GRUMPY old men have long been an established figure of fun. In recent years they’ve even had their own television shows. But now they’re up for therapy. For it now seems that crustiness among us mid-life chaps isn’t necessarily a natural carnaptious rite of passage we must undergo before collecting our bus pass and slippers: just as women have to negotiate the change of life, with its attendant hormone-generated mood swings, depression and low libido, now it is being argued that men also experience “change of life”, and can suffer from a related condition, labelled irritable male syndrome, which should be more widely recognised.
Irritable male syndrome (IMS) is not just the long-suffering spouse’s nickname for what happens when the TV remote gets lost down the side of the sofa. According to Jed Diamond, an American psychotherapist specialising in men’s health, it is an identifiable condition, resulting in depression, moodiness, anxiety and low sex drive. And, he believes, going by the testimony of hundreds of people he has interviewed, IMS can, and does, destroy relationships – it almost broke up his own marriage.
Diamond’s book, The Irritable Male Syndrome, has just been published in Britain, having already created much interest in the United States. But before you roll your eyes, presuming this to be yet another manifestation of New Age loopiness from California – and the 61-year-old Diamond does indeed reside in the small town of Willits, north of San Francisco – it’s worth bearing in mind that the very term, irritable male syndrome, was, in fact, coined in recent years by an Edinburgh researcher, Dr Gerald Lincoln, of the Medical Research Council’s Human Reproductive Sciences Unit. Lincoln, while not endorsing all of Diamond’s book, emphasises that there is a gradual decline in testosterone levels in men after about the age of 30 which may be causally linked to mood changes and irritability.
Testosterone, of course, is that much-maligned male hormone which gets blamed for everything from adolescent pimples to road rage, but it is fundamental to the development of male sexual characteristics. Irritable male syndrome, however, is down to more than just hormones, stresses Diamond, who was in Britain last week promoting the new book (his last, The Male Menopause, has been translated into almost 20 languages). IMS is a multidimensional problem, in which hormonal fluctuations interact with the psychological and sociological factors which can affect men, particularly in mid- life. “There are four related aspects of irritable male syndrome,” he says. “One, the hormonal fluctuations, particularly testosterone; secondly, physiological changes in things such as dopamine and serotonin (both neurotransmitters) levels; thirdly, we can see that it’s related to the stresses which men are experiencing more prevalently these days (such as whether they will find a good job or have enough money to retire) and, finally, changes in male identity that men are going through, concerning their place and importance in society these days, when women can do anything, including having babies, without them.”
Diamond relates the problem to the andropause or male menopause, which, he says, occurs generally between the ages of 40 and 55 but sometimes as early as 35 and as late as 65, but adds that not all men necessarily go through it. And he likens it to “adolescence – hormonally-driven but more complex”. It is tempting to lump many of the symptoms – particularly the anxiety and irritability and their erosive effect on relationships – under what we loosely term mid- life crisis, but Diamond regards mid-life crisis as purely the psychological and social side of a broader problem. “What IMS adds are the hormonal and physiological aspects.”
Following up his book on the male menopause, he conducted an online survey on the Men’s Health website and was taken aback by the worried men and disrupted relationships he discovered through some 10,000 responses. “I’ve seen hundreds of men and their wives who talk about these problems destroying relationships.”
Far closer to home, however, Diamond, 61, who has ten grandchildren, describes in the book how his own marriage almost went down the tubes due to his own irritability and anger, which he now puts down to IMS. He believes the condition is treatable, using a combination of mental, spiritual and physical exercises but also advocates testosterone replacement therapy (TRT), which remains a controversial issue, having been regarded in the past as both unproven and also possibly linked to prostate cancer.
Diamond recognises this, but points out that studies carried out in London by Dr Malcolm Carruthers, of the Andropause Society, have been studying TRT with patients for ten to 15 years without finding increases in cancer levels, and adds that similar research has been going on in Denmark for 60 years without grounds for concern.
However, the medical world remains far from decided on the issue of the male menopause itself, although, claims Diamond, more and more medical authorities are accepting it. “If we only see it in terms of drops in testosterone, well, many men don’t have significant drops and they obviously don’t have the cessation of hormones the way women do when their ovaries shut down; but if we regard it as a continuing change to do with hormonal fluctuations, over time that can affect our psychological, interpersonal and social well-being, we then see that it’s really a very common change of life that we go through as men, and I think more health care professionals are recognising that.”
In Edinburgh, Dr Lincoln coined the term, irritable male syndrome, after carrying out research on male animals, including Soay rams, whose sex hormone levels dropped “precipitately” after the mating season and who became irritable and unpredictable. “At the same time,” he says, “I was working alongside colleagues dealing with young men on testosterone replacement therapy, for testicular cancer or other conditions, and if they came off their testosterone supplement, they became depressed and sometimes irritable. They could tell you if you had given them a placebo [instead of testosterone]. So, men clearly require a critical level of testosterone to maintain male behaviour.”
Dr Lincoln has reservations, however, at any idea of a quick- fix solution for problems associated with aging. “Women have a menopause because they have run out of eggs and there is associated decline in hormone secretion, producing marked behavioural effects. In men, it is a much more gradual aging process , and although depressive and irritable behaviours become more common, it’s still not clear how much is attributable just to hormone change.
“Clinicians are concerned at the idea of the widespread use of testosterone supplementation in men. There have been detailed studies on giving older men testosterone and it doesn’t necessarily help, although it can in some cases. And there are obvious risks.”
Lincoln points out that low libido can also be associated with other conditions which should also be checked out. “Diabetes is a classic example associated with impotence, the same with low thyroid function. But if you genuinely did have low testosterone, this could be supplemented.” What Dr Lincoln does commend in Diamond’s book is its highlighting of the issue and of men’s health in general. “I believe there should be more research into this. There is already research into the male contraceptive pill, in which the behavioural issues are being carefully studied.” In his book, Diamond quotes the comedian Elayne Boosler’s line: “When women are depressed, they either eat or go shopping. Men invade another country.” For men on the verge of TRT, however, the solutions may not be quite so simple.
* The irritable Male Syndrome, by Jed Diamond, is published by Rodale/Pan Macmillan at GBP 12.99
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