Hot Flashes or Flashes in Men
Hot Flashes or Flashes in Men
Flushing or hot flushes are synonymous words for the episodes of sensation of increased warmth usually in the upper body and face. Technically hot flushes is the correct term, but hot flashes seems to be commonly used.
Hot flashing occurs with a reddening of the skin and often with sweating. The episodes may last anywhere from seconds to many minutes, but usually last only two or three minutes. Most of the time the episodes occur without cause, but in some men can be triggered by changes in position, ingestion of hot fluids or changes in outside temperature. Hot flashes occur in two-thirds of the men who receive drugs which inhibit the production of male hormone, and at least 50% of the men who have undergone removal of the testicles.
In many patients the incidence of hot flushes decrease over time, but unfortunately in some other patients the flushing continues unabated for years.
Hot Flash Treatment
One of the most common treatments historically for hot flashes is to use a female hormone, usually diethylstilbestrol or ‘Stilbestrol’. Given in low doses (even as low as 0.25 mg/day) this is at least 70% effective in treating hot flashes. Unfortunately, the female hormone causes breast swelling or tenderness in almost all patients. More importantly the use of stilbestrol may increase the risk of heart attack or stroke. Many of the reports do suggest at low doses these significant side effects do not occur and may be prevented possibly by the use of aspirin or other blood thinners. In patients who are at high risk for heart attack or stroke, the use of stilbestrol must be questioned, but it is probably the simplest and least expensive way of treating the problem.
If breast enlargement and tenderness is a concern, the patient can undergo radiation treatments for three days to the breast area prior to treatment, which usually helps significantly in preventing symptoms or changes.
Another drug called megestrol acetate (Megace) is almost as effective. Using 20 mg tablets twice a day, as many as 70% of men will have relief of their hot flashes. The megestrol acetate has a very simlar response rate to stilbestrol and was associated also with very few side effects. In the some woman using large doses of megestrol acetate retention of water was seen with edema of the legs. This has not been seen usually in the doses used in men being treated for hot flashes. Unfortunately, the drug is significantly more expensive and may cause weight gain from fluid retention.
These are used as patches or pills with minimal side effects. The dose is 0.1 mg daily and one must be careful for reactions of any sedatives are being used. In a recent study patients taking clonidine by pill or by patch, no patients had complete response and only 33% of the patients taking the pill and 40% of patients using the patch had a partial response.
ERGOTAMINE AND PHENOBARBITAL: Another drug combination that is occasionally used is ergotamine (Bellergal) and phenobarbital. These drugs are most commonly used in patients with migraine headaches. For hot flashes this combination has an overall success rate of only 5% complete response and 45% partial improvement.
Vitamin E is safe, inexpensive and easy to buy over the counter or at health food stores. Unfortunately, it probably doesn’t work and there are no scientific studies to support its use or why it might work.
As long as the reduction of male hormones remains the primary treatment for extensive prostate cancer, hot flashes will continue to be a problem. The treatments of choice at this point remain somewhat controversial, but we would probably start with megestrol acetate, 20 mg twice a day, and , if effective, continually lower the dose down slowly to the lowest effective dose.
If this is not effective, then the use of diethylstilbestrol starting at 1.0 mg per day and slowly changing the dosage up or down to find the lowest but effective dose. However, diethylstilbestrol is used with the understanding that breast tenderness and a possible increased rate of stroke or heart attack might result.