mental illness reported, if nothing else, we have a significant financial and time off work incentive to figure this out. (WHO) The second leading cause of disability is low back pain. Studies show depression as the number one cause of “work-related” low back pain. That may make depression the cause of disability through two vectors and compound the resulting financial impact worldwide. (CDC)

Depression claims more years of life than war, cancer, and AIDs combined, and with its impact on other health and behavioral issues, depression may be the single biggest cause of preventable death on the planet. (Book: Noonday Demon).

I believe the reason we don’t identify at-risk men for depression earlier is that we write off the signs as typical male stress-related issues.

Rebecca Voelker, the author of Depression: A Somber Issue for Women, says it quite well in her book, “When men experience depression, it is more likely to appear as a loss of concentration, anger outbursts, withdrawal, and sleep disruption, and identified as stress-related and not depression.”

That’s where the lightbulb lit up in my mind when I was reading about Irritable Male Syndrome, or IMS, a play on a woman’s hormonal experience with PMS, as the hormonal profile for men nearing andropause and as an early sign of depression in men.

By looking at depression strictly through a woman’s presentation, we inevitably make depression less masculine and challenging for men to identify with it or speak up about it. At the same time, when men show signs of depression, we tell them it’s just their “type A personality” or that it’s just stress and they need to manage or cope with it better.

Not reasonable considering men’s suicide rates outnumber women in every age group ranging from 3 to 1 in people 5-14 yrs to 15 to 1 in over 85 yrs, while men with alcohol use disorder are 120 times the risk of suicide than the general public. (CDC2)

Behavioral sign in IMS shortlist: (IMS):

  • Grumpy
  • Angry
  • Gloomy
  • Impatient
  • Tense
  • Hostile
  • Lonely
  • Stressed at Home
  • Annoyed
  • Touchy
  • Stressed at Work
  • Overworked
  • Unloved
  • Jealous

That list is what got my attention and interest laser-focused. As I read through it, I did not like how many of those signs I saw in myself. Learning is fun, right?

A man might want to give more thought to male-centric depression or IMS if he regularly suffers from 6 or more of the characteristics on this list.
Note: men, if you believe you only have a couple of those signs, I suggest you ask your wife or close woman friend to tell you which of those, if any, they see in you.

That’s what brought my focus from, “Hey, this is interesting,” to the laser focus and years of study since I asked my wife at the time and kids to take that little questionnaire about me.

Yeah, that happened. Don’t miss this chance, my fellows, to get an outsider’s eye to point out any blind spots you might have. I wish I had done it five years earlier.

We can do better!
Dr. Don