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DEAR DR. ROACH: Is there such a thing as irritable male syndrome, similar to PMS in women? If it is real, does it cycle yearly or monthly? My husband is negative and blames others for things at some times more than others. Also, is there a cure or ways to manage it? – Anon.

ANSWER: The term “irritable male syndrome” was coined in 2002 in a review of animal behavior, among male animals with a strictly seasonal breeding pattern. After mating season in these animals, testosterone levels drop markedly, and the animals exhibited symptoms of nervousness and irrationality.

In humans, low testosterone has a set of common symptoms, including low libido and low overall energy. Loss of body hair and decreased muscle mass happen after prolonged time without testosterone. Psychiatric symptoms, such as depressed mood and anxiety, are less strongly tied to low testosterone levels.

Most experts do not believe that the findings in animals are analogous to what healthy men experience. While it is possible that your husband has low testosterone, and that this level may be causing a degree of irritability, it is much more likely that his behavior has a different underlying cause than loss of testosterone.

By contrast, premenstrual syndrome, where there are dramatic shifts in hormones, is clearly associated with mood swings, irritability, anxiety and depression. As the hormone changes are cyclical, so the symptoms are cyclical as well. No such cycles exist in men for testosterone.

I have certainly known many irritable males, however, and anybody can be more irritable one day compared with another. I would note that, especially in men, irritability and being easily angered can be a sign of depression, among many other possibilities.

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DEAR DR. ROACH: I am a healthy 73-year-old man who has always had a large prostate. Thirty years ago, my urologist described it more like the size of an orange rather than a walnut. Despite its size, it has never given me any problems – no UTIs, sudden urination, poor stream, waking me in the middle of the night, etc. Despite not having symptoms, about 10 years ago I was prescribed finasteride at a dose of 5 milligrams, and Rapaflo to “try to keep it in check.” In 2018 I had an ultrasound done of my prostate, and it was measured at 185 grams. It was measured again recently and is now 232 grams. My PSA is always in the 3.2-3.5 range.

At what point does a prostate get too large? Should I be concerned even without having any symptoms? To his credit, my urologist discussed my surgical options, along with the related side effects. I am reluctant to do anything if it’s not necessary. – J.J.

ANSWER: The normal prostate gland is about 20 grams, and only 4% of men will develop a prostate over 100 grams. Yours is well past that, though far short of the world record of 2,410 grams.

It is striking that the size of the prostate does not well correlate with a man’s symptoms. Since you have no symptoms and a low PSA level (especially considering the size), there is no indication to do anything surgically. The risk of surgical complications is higher in men with very enlarged prostate glands, so I would certainly be cautious about considering surgery.

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DEAR DR. ROACH: I read your recent column on vaginal estrogen. Based on plants such as soy, bioidentical hormones are a safe solution for older people that provide sexual rejuvenation. You should spread the word! – P.F.

ANSWER: I appreciate your passion, but there are several problems with your statement.

First, the bioidentical female hormone in humans is estradiol, which is available only by a prescription. It remains my choice for women who need hormone replacement, such as women with severe symptoms of menopause (replacement is given by mouth or patch), or for women with atrophic vaginitis (given vaginally, by cream, tablets or ring). It is certainly the most natural option.

Second, phytoestrogens (the soy-based hormones, such as isoflavones and lignans) have chemical structures similar to estradiol, but absolutely are not bioidentical. They have both estrogen and anti-estrogen properties. They may slightly reduce breast cancer risk, probably have no effect on endometrial cancer risk and probably do not increase clotting risk. However, for women with a history of breast cancer, many oncologists recommend against soy protein due to its estrogen activity. Some hematologists warn against these in people with history of abnormal blood clots.

The effect of phytoestrogens on sexual function has been studied, and a 2018 review showed that soy “had no promising effect” on sexual function. Of course, some women will have better effects than others.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]

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