Irritable Male Syndrome: Fact or Fiction?

From the WebMD Archives

There’s a lot of information going around that says that as men age, they get moodier, more irritable, and easily frustrated -- kind of like a “male menopause.”

Some say this happens because their testosterone levels start to go down. But can a lack of one hormone really create a bunch of grumpy, older men?

“It’s nonsense,” says Bradley Anawalt, MD, chief of medicine at the University of Washington. “Older men are irritable -- it’s almost never due to testosterone.”

The science doesn’t point to a single right answer. But some experts do see a link between low testosterone levels (or “low T”) and mood shifts in aging men.

What Doctors Know for Sure

Generally, men make less testosterone as they get older. Forty percent over age 45 have levels that doctors consider below the norm (<300 ng/dL). Problems with the testicles or the pituitary gland can cause it. It can also be linked to a number of ailments, like high blood pressure and diabetes. Many times, doctors can’t pinpoint the cause.

Some symptoms, like low sex drive, loss of bone density, and loss of muscle mass are linked to low testosterone. But Abraham Morgentaler, MD, founder and director of Men’s Health Boston medical clinic, says he often sees other side effects in his patients. “Men with low testosterone find that their emotional reserves are lower,” he says. “They have a shorter fuse. In popular culture, people link male anger with high testosterone, but as a rule we see it more in men with low testosterone -- most commonly when levels are dropping. That’s when men get cranky.”

There’s some research that shows that men with low T even have hot flashes just like women do during menopause.

Menopause vs. Andropause

But other studies show that what’s going on inside a man’s body as he reaches late-middle age is far different than what happens to a woman. During menopause, the production of estrogen drops sharply. Men tend to lose testosterone gradually, about half a percent per year.

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For some doctors, a “male menopause” caused by slowly decreasing testosterone is too far of a leap. Alvin Matsumoto, MD, professor at the University of Washington School of Medicine, says that sexual symptoms, like low libido, poor sexual performance, and erectile dysfunction have strong links to lower levels of the hormone. But the studies he’s seen show that other symptoms, like fatigue, depression, and mood issues, aren’t necessarily tied to low T.

“I think it’s a little naive to think it’s all related to testosterone,” Matsumoto says. “I think there are a lot of things going on when you get older.”

He points to the fact that a majority of aging men experience low T as a side effect of other chronic problems, like obesity and high cholesterol. If your beer gut is starting to make your back hurt and slowing you down, you’re more apt to be grumpy, right? And even if testosterone is an issue, causing problems in the bedroom, for example, maybe it’s that, not the hormone level, that’s got you in a sour mood.

“If you’re androgen deficient and you’re experiencing a low sex drive, will you get a little irritable?” Matsumoto asks. “Yes!”

Not-So-Grumpy Old Men

So what can you do if you’re getting older, your testosterone is in decline, and you feel unusually moody or irritable?

If your levels are consistently low and you show multiple symptoms, like fatigue or malaise, some doctors might recommend hormone therapy. “Low testosterone affects our quality of life,” Morgentaler says. “Some people might say it’s a normal part of aging. Well, so is declining vision, but that doesn’t mean we don’t treat it.”

Ronald Swerdloff, MD, a spokesperson for the National Institute on Aging, says there’s some truth to that. “I’m not aware that low testosterone is responsible for grumpy old men,” he says. “But people with low testosterone have been shown to have a decrease in mood, and there is some evidence that treatment will improve that.”

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But Anawalt and Matsumoto say that regardless of whether you believe there’s such a thing as irritable male syndrome that’s caused by low T, the best way to feel better is to tackle your overall health.

“I don’t think you should be paying attention to testosterone levels,” Matsumoto says. “Pay attention to how you feel. Pay attention to the things that everybody knows are good for you, like diet, exercise, weight control, not smoking or drinking too much. Even though testosterone is my area, I believe these things are much more effective in getting people to feel better. And maybe a little less irritable.”

WebMD Feature Reviewed by Melinda Ratini, DO, MS on December 13, 2015

Sources

SOURCES:

Brawer, M. Reviews in Urology, published online 2004.

Bradley Anawalt, MD, chief of medicine, University of Washington Medical Center; spokesperson, Endocrine Society.

Home Health Network: “Hypogonadism.”

Abraham Morgentaler, MD, founder and director, Men’s Health Boston.

Steward: “Andropause: Do Men Go Through Menopause Too?”

Alvin Matsumoto, MD, professor, University of Washington School of Medicine; spokesperson, National Institute on Aging.

Ronald Swerdloff, MD, chief, division of endocrinology, department of medicine, David Geffen School of Medicine, UCLA; spokesperson, National Institute on Aging.

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