Hot flashes – can they occur in men?

Hear the words “hot flashes” and everyone will automatically associate them with a woman going through menopause.  However, hot flashes are not exclusively experienced by women – men also report having hot flashes.  In fact, more than 25 million men annually in the U.S. seek treatment for this condition and worldwide, it affects more than 408 million men.

What are hot flashes?

A hot flash is a feeling of intense heat that isn’t triggered by your immediate surroundings.  They feel the same in both men and women – a sudden feeling of warmth or flushing most intense over the head and trunk, often accompanied by visible redness of the skin and sometimes profuse sweating.  Generally, they only last briefly with an average of about 4 minutes and once over, can leave a cold sweat behind. 

Hot flashes are different for everyone.  Some people have them only infrequently and are quite mild while others suffer more bothersome hot flashes that sometimes may occur up to 10 times a day.  Anxiety, heart palpitations, and irritability can also accompany hot flashes when they occur.

What causes hot flashes in men?

The primary trigger of hot flashes in both men and women is due to hormones.  About 70% of women get hot flashes at the time of menopause when estrogen levels plummet.  This sudden fluctuation in hormones as they age sets off a chain reaction of a hot flash to happen.

In men, the hormone testosterone is the culprit.  Men do not experience as much of a sharp decline in testosterone.   In fact, although testosterone levels do trickle down by about 1% a year after the age of 40, most men maintain levels within the normal range.  This decline in testosterone in men is considered to be normal and healthy.

The most likely reason some men will have hot flashes is a result of a prostate cancer treatment called androgen deprivation therapy (ADT).  This treatment works by restricting the production of testosterone so that it won’t stimulate further cancer cell growth.  ADT can also be used in some men as a temporary measure to boost the effect of radiation therapy.   The treatments of ADT usually rely on injections to reduce testosterone production or to block testosterone’s effects on tissues.

Between 70-80% of men receiving ADT will experience hot flashes.  The cause is due to low testosterone but it is unclear as to why reduced sex hormone activity produces the problem.  It is likely that the part of the brain called the hypothalamus, which is the thermal control center, is involved.  The nervous system sends out signals causing blood vessels in the skin to widen, producing flushing and warmth.  To counter the rise in skin temperature, the body rapidly converts a warm flush to a cold, clammy sweat. 

Other possible triggers of hot flashes in men can coincide with symptoms of erectile dysfunction, loss of libido, and mood swings. 

Treating and preventing hot flashes in men

If a man is on ADT for prostate cancer, they cannot take testosterone but they can use female hormones such as Estradiol for hot flashes.  A few studies have shown that when men tried female hormones, around 80-90% did report reductions in hot flashes but experienced side effects which included bloating, weight gain, and breast swelling or tenderness.

Other possible treatments for men to consider can be using antidepressants.  Selective serotonin reuptake inhibitors (SSRIs) such as Paxil have been effective along with another antidepressant, Effexor.  Most men tolerate them well however they could have increased blood pressure or sexual dysfunction. 

Other more natural means of reducing hot flashes can be to avoid alcohol, smoking, coffee, spicy food, warm room temperatures, and tight or heavy clothing.