Cisgender men are not born with a uterus and thus cannot have periods. Therefore, any bleeding a man notices from or around his genitals is abnormal and should be investigated. Periods are a part of the monthly uterine cycle for premenopausal, cisgender women. If an ovulated egg is not fertilized and not implanted in the uterine wall during a woman’s cycle, estrogen and progesterone (female sex hormones) decline, which triggers changes in the blood supply to the inner lining of the uterus, causing it to shed.
Decreasing estrogen and progesterone levels also cause the symptoms associated with premenstrual syndrome. Because men’s testosterone levels fluctuate throughout the day and decrease with age, it begs the question, “Can men have periods?”
No, they cannot have periods, but they can have a premenstrual-type syndrome that is dubbed irritable male syndrome (IMS) or male PMS. IMS and male menopause (andropause) may be the same syndrome, and like andropause, IMS is not recognized as a medical diagnosis, but it is worth considering whether dips in testosterone levels can cause depression, fatigue, and mood swings.
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Normal testosterone levels range from about 300 to 1,000 nanograms per deciliter of blood. Testosterone levels fluctuate throughout the day, peaking around 8 a.m. and gradually declining throughout the day. Levels reach a nadir around 8 p.m. and gradually climb through the night. The difference between the highest and lowest testosterone levels for the day is greater for men under the age of 40 than for men over the age of 70.
The most consistent hormonal change in men is a decline in testosterone with aging. Testosterone levels generally begin to decline by about 1% each year, starting around the age of 40. However, the decline is not at the same rate for all men. Only about 10% to 25% of men have a measurably low testosterone level, and there is no threshold testosterone level that is associated with symptoms. The prevalence of low testosterone in men in the United States is reported to be approximately 20% in men over age 60, 30% in men over age 70, and 50% in men older than age 80. About 25% of men over age 75 have testosterone levels equivalent to the upper quartiles in young men.
High testosterone levels, a condition known as hypergonadism, are more common in men using anabolic-androgenic steroids and testosterone replacement therapy. High testosterone levels can cause mood changes, insomnia, and headaches, along with infertility, acne, blood clots, sleep apnea, high blood pressure, and liver disease. Resistance training increases testosterone, albeit temporarily.
Obesity causes testosterone levels to plummet due to insulin resistance associated decreases in sex hormone-binding globulin. In a 2007 study of 1,667 men aged 40 and older, for each one-point increase in body mass index, the men had a 2% decrease in testosterone.
Testosterone levels fluctuate in response to internal and external factors, which make it difficult to correlate changes in testosterone levels with physiologic or psychologic symptoms.
Symptoms of low testosterone levels are like those experienced by cisgender women when estrogen and progesterone levels decline. These symptoms may include:
These symptoms could be caused by dips and changes in testosterone throughout the day or they may be caused by longer-term hormone changes. If these symptoms are severe or persistent, they may indicate a medical problem, such as low testosterone. Low testosterone levels, especially with aging, are associated with low libido and fertility issues, along with other symptoms.
The most likely cause of IMS is fluctuations in testosterone and other hormones. However, there is not much evidence to support the supposition that IMS has a medical basis in humans, though animal studies are supportive.
Jed Diamond, author of The Irritable Male Syndrome: Understanding and Managing the 4 Key Causes of Depression and Aggression, defines irritable male syndrome as “A state of hypersensitivity, anxiety, frustration and anger that occurs in males and is associated with biochemical changes, hormonal fluctuations, stress and loss of male identity.”
External factors can put expectations on men to behave in certain ways that can affect their mental health, can cause stress, and loss of male identity, some of the factors associated with IMS. Read more about toxic masculinity and the cultural pressure placed on men and boys to act in certain ways.
Many factors can affect testosterone levels and could consequently contribute to IMS symptoms. These include:
IMS is not a formal medical diagnosis, and therefore there is no recognized treatment for these symptoms. It is best to discuss your symptoms with a doctor to determine if low testosterone levels are a potential cause.
After speaking to a licensed healthcare professional, such as the medical providers at Invigor Medical, men may be advised to have lab tests for testosterone and other hormone levels.
After completing your history forms and evaluating your blood panel results, a licensed Invigor Medical health care provider in your state will review your lab results and discuss treatment options with you. Men with symptoms and documented low testosterone levels may be candidates for testosterone replacement therapy.
While scientists continue to study the complex interactions of hormones in both men and women, there are lifestyle changes anyone can make that can support overall health. Poor health can adversely affect hormone levels and cause many of the symptoms attributed to IMS.
Testosterone replacement therapy, like all medical treatments, has potential side effects. You and your doctor can work together to find the best treatment option with the fewest side effects. Consider making some or all of the following healthy lifestyle changes to help manage symptoms associated with IMS.
Occasional feelings of hypersensitivity, anxiety, frustration, and anger are normal and frequently situational, meaning they are reactions to something external. However, when symptoms are persistent, when stress becomes unmanageable or depressive symptoms develop, it is time to seek help. Reach out to your partner, family, or friends for support and seek professional help. Research has progressed over the last few decades, and much more is known about aging processes and how psychology affects physical health. As a result, there is a wider range of treatment options available than ever before.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.