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Male PMS: Myth or Fact?

Depends who you ask. But the symptoms are real.
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Fast Facts

  • Experts disagree about whether irritable male syndrome is a diagnosable medical condition, but its symptoms—including mood swings, irritability, and fatigue—are real.
  • Symptoms of IMS are likely caused by fluctuations in testosterone and other hormones as men age.
  • If you are experiencing symptoms of irritable male syndrome, your doctor can prescribe treatments that can ease your discomfort.

Every month, as many as three out of four women experience premenstrual syndrome (PMS) where shifting hormones cause mood swings, headaches, breast tenderness, and other uncomfortable symptoms. Plenty of men(and women) have joked about a male version of PMS dubbed irritable male syndrome (IMS). But is IMS a real condition, or just a way to brush off crankiness that often rears its head as men age? Experts are divided. But one thing they agree on: the symptoms associated with IMS are real.

Psychotherapist Jed Diamond, Ph.D., says that irritable male syndrome is absolutely a condition that plenty of men experience, especially as they age. His book, The Irritable Male Syndrome: Understanding and Managing the 4 Key Causes of Depression and Aggression, argues that men experience hormonal highs and lows that can cause “fluctuating testosterone levels, biochemical imbalances, loss of masculine identity, and stress.”

Other experts aren’t entirely sold on IMS or a related phenomenon known as male menopause—a term used to refer to the symptoms some men experience as their testosterone production levels decrease in middle age. Men don’t lose their ability to reproduce as a result of the condition, they note. Nor do all men inevitably experience it.

Your general practitioner may have never heard of IMS—or have a protocol to treat it—but plenty of studies show that men experience age-related hormonal changes that impact mood. In other words, the symptoms of IMS are real and can cause negative physical and mental health effects in men who suffer from them.

If you’re experiencing symptoms of irritable male syndrome, here’s how to talk to your doctor about them, and treatments that can provide relief.

What Is IMS?

  • While experts have argued whether or not irritable male syndrome is a medical condition, they agree the symptoms associated with it are real.
  • Men experience hormonal highs and lows as their testosterone levels decrease with age.

What is Irritable Male Syndrome?

Diamond wasn’t the first to explore the idea of irritable male syndrome. A 2002 article in the journal Reproduction, Fertility and Development (1) described the condition as a cascade of behavioral symptoms and mood disturbances in males attributed to low testosterone. “[IMS is] a behavioral state of nervousness, irritability, lethargy, and depression that occurs in adult male mammals following withdrawal of testosterone (T),” the article noted.

That article was about the behavior of rams, not humans. The male sheep got agitated and fought each other more when their testosterone levels dipped during mating season. Still, experts say similar patterns might hold true for humans.

“I could imagine that low testosterone would lead to some degree of irritability, lack of energy, and depression,” says board-certified family medicine physician, Shilpi Agarwal, M.D.

Signs and Symptoms of Irritable Male Syndrome

Some men experience sexual, emotional, and physical changes as their hormones fluctuate. “The two hormones most closely associated with the condition are testosterone and progesterone,” says Naheed A. Ali, M.D., Ph.D.

That’s right: progesterone isn’t just a female hormone. In fact, men’s adrenal glands and testes require the hormone to produce testosterone.

According to Ali, some of the most common symptoms of IMS are:

  • Fatigue
  • Confusion or mental fogginess
  • Depression
  • Anger
  • Low self-esteem
  • Low libido
  • Anxiety
  • Hypersensitivity


What Age Does Irritable Male Syndrome Start?

Most men experience a decrease in testosterone as they enter their mid-thirties. Testosterone levels begin to drop by around 1 percent per year around the age of 35.

But chronic illness, injury, alcohol misuse, medications, genetics, and other factors can cause T levels to drop earlier, or faster. Nearly 40% of men aged 45 and older experience a drop in testosterone (2) that is considered clinical hypogonadism (having a total testosterone of less than 300 ng/dL plus symptoms of low T), which can result in the symptoms associated with IMS.

If low T is behind your mood shifts, we can help. Hone’s at-home testosterone assessment today is a fast, simple way to find out if you have low T.

IMS Symptoms

  • Symptoms of IMS are related to low T. Testosterone levels begin to drop by around 1 percent per year around the age of 35.
  • Chronic illness, injury, alcohol misuse, medications, genetics, and other factors can cause T levels to drop earlier, or faster.
  • Nearly 40% of men aged 45 and older experience a drop in testosterone

How to Prevent and Treat Irritable Male Syndrome

According to Ali, the symptoms associated with IMS can be addressed with medication or lifestyle changes.

If you’re experiencing symptoms associated with IMS, speak to your doctor. He or she can determine the cause for your symptoms, such as a physical condition or hormone imbalance,” says Ali.

Depending on what he or she finds, here’s what your doctor might suggest.

Testosterone replacement therapy (TRT) or Hormone Replacement Therapy (HRT)

One of the most common treatment options for addressing IMS symptoms is testosterone replacement therapy (TRT). If you are prescribed TRT, you’ll be given testosterone, most commonly testosterone cypionate, to replace what your body lacks.

TRT’s benefits include boosted mood, energy levels, sense of well-being, sexual function, lean body mass, muscle strength, and more (3).

Another common treatment for IMS symptoms is a medication called Clomid, which tricks your brain and body into increasing its natural production of testosterone, but that doesn’t impact fertility (which TRT can).

Like any medication or clinical treatment, TRT carries some risks, from hair loss to enlarged prostate and blood clots. But these risks can be mitigated by following your blood levels and taking the medication as prescribed under the careful direction of a physician.


Men who exercise regularly have higher levels of testosterone (4). Resistance training in particular (i.e. lifting weights) has been shown to be one of the best forms of exercise to boost the hormone (5), so hitting the gym may help with symptoms of irritable male syndrome.


Both undereating and overeating can disrupt testosterone levels (6). Eating a balanced diet with adequate amounts of protein, carbs, and fat may help maintain healthy testosterone levels (7).


Inadequate sleep (less than five hours) has been associated with a decrease in testosterone levels (8). A healthier amount of sleep (anywhere from 7-10 hours) can significantly boost testosterone levels (9).

Stress management

Long-term stress can impact hormones. It boosts cortisol (the stress hormone), which in turn drastically lowers testosterone. Mindfulness, meditation, and other forms of relaxation can go a long way in helping to minimize stress, but in some cases, antidepressants or other medications may be beneficial.

The Bottom Line

While IMS isn’t a defined clinical disorder, the symptoms associated with it—including moodiness, fatigue, depression, anxiety— are real and should be taken seriously. If you are struggling with the mental or physical symptoms linked with IMS, it’s worth scheduling some time to sit down with a medical professional and consider your treatment options.