You’re sitting in a meeting and suddenly a participant leans back, exhales and starts doing the fanning thing. Perspiration may soon follow, as heat radiates in waves from the face to the neck and chest. Call it a hot flash, hot flush or thermoregulatory dysfunction. We’ve all seen it happen.
But, hey, what if it’s a guy? Men do indeed get hot flashes and, just as in women, the roots are usually hormonal. The most common situation involves men being treated for prostate cancer. According to a 2003 article by Dr. A.C. Spetz and colleagues published in the Journal of Supportive Oncology, “hot flashes are as common in men who have been castrated due to prostate cancer as hot flashes are in women after menopause.” Those taking drugs to lower their testosterone levels are also subject to these annoying flushes.
It turns out it’s not just the absolute level of testosterone, but the sudden drop that causes the problem. Men with congenital conditions like Kleinfelter’s Syndrome don’t generally experience hot flashes, even though they may have lifelong low testosterone levels. While low testosterone is the major culprit, other causes include an overactive thyroid gland, hypoglycemia (low blood sugar) and hypotension (low blood pressure). Reactions to certain drugs and infections like HIV and tuberculosis are also possible causes.
Other conditions that doctors need to rule out, especially in otherwise healthy patients, include tumours of the pituitary gland or the hypothalamus, which is the body’s temperature regulator. On a lighter note, perhaps the patient has just been eating too much ginger beef. Some people get hot flashes and other symptoms after eating food prepared with monosodium glutamate (MSG) or other ingredients, in what’s called the Chinese Restaurant Syndrome.
According to the Harvard Men’s Health Watch, “hot flashes feel the same to men and women.” They are most common at night, and last an average of four minutes. Some people experience other symptoms including anxiety and irritability.
As for treating hot flashes in men, decreased testosterone levels can be treated with injections, gels and patches. But in many prostate cancer patients, that’s a no-no because it can stimulate cancer cell growth. Researchers have tried treating men with estradiol, a female sex hormone, and one study showed “83 per cent of men reported relief” -- but not without side-effects. According to the Harvard publication, “more than 40 per cent experienced breast swelling or tenderness, and the trial was too brief to exclude the possibility of cardiovascular side-effects.”
Other treatments that have helped men with hot flashes include antidepressants such as paroxetin (Paxil) and venlafaxine (Effexor), as well as the anti-seizure and migraine medicine gabapentin (Neurontin).
Dr. Patrick Massey reported good results from giving men who were having hot flashes “a combination of B vitamins and vitamin C intravenously every week.” He notes that vitamins taken orally would probably not have the same effect. Massey notes the problem can be fairly serious in men and that “hot flashes and perspiration for one of the participants were so severe that he had to change his clothes several times a day.”
In a commentary in the Journal of Supportive Oncology, J.L. Hudak and colleagues note hot flashes in men may cause them to discontinue hormone therapy, "thereby potentially negatively affecting their prostate cancer outcomes.” They go on to suggest a “domino effect” with hot flashes interfering with a man’s daily activities and sleep.
“The resulting fatigue from sleep disturbance may exacerbate the fatigue caused by the hormone therapy itself and potentially compromise the patient’s ability to cope with his disease and treatment.”
A safe, non-prescription treatment for this condition would be great, but the search hasn’t been too fruitful so far. A study of herbal remedies, notably black cohosh, was published recently in the Annals of Internal Medicine. It looked at vasomotor symptoms including hot flashes and night sweats in 351 Washington state women. All were in or past menopause. The researchers concluded that “black cohosh, used in isolation, or as part of a multibotanical shows little potential as an important therapy for vasomotor symptoms.”
As for dealing with hot flashes, the advice for men closely parallels that for women. Drink a glass of cold water when the symptoms start. Use light bed coverings that can be kicked off easily. Avoid caffeine and alcohol, which can make things worse. Harvard experts also advise avoiding red wine, aged cheeses and chocolate, all of which “contain a chemical that can trigger hot flashes by affecting the brain’s temperature control centre.”
Probably the best advice of all for men is to have some sympathy for women, 85 per cent of whom will eventually have to put up with this symptom.
For those whose hot flashes are due to a time-limited course of testosterone suppression, the odds are good the episodes will go away. Some women, on the other hand, have to put up with 10 or 15 years of suddenly grabbing a file folder to use as a fan.
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