Welcome to WebMD Live, Jed. Thank you for joining us today. What is irritable male syndrome? Is this a new problem or a newly recognized problem?This is really based on 40 years of my own clinical research as well as responses from 10,000 men. We've discovered why millions of men are becoming angry and depressed , and why they so often vent their frustration on the women they love the most.Irritable male syndrome (IMS) can be defined as a state of hypersensitivity, frustration, anxiety , and anger that occurs in males and is associated with biochemical changes, hormonal fluctuations, stress , and loss of male identity.How are depression and aggression linked in men?What we've found was that most of the professional research and, in some ways, common experience have assumed women suffered from depression at twice the rate as males. We've found in our research that men often experience depression in different ways than women. And often, irritability and anger and hypersensitivity are male aspects of depression that often go unrecognized.What is the role of stress in IMS?What we found is that stress is destroying marriages and destroying relationships. There are a number of reasons for this. There are more new and more deadly stresses that we face today than ever before. In the past, stress came from physical sources. A wild animal would run into the camp or there would be physical danger. And men knew how to respond to that, the fight or flight response.But now, stress comes from many other sources. From too much traffic, stress from where our country is going, and the direction we're going, fears about unknown attacks from outside or stresses from inside our country. The traditional male responses don't work. We can't fight it if we don't know what it is. As a result, male stress tends to be taken out on the partners that we are in relationship with.Some men turn inward and harm themselves; others become aggressive. What determines which way a man will go?As I described IMS as having two types or directions, we can say it's either acted in -- reflecting in depression, and if not treated even suicide . Or it's acted out in terms of anger, aggression and violence. What determines which one has to do with often our upbringing, in some cases our genetic heritage and biochemistry. But quite often, we see men going from one extreme to the other. These are the men that seem to hold it inside and then, out of the blue, tend to explode.Are there hormonal factors in IMS? We so easily throw around the idea that hormones affect women's moods , but for men it never seems to come up.Again, there is the assumption that women are hormonal but men are moved more by logic. But the truth is men are as hormonally driven as women. In fact, men have a number of hormonal cycles:1) Men's testosterone, for instance, varies and goes up and down four or five times an hour.2) There are daily cycles with testosterone being higher in the morning and lower at night.3) Men have a monthly hormonal cycle that is unique to each man, but men can actually track their moods and recognize they are related to hormonal changes through the month.4) We know that there are seasonal cycles with testosterone higher in November and lower in April.5) We know about hormonal cycles with males during adolescence, but also the years between 40 and 55 have what we call male menopause or andropause.6) Finally, we know there are hormonal changes in men going through IMS, related to stress in a man's life.What causes hormones to go out of whack in a man?There are a lot of things that can make hormones go out of whack. Let's start with something we all do, and that is eating food. If we gain weight, we run the potential of increasing IMS.Here is how it works: In the body, a certain amount of testosterone gets converted to estrogen. Males and females have estrogen and testosterone in our bodies. When we put on weight, our fat cells are more active in converting testosterone into estrogen. The more estrogen we have and the less testosterone we have, the more irritable we become and the less sense of our own manly strength that we have. That's one way they get out of whack.A second way is that we know when we are under a great deal of stress our testosterone levels drop. The third way they get out of whack is when we use various medications that can have in impact on hormonal levels. Many people are using multiple medications, not always with the knowledge of their doctors. And when I say medication, I include herbal remedies that many people think that because they're natural, they're safe, or that they're not real medications.What I tell people is that all of these things are important to be explored by your health care provider to be sure you're not causing reactions between the various things you may be taking that can make your condition worse rather than better.What are the signs of irritable male syndrome? My husband is depressed and stressed. Sometimes I have no idea what sets him off. How is IMS different from just regular depression?We've set up a specific web site for you, at www.theirritablemale.com. On that site, you can take a quiz that will score your answers and give you an idea of whether you are suffering from IMS or the man that you may be concerned about is suffering. The quiz will also tell you which of nine types of IMS a man may have.What we've found is that one of the primary symptoms is denial. That is, men think the problem is anywhere other than in themselves. They think it's their wives, their boss, people on the highway, the people in the White House, anybody but what's going on with themselves. So one of the primary things we help couples do is help men break through the denial.What we know is that depression obviously can be present in people, male or female, who are not experiencing IMS. But we do think depression is a very significant aspect of IMS, and it is often unrecognized in males, because we tend to see irritability and anger and aggression as something that is acted-out behavior or negative behavior. We rarely see how sad and unhappy the men are.

MODERATOR:

Are you sure this shouldn't be called Typical Male Syndrome? (Sorry, your male moderator couldn't resist)



DIAMOND:

There really are humorous aspects that can be typical. There is a question, "How can you tell if a male has IMS?" and the answer is, if you ask, "Can you please pass me the salt," and he replies, "Take, take, take, that's all you ever do!"



