Hot flashes in men

With all of the challenging changes women have to go through at different points in their lives - from their first period to pregnancy and finally menopause - it can easily appear as though their male counterparts have it easy.

But did you know that men can also experience several far-from-ideal physical changes as they age?

These changes are often referred to as 'male menopause' (or 'andropause'), likening it to the final years of the female reproductive cycle. The comparison may be inaccurate however, as the medical profession is divided over whether or not these changes are an inevitable part of the aging process, or instead, a product of lifestyle and medical conditions.  Some experts would take it a step further and discount the very existence of male menopause as a distinct condition.  

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This may be a valid point, since if male menopause was as inescapable as death, taxes, and yes, female menopause, then every man would experience it at some point. In fact, only 2.1% of men will develop male menopause.  For those 2.1% however, the condition and related symptoms are quite real.

Although the causes of hot flashes in men and women are different, the sensation is one and the same. A hot flash can spring up on a person spur of the moment, without regard for circumstances or surroundings. In those seemingly eternal, sizzling seconds, the intense heat gushing through your face, neck, and upper body will make you feel like you're about to melt away, right before you break out into a cold, clammy sweat.

These unfortunate episodes can last anywhere between a few minutes to an hour, and can occur up to ten times per day. Hot flashes are often accompanied by other symptoms such as skin redness, heart palpitations, nausea, and anxiety.

Read on to find out how to remain cool, calm, and collected, and keep those bothersome flashes at bay.

What causes hot flashes in men?

Contrary to common belief, hot flashes do not occur due to the natural drop in testosterone levels that accompanies aging.  Actually, the drop in testosterone is insignificant when compared to the related drop in estrogen which occurs in menopausal females.

Testosterone levels generally decrease at a rate of about 1% per year after age 30, but they usually remain high enough to avoid significant long-term, adverse effects.                                                                                                     

There is a condition known as hypogonadism however, that results in little or no sex hormone production in the testicles. While this condition can be present from birth, it can also be acquired later in life. Underlying health conditions such as obesity or type 2 diabetes are known risk factors for developing hypogonadism.

Men with a history of prostate cancer treated with androgen deprivation therapy (testosterone blocking therapy) are likely to have a functional testosterone deficiency severe enough to trigger hot flashes and other related symptoms. Symptoms of severe deficiency may include loss of libido, erectile dysfunction, irritability, loss of muscle mass, weakness, and lethargy.

As cancer cells in the prostate are stimulated by testosterone, treatment for prostate cancer focuses on reducing its levels or blocking its effects on tissues.  When levels become very low, hot flashes and the aforementioned symptoms may ensue.  

The biological mechanism of a hot flash is complex. Low levels of testosterone trigger a reaction in a part of the brain responsible for controlling the body's core temperature.  This causes the brain to mistakenly believe the body is overheating. Blood vessels in the skin dilate in order to convect the imaginary excess heat, and the end result is a furious hot flash.  Lastly, to counteract the perceived rising temperature, the body responds to the feeling of intense heat by breaking out in a cold, uncomfortable sweat.          

Hot flashes afflict a staggering 70%-80% of men who have undergone androgen deprivation therapy. So how can you avoid this loathsome symptom, or at least make it less severe?

How can I effectively treat my hot flashes?

Thankfully, hot flashes in men are treatable, and there are a number of routes you can take to gain some relief. The course of treatment you start on all depends on the severity of your symptoms and your medical history. Here's a quick rundown of the types of treatments available and how each one works:

1. Testosterone replacement therapy: A simple blood test will identify whether or not you have a testosterone deficiency. Once the diagnosis is confirmed, undergoing testosterone replacement therapy in the form of tablets, patches, gels, implants, or injections, can correct your deficiency and make your hot flashes disappear in a matter of weeks.
2. Female hormone or anti-androgen therapy: Of course, for men with a history of prostate cancer, testosterone replacement therapy is not a viable option, in which case, taking female hormones, such as estrogen and progesterone, or ones that inhibit testosterone, such as cyproterone, can work exceptionally well in taking the edge off hot flash episodes.                                                                    
3. Antidepressants: For those who want to experience relief without having to worry about the side-effects accompanied by hormone therapy, some antidepressants are an option with proven benefit in countering hot flashes.

Useful tips to prevent hot flashes in men

Often, low levels of male hormones are not the only offender when it comes to hot flashes. Underlying health conditions like diabetes, heart disease, high blood pressure, or obesity, paired with an unhealthy lifestyle can cause or exacerbate your symptoms, which is as good a reason as any to give any bad habits the boot.

1. Diet: A healthy, well-balanced diet can help prevent or ease the frequency and severity of hot flashes; this means eating modest, regular meals that are full of fruit, vegetables, healthy fats, and whole grains, while dropping fatty and processed foods as well as common triggers such as caffeine, and alcohol.  
2. Sleep regimen: If your night sweats have you dreading bedtime, good sleep hygiene could have you well on your way to sleeping like a baby. Keeping your bedroom dark and cool (try popping open a window or turning on a fan) can also work wonders.  Avoid exposure to artificial light from phones, laptops, and TV screens at least an hour before bedtime. Instead, try doing something relaxing like taking a cool shower, reading a book, or meditating.                                                                                
3. Fitness: Improving your overall fitness can help reduce discomfort during a hot flash. Small steps, such as choosing to take the stairs rather than the elevator, to more committed efforts such as a formal fitness program, will help you manage your hot flash better. Just remember to pace yourself and not overstretch yourself (figuratively and literally) as injuries could leave you worse off than when you began.   
4. Stress and anxiety levels: Keeping calm may be the key to preventing the onset of a hot flash. Focus on doing activities throughout the day that keep your stress and anxiety levels to a minimum. Deep breathing, engaging in a hobby, nature walks, listening to music, and meditation are some great options.
5. Loose, breathable clothing: Having layers of clothes that you can easily remove is your concealed weapon when a hot flash strikes unexpectedly. Choosing natural fabrics like silk or cotton over synthetic ones will also help your skin breathe and remain cool.

Hot flashes in men essentially boil down to one key thing: low testosterone. While the majority of men won't have to worry about hormone deficiencies, for those that do, there are thankfully, several treatment options are available that can be tailored to suit your individual needs. Take a proactive stance on your health and wellbeing to help your body stave off future hot flash episodes.

References              

1. Body Logic MD 2020, Hot flashes in men, viewed 11^th August 2020, https://www.bodylogicmd.com/for-men/hot-flashes/#:~:text=The%20Cause%3A%20Andropause%20Hot%20Flashes,deprivation%20therapy%20for%20prostate%20cancer.
2. Cancer Research UK 2018, Hot flashes and sweats in men, viewed 11^th August 2020, https://www.cancerresearchuk.org/about-cancer/coping/physically/sex-hormone-symptoms/men-coping-with-hormone-symptoms/hot-flushes-and-sweats
3. NHS 2019, The ‘male menopause’, viewed 11^th August 2020, https://www.nhs.uk/conditions/male-menopause/

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