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Researchers at the University of Michigan have discovered new information about hormonal biomarkers that can address the beginning of the menopause transition.”In the end, this information can change the way we do business,” said MaryFran Sowers, professor in the University of Michigan School of Public Health Department of Epidemiology. “The information provides a roadmap as to how fast women are progressing through the different elements of their reproductive life.”Ms. Sowers led a research team that examined the naturally occurring changes in three different biomarkers over the reproductive life of more than 600 women: follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH) and inhibin B.

Below is a portion of that interview, along with some Q&A. MD: 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?

JD: This is really based on 40 years of my own clinical research as well as responses from 50,000 men who have taken the IMS quiz. 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.

MD: How are depression and aggression linked in men?

JD: 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. Irritability, anger and hypersensitivity are male aspects of depression that often go unrecognized. MD: What is the role of stress in IMS?

JD: 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 economic worries, too much traffic, environmental destruction, global warming, fear of terror attacks, and many other areas of concern. 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.

MD: Some men turn inward and harm themselves; others become aggressive. What determines which way a man will go?

JD: 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 direction we go often has to do with 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.

MD: 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.

JD: 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.

QUESTION: 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?

JD: We’ve set up a specific web site for you, at IMS quiz. 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. 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. T

hey 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, anger and aggression as something that is acted out behavior or negative behavior. We rarely see how sad and unhappy the men are.

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?

JD: 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.

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?

JD: 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 which 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.

QUESTION: 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?

JD: 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. 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 30 years now. And I believe it’s one of the absolutely essential elements of support that men need today.

QUESTION: It seems part and parcel of a much larger problem – we’re not adapting quickly enough to our rapidly changing societal environment, perhaps?

JD: 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. 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 coming years.

QUESTION: 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?

JD: I get literally thousands of letters and emails from women that experienced these common elements: 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. 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.

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?

JD: If he’s smart he will. What I found when I wrote my book, Male Menopause, which has been translated into 25 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 treating 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.

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

JD: I always recommend people have a relationship with their family doctor, because many of the aspects of these problems can be physically 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.

MD: What kind of feedback are you getting from wives and girlfriends about your book?

JD: The response has been overwhelmingly positive. Twenty four hours after the book came out, it got to No. 5 on the Amazon bestseller list. More and more women are recognizing IMS is a problem in their lives and want to get help for themselves and the man they love.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 http://www.imsquiz.com/ 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.

MD: We are almost out of time. Before we wrap things up for today, do you have any final words for us, Jed? JD: 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.

MD: Our thanks to Jed Diamond, PhD, for joining us. For more information, please read his newest book, The Irritable Male Syndrome or go to http://www.imsquiz.com/ to see whether IMS is a problem in your life.