It's so baffling to the people that live with the men because it seems to be happening without any seeming cause. And that's what we try to do through the quiz and questionnaire and the research, is to help people understand what's going on so we can treat it and help save the millions of relationships that this problem is destroying.



MEMBER QUESTION:

What are the nine types of IMS you mentioned?



DIAMOND:

Again, I recommend that you go to the web site and take the quiz to identify them. Here are some examples:

One is more irritable. The fuming, the frustration that gets turned inward. The guy that's at slow boil.

A second type is more aggressive. The men might blow up without provocation and start yelling, or they may become physically violent.

A third common type is withdrawal. That man seems to not want to interact in his important relationships. He seems to disappear, and there's a question of, where did the man that I love disappear to? Where has my best friend gone to?

So I would, again, recommend that people check out for themselves which type they may have in their lives, so you can recognize the various options available for help.

MEMBER QUESTION:

So how does a man come to recognize that it's not the boss, the highway, or the White House that's driving him, when he's denying his own contribution?



DIAMOND:

Men tend to learn about this slowly over time.

The first way men often learn about it is they begin to recognize that even though it may appear that the problem is outside themselves, their reaction seems to be overly drawn. He seems to be too angry for the situation.

Step two is that he begins to see that regardless of the cause, the relationships that are important to him are suffering.

Thirdly, he begins to see that there is something that can account for these problems without him feeling even worse about himself. People say that when they take the test, they find out they're not crazy, and it helps them accept that it's something real.

And finally, when they recognize there are so many things they can do to make things better, they're more willing to accept that there's a problem.

MODERATOR:

This question is a good example of what you just mentioned about overreacting.



MEMBER QUESTION:

I get angry so easily, in traffic, when something I'm trying to put together doesn't work, when I burn toast! I wasn't always like this. I'm in my mid-30s and don't have any particular life problems, but something has definitely changed in me. Is this a sign of IMS and what can I do about it?



DIAMOND:

Yes. What we know is that any time a man starts having these added kinds of irritable responses, when that has not been typical of him before, we suspect IMS. We then follow that up by having the man, or person that cares about him, take the quiz that gives us more detailed information, and it also begins to help us see what we can do to improve things.



What people can do, depending on what their particular issues are, can range anywhere from changing diet to shifting exercise programs, to stress reduction and relaxation practices, to checking hormone levels. And I do a great deal of counseling in my own practice in my office here in Northern California, by phone, and by email to help guide men and their partners through the steps of healing.





"We don't need to go back to some kind of idealized, pseudo manly persona in order to be manly. What we do need is a clearer sense of purpose in our lives."

MEMBER QUESTION:

DIAMOND:

MEMBER QUESTION:

DIAMOND:

MEMBER QUESTION:

DIAMOND:

Number one, my husband has changed.

Number two, he seems much more unhappy than he's ever been before.

Number three, he tells me that he loves me, but he's not in love with me anymore.

And four, he doesn't know what to do.

You said one of the factors in IMS was loss of male identity. Could you explain what you mean by that? Surely you don't mean that men should have to go back to being Ward Cleaver or Matt Dillon in order to be real men?No indeed. We don't need to go back to some kind of idealized, pseudo manly persona in order to be manly. What we do need is a clearer sense of purpose in our lives, a sense of direction of what it means to be a man at this time in the human experiment on the planet; these are difficult times to be a man. And finally, we need a greater degree of support and appreciation of manhood in all its various manifestations.I've found that the traditional men's support groups, which started in many cases in the late 1800s -- the elks clubs, lions clubs, etc., where men could come together to talk, joke, and just be together, weren't originally clubs to make money. But those have changed now. Not only have they lost their support aspect, they've become more business oriented. And, of course, they now allow women members. So we need places where men can be in group situations with other males. I've been in a men's group that's been meeting for 25 years now. And I believe it's one of the absolutely essential elements of support that men need today.It seems part and parcel of a much larger problem - we're not adapting quickly enough to our rapidly changing societal environment, perhaps?Yes, I think that's a perceptive observation, that we are moving into a world where things are changing much more rapidly than the human psyche is able to adapt. And in many ways, we're creating an environmental catastrophe by the way we're using our natural resources. And clearly, unless we change the way we utilize our resources, humans are going to have an increasingly stressful and difficult time living on the planet over the next 20 to 30 years.I believe my husband of 23 years is going through something like this, with lack of interest in everything that he once liked. He is unsure if and what is making him unhappy or what can be done to make himself happy, and not sure if after 23 years he is in love with me. What can I do if he is unwilling to seek professional help? He seems depressed and uninterested in everything that once made him happy. He has devoted all his energy to his job instead. Are there vitamins , etc. that I can give him to help him?I get literally thousands of letters and emails from women that experienced these common elements:

For starters, what I tell women is that you have to be willing to get some help for yourself to know how to deal with these issues. You have to know when and how to be supportive of him; you need to know how to best take care of yourself; you need to know when to insist that he come with you to get help, and when to leave the decision to him. These are the kinds of issues I work with people every day to help answer and solve these kinds of problems.

