“Man up, boys don’t cry” is a very common saying in our society. Although undeniably toxic, this motto has been ingrained in most men. Fortunately, the emerging field of male endocrinology may be able to help us unlearn this societal expectation. After all, if there are biological explanations as to why men experience moodiness, who can deny science?
by Jasmine Gowidjaja
Cis women are very aware of their monthly cycle. For most, having four weeks in a month equates to one week of low mood and irritability, one week of utter pain from cramps, one week of uncomfortable post-recovery, and a mere one week of sanity. While the female menstrual cycle is a very common topic among the general public and medical communities, knowledge about the hormonal cycle of our male counterparts is much more obscure.
Hormones are chemical messengers in the body that affect and manage different biochemical processes, including metabolism, mood, sexual function, and reproduction. Among the 50 hormones that have been identified in the human body thus far, perhaps the most associated hormone with males is testosterone.
Testosterone is part of a group of hormones called androgens—hormones that primarily influence the growth and development of the male reproductive system.1 The production of testosterone first picks up during puberty, allowing men to develop their male sex organs and masculine characteristics.1 As such, they play a critical role in the production of sperms.2
As with any other hormone, fluctuations in testosterone levels inevitably lead to changes in mood and behaviour. According to the Society for Endocrinology, testosterone has a diurnal pattern of secretion.3 Peak levels of testosterone are reported in the morning, decrease significantly in the afternoon, before beginning to rise again at night.3 In young males, this decrease in testosterone levels can be as drastic as 35%.4 This variation in testosterone levels was what sparked the concept of male periods, or more scientifically, the Irritable Male Syndrome (IMS).
Although made popular by psychotherapist Jed Diamond, the term “IMS” has been around since the start of the millennia. It was first coined by the late Dr. Lincoln A. Gerald, a professor at the MRC Human Reproductive Sciences Unit in the Centre for Reproductive Biology. In his paper titled “The Irritable Male Syndrome”, he defines IMS as a “behavioural state of nervousness, irritability, lethargy, depression, and low libido that occurs in adult male mammals following the withdrawal of [Testosterone]”.5 In the case of IMS, the drop in testosterone is usually attributed to the 24-hour cycle of testosterone, and the behavioural effects vary according to one’s health and nutrition.5 Like any other endocrine regulation pattern, he found that the change in behaviour due to testosterone withdrawal may take several weeks before becoming apparent.5 This discovery of IMS challenges the dogma that males are always reproductively active at the onset of puberty.5
Interestingly, there have been little to no follow-up studies on IMS since Jed Diamond’s books and Dr. Gerald’s study. Conducting such research would be pivotal in helping us understand the causes and pathophysiological patterns that arise due to testosterone fluctuations, as well as enable the invention of treatments options to help ease the discomfort of the IMS experience. Furthermore, if it is true that men experience IMS regularly or periodically, gaining a better understanding of the male hormonal cycle would provide a stronger foundation to challenge the toxic societal expectation placed on men, such as the need to be tough and not emotional.
If the idea of “male periods” exists, then it is not too farfetched to believe that “male menopause” may exist too. Medically, the term “male menopause” is referred to as andropause or late-onset hypogonadism—a clinical and biochemical syndrome associated with advancing age.6 As andropause gains more medical recognition, this definition is slowly becoming endorsed by credible institutions, such as the International Society of Andrology (ISA) and the European Association of Urology (EAU).6
As one ages, it is common to see a decline in bodily functions. Specifically, in males, the most prominent decline in bodily functions is the reduction of testosterone levels and circulation. According to a clinical guideline from the American College of Physicians, blood testosterone levels begin to decline in the mid-20s and continue for an average of 1.6% per year.7 However, this criterion alone is not enough to be considered as suffering from andropause. According to the current guidelines, men must fulfil a set of clinical symptoms and, more importantly, be testosterone-free or have a low testosterone level in the blood.6 This age-related change in testosterone levels has negative implications for both cardiovascular and mental health. For instance, andropause symptoms, such as an increase in weight, may lead to elevated blood pressure and moodiness.4
Several studies have pointed out that this decline in testosterone levels may not be solely age-dependent but can arise from co-morbidity issues, such as diabetes and obesity.4,8 Despite this clause, it does not change the fact that a drop in testosterone levels does have implications for one’s health and well-being.
Although their names are similar, andropause and menopause cannot be associated as two sides of the same coin. Menopause occurs in women due to a sudden drop in the hormone estrogen, causing massive physiological changes. In contrast, the decrease in testosterone levels in males is known to occur gradually. Furthermore, a Polish study comparing the hormonal changes in ageing men and women reveals that andropause symptoms can only account for around 33% of menopause symptoms,9 further emphasising that the causes and pathology of andropause should not be extrapolated from our current knowledge of menopause.
What can be done?
Low testosterone levels can be reversed using testosterone treatment, such as in the case of erectile dysfunction. However, a recent clinical guideline released by the American College of Physicians recommends that clinicians not initiate testosterone therapy in men with age-related low testosterone.7 This is because there is little to no benefit to reducing common ageing concerns, such as low energy and vitality. Essentially, they advocate for the understanding that these symptoms related to andropause are a natural extension of ageing and cannot be treated with supplements. Instead, men suffering from andropause should try to attain hormonal balance using exercise, weight management, proper diet, and stress management.4
At the time of writing this article, the terms “IMS” and “andropause” are still understudied and underrepresented and are only beginning to be taken seriously by the medical community. Hence, further research on the endocrinology of testosterone and the behavioural effects of these disorders needs to be carried out. Again, it is important to emphasise that while the symptoms of IMS and andropause mimic those of PMS and menopause, respectively, they are not comparable to one another. Understanding the biological basis of IMS and andropause symptoms will significantly contribute to our knowledge of other fields, such as social psychology and relationship science. Hopefully, these studies will play a significant role in breaking down the negative societal expectations and stereotypes placed on men. [APBN]
This article was first published in the June 2023 print version of Asia-Pacific Biotech News.
About the Author
Jasmine Gowidjaja is an editorial intern at World Scientific Publishing and is currently pursuing an undergraduate degree in Life Sciences at Yale-NUS College. Evident in her diverse research background, from insect biodiversity to disease pathology, Jasmine is interested in just about anything.