Hi Dr. Kim,

My question is about relationships and health. Lately, I’ve been stressed, annoyed at everything and nothing, and somewhat depressed. My wife says I used to be a different person and I believe her. My kids regularly ask if I’m OK. These days I bounce back and forth between irritation and resignation, though I love my wife and family dearly and want to please them. I went to the doctor and they found nothing medically wrong. What do you think? — Grumpy Man from Elizabethton

Dear Grumpy Man,

I hope you will stop for a moment as you are reading this and let this sink in: You are not alone. We live in a high-stress world. Stress is consistently one of the top 10 complaints of patients to their doctors. Depression affects a growing percentage of people, and new research is showing that men and women experience depression differently. While women may ruminate, cry, seek out loved ones to talk to or look for distraction, men tend to hold all their feelings inside, become irritable, and overwork. This situation of feeling sad, overworking, and avoiding the problem leads to a repeating cycle of burying emotion in an attempt to keep things “under control,” which ultimately leads to feeling worse. The names for this condition are “Male Depression” or “Irritable Male Syndrome.”

Irritable Male Syndrome has a specific definition by Jed Diamond, a clinical researcher who studied and wrote a book on the subject. He describes Irritable Male Syndrome as “A state of hypersensitivity, anxiety, frustration, and anger that occurs in males and is associated with biochemical changes, hormone fluctuations, stress, and loss of male identity.”

Medical causes may play a part in how you perceive emotions. Hormone imbalances such as low testosterone or high estrogen give rise to low energy, moodiness, and irritability. Nutrient deficiencies from poor diet can disrupt the functioning of the brain and create depression-like states. Depression and irritability may appear as unwanted side effects of medication, or could also be part of adrenal fatigue or a prolonged stress syndrome. If you want to be thorough, I recommend seeking a second medical opinion and blood testing for hormone and vitamin levels. In the case of Irritable Male Syndrome, a person whom you can speak openly with, such as a therapist, counselor, or trusted physician, can help you navigate diagnosis and treatment. Irritable Male Syndrome can start out mild and seem like a passing phase or a bad mood, but left alone, it could become worse over time. Whenever you have a persistent emotional concern, it is important to seek help because it could impact your physical health and relationships.

Irritable Male Syndrome is often perceived by the partner or family more clearly than the man himself. That is one thing that makes Irritable Male Syndrome so frustrating. Your wife, kids, family or friends may complain that you have changed or are not as kind as you used to be, while you feel that you’re doing fine, just keeping everything together and having bad days now and then. If the bad days become a pattern, it is time to seek help. Life transitions such as a new job, retirement, entering mid-life, moving, or having a new child, though they are positive events, come with their own form of stress. When I was in school, we learned about “positive stress” but I do not believe in any such thing and am glad that this term is fading out of medical practice. The events that create change, improvement, and more happiness in life are of course, positive. However, there is no physical or mental benefit from stress, and in our modern lives we live in an environment that is saturated by stress. So changes that require extra time, thought, and careful navigation tend to create a stress-response to the situation. We live through these times with heightened adrenaline and cortisol, and few of us take the time to relax properly. The instability of modern life partly contributes to chronic stress, and that is another conversation altogether.

When the problem you are having consists of an emotional state, there is a tendency to look for emotional causes. You may think there is something that you, your wife, or a family member are doing to create anger, sadness, or frustration in your mental state. Commonly, it is only a last-resort thought that the causes of these negative feelings could be hormonal, nutritional, or physiological in origin. Irritable Male Syndrome is both emotional and physical. The hormonal fluctuations that influence mens’ emotions should not be overlooked. There are predictable hormonal shifts that men go through just as women do. The first occurs at puberty. There is another around the age of 25, another at 50, and perhaps another at 75. After midlife stage, there is a gradual decline in testosterone levels called “andropause.” Andropause describes any age-related decline in male hormone levels, and the symptoms are emotional upset, decline in muscle mass, decreased sexual performance, and sleep disturbance. Though it is a different condition than Irritable Male Syndrome, I think of them as two sides of the same coin: hormone imbalance is the physical side, while Irritable Male Syndrome is the emotional side.

Four key components are the signs of Irritable Male Syndrome. The first is hypersensitivity. You are hypersensitive when things that normally wouldn’t bother you are suddenly very irritating. You feel sad or angry at the drop of a hat. You become frustrated and confused at situations that you can’t explain, or might feel that you and your partner don’t talk anymore or cannot connect like you used to.

Next is anxiety. It seems that males are trained to be angry, never anxious. Admitting anxiety is perceived as a weakness, or so we think. Actually, there is plenty to be anxious about due to life’s daily concerns and uncertainties, and admitting it doesn’t make you weak or unreasonable at all. A feeling or dread or fear that doesn’t go away and impacts your decisions is anxiety. Anxiety is perceived differently by different people, and with other symptoms present may be part of Irritable Male Syndrome rather than generalized anxiety.

Frustration is the third key component. If you constantly feel thwarted or sabotaged, “set back” or like there are too many obstacles between you and your goals, frustration is present. One common complaint I hear from people experiencing frustration is that they “can’t get it right” or they say, “darned if I do, darned if I don’t.”

Frustration is a feeling like being trapped, as if there is no correct action to take.

Anger is the fourth and final component. Anger turned toward yourself creates a loss of faith in yourself, or low self-esteem. The alternative is to release anger onto your peers, causing the partner and family to feel as if you aren’t happy with them. Anger is not resolved easily when we don’t have the comfort or ability to express ourselves. The loss of “male identity” is a state of confusion which generates anger. The average man wants to feel that he can take care of things, is competent in his work, valued and respected at home, to be in good physical health, and in charge of his own life. There is nothing negative in this desire to have a strong male identity.

You have the right to be supported by the people who love you most and by your team of health professionals. Irritable Male Syndrome may seem like a never ending roller-coaster that you are stuck on, but actually it is a very understandable condition with clear causes and effects. If you seek help you can get past it, and on the other side of it is a renewed sense of identity, a balanced mental state, enthusiasm for life and better physical health. You can definitely reclaim who you were before and become the man you were destined to be. I encourage you to seek help. For more information, I recommend the book, The Irritable Male Syndrome, by Jed Diamond, and Male Menopause, by the same author. The “Grumpy Man” is not who you are — he is the condition that you are going through right now. Look for answers and don’t give up.

There are better times ahead for men as research provides more insight into health and emotions.

————

Dr. Kimberly McMurtrey DNP, APRN, FNP-C is the Primary Provider at Tri Cities Health, located on West Elk Ave., Elizabethton. If you would like to submit a question for her to answer you can call 423-543-7000 or email your questions to tricitieshealth@outlook.com.

**Medical Disclaimer: The information contained in this column is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.