MEMBER QUESTION:

What kinds of diet changes are you talking about as possible treatment for IMS?



DIAMOND:

There is an important need to be able to make some strategic decisions about the level at which a man may need help. For instance, when a man is acting very depressed and saying he doesn't feel that life has much to offer, or he's saying he feels that there's nothing here in this relationship, that's not the time to talk about diet or nutrition. That's the time to get involved with a professional therapist to deal with more possible depression that could be life threatening.



That's why it's important to not try to diagnose yourself or hope it works out by itself. These issues need professional understanding and guidance.



Having said that, there are many things we can do with diet, both things that we should be eating to help, and things we should not be eating that contribute to IMS. For instance, we know that one of the causes of IMS is a low testosterone level. We also know that the more weight a man puts on, which is a problem for many of us in society, the lower his testosterone level will become. So anything a man can do to lose those inches around his waist, not only helps him look better, feel better, and live longer, it will help eliminate the IMS.



MEMBER QUESTION:

If I went to my family doctor with your book in hand and said I think I have this, would he take me seriously?



DIAMOND:

If he's smart he will. What I found when wrote my book, Male Menopause , which has been translated into 20 foreign languages and is a national bestseller, was that initially doctors were reluctant to take the information seriously. Now, increasingly, doctors understand these issues, and many are open to treat them.



For the most part, until doctors actually read the book and understand it, they may be reluctant to be supportive of their patients who recognize the problem and want to do something about it. That's why I try to link people with physicians in their area that might be responsive to treating these kinds of problems.



MEMBER QUESTION:

Who do you see first, your family doctor or psychotherapist?



DIAMOND:

I always recommend people have a relationship with their family doctor, because many of the aspects of these problems can be psychologically based. I also recommend that people have a regular psychotherapist that they go to periodically, because many aspects of life have a psychological base.



Ideally, there would be one clinician we could go to that's trained in all aspects of men's health. Just as women go to see a gynecologist, I would like to see a time when males have a doctor that speaks to the unique needs that men have. And perhaps we'd call him a guy necologist. There actually is a medical specialty that's called andrology and a specialty called andrologist. But it's more common in Europe than in the United States.





"I get literally hundreds of letters a day, mostly from wives and girlfriends that say, 'This is him. How did you know? Have you been listening in on our private conversations?'"

MEMBER QUESTION:

DIAMOND:

MODERATOR:

DIAMOND:

MEMBER QUESTION:

DIAMOND:

MODERATOR:

DIAMOND:

MODERATOR:

What is the effect of alcohol smoking on the possibility of getting IMS, or the worsening of it if you have it?Alcohol, smoking , medications, drugs of different kinds, can contribute to IMS in a number of ways. As I mentioned, they can affect hormone levels, they can affect the biochemistry in the brain, they can affect our stress levels, and they can also contribute to IMS or exacerbate it in people that have it. We know, for instance, that people who drink too much can become more irritable and angry, and in some cases, more violent.What kind of feedback are you getting from wives and girlfriends about your book?The response has been overwhelmingly positive. Twenty four hours after the book came out, it got to No. 5 on the Amazon bestseller list. It's in its second printing after being out for two weeks.I get literally hundreds of letters a day, mostly from wives and girlfriends that say, "This is him. How did you know? Have you been listening in on our private conversations?" And once having gotten the book and reading it and taking action, I get letters saying, "Thank God I got this in time, because this has saved our marriage."Unfortunately, I also get letters from people who say, "I wish I'd gotten this book five years ago. It may have saved our marriage had I known these things." That's why I'm so committed to getting this message out, and get people to go to the web site to not only find out if you have it, but I have a free newsletter that people can sign up for to keep you posted to various issues related to IMS. Again, that's www.theirritablemale.com.It seems impossible for parents to prepare children for a future that is so unknown. What advice would you give parents that might help them pave a more flexible road for their children to travel?I think there are two models that we have in this country about raising children. One is a nurturing, caring, supportive model, and the other is a stricter model.What we've learned in research over the years is that a strict disciplinary model will push people to obedience, but will lead boys, particularly, over time toward a more angry and aggressive position in the world. The nurturing model will lead to more caring, more interactive nurturing way of being with wives, girlfriends, and children when they have children. Hopefully, parents can move towards a nurturing model for parenting We are almost out of time. Before we wrap things up for today, do you have any final words for us, Jed?I really encourage people to write in, if you want to contact me. You can do that through the web site, and I'd enjoy hearing from you.Our thanks to Jed Diamond, MSW, for joining us. For more information, please read his newest book, The Irritable Male Syndrome .

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