Do Men Get Hot Flashes?

Hot flashes are uncomfortable.  They are caused by a sudden relaxing of blood vessels in your body, resulting in warmth over the upper body and face.[13]  The skin may also become red, and sweating may occur.  Hot flashes are most commonly associated with perimenopause and menopause in women, but they can occur in men as well.[11] 

While rare, hot flashes in men can be disruptive to daily life and cause significant discomfort, so it's important to recognize the symptoms and understand why they occur and how to treat them.

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Understanding Hot Flashes

Hot flashes are generally brief, lasting up to 5 minutes.  Symptoms include [13]:

• Sudden warmth spreading through the upper body, neck, and face
• Flushing, red, blotchy skin
• Rapid heartbeat or palpitations
• Sweating
• Chills
• Anxiety

The symptoms of hot flashes can vary from mild annoyance to severe disruption of sleep or daily activities.  

In women, hot flashes are usually associated with sudden decreases in estrogen during perimenopause or menopause.[19]  Hot flashes are vasomotor symptoms associated with menopause that are not fully understood.  Estrogen, norepinephrine, and serotonin are all believed to play a role in hot flashes.[19]  During a hot flash, peripheral temperature may increase 10-15 degrees Celsius, and blood pressure and heart rate may also increase.[19]

Do Men Get Hot Flashes?

Hot flashes may also occur in men but are often overlooked because they are less common.[15]  They are more common in men who have been treated with anti-androgen medications (testosterone blockers), such as those used to treat prostate cancer.[11]  Hot flashes may also occur in men who have low testosterone.

The incidence of low testosterone in men increases with age.  Around 40% of men over age 45 will have low testosterone.[23]  In people who have other conditions that increase the risk of low testosterone, the prevalence may increase as high as 80%.[1]

Causes of Hot Flashes in Men

In men, testosterone decreases naturally with age.  Many factors can cause low testosterone in men.  Some of these factors include[33,7]:

• Obesity
• Poor sleep
• Nutritional deficiency
• Stress
• Medications
• Low vitamin D levels
• Processed sugars
• Thyroid abnormalities
• Imbalanced gut microbiome[21]

Obesity is one of the diseases associated with low testosterone levels.  Moderate obesity may decrease testosterone by lowering sex hormone binding globulin due to the relative insulin resistance associated with the fatty tissues (adipose).  In people with more severe obesity, the hypothalamic-pituitary-testicular access (the feedback system that the body uses to regulate hormone levels) is suppressed.[10]  Low testosterone can further increase adipose levels, which makes this a self-perpetuating problem.

The most common cause of hot flashes in men is medication-related.  Androgen deprivation therapy used for treating prostate cancer blocks testosterone hormones and leads to hot flashes.   Androgen deprivation therapy is part of standard therapy for prostate cancer which is the most common cancer in men.[15]  Up to 80% of men on androgen deprivation therapy experience hot flashes.[11]

Symptoms and Impact on Quality of Life

Hot flashes in men have the same symptoms as hot flashes in women.  They most commonly occur at night and average about four minutes in length.  They are frequently followed by a cold sweat.[11]

Hot flashes occur because blood vessels in the skin relax and dilate.  The arms, legs, upper body, and face are most affected.[9] This typically causes sweating, flushing, and rapid heartbeat.[8]  Other symptoms associated with low testosterone include reduced sexual desire, erectile dysfunction, breast pain or swelling, infertility, and decreased bone density, potentially leading to fractures.[20]

One study in men receiving androgen deprivation therapy showed that men who didn’t experience hot flashes had significantly less cancer-related distress than men who experienced hot flashes.[32]  

Diagnosis and Evaluation

Hot flashes are generally diagnosed based on history and review of the symptoms.  Determining the cause of the hot flashes can help guide treatment options.  For men on androgen deprivation therapy for the treatment of prostate cancer, the cause of hot flashes is readily apparent.

For men who are not on androgen deprivation therapy, additional questions may be necessary to determine the source of the symptoms.  A detailed history should include information regarding all medications and supplements you may be taking.  It should also include dietary information and questions about sleep and sleep quality, including snoring and stress levels.[33,7]

If low testosterone is suspected, your healthcare provider may recommend testing your testosterone levels.[6,27] Several testing options are available for measuring testosterone levels.

• Blood testing for testosterone should be done in the morning because that is when levels are the highest. 
• Saliva testing for testosterone can help determine the amount of testosterone available in your body for immediate use
• Urine testing can show how the enzymes that affect testosterone levels are working and how it is broken down

In some cases, additional testing may be recommended to determine the reason for the low testosterone levels.

Treatment and Management

If low testosterone is the source of symptoms, then hormone treatment therapy may be reasonable for the treatment of low testosterone.  However, in the case of prostate cancer, androgen deprivation therapy is used to treat the cancer, so replacing testosterone would be counterproductive.  

For men who cannot take testosterone replacement therapies, other medications may be an option.

Estrogen and progesterone therapies have been used to treat hot flashes in men who are on androgen deprivation therapy.[22,26]  Other medications include antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs), venlafaxine, clonidine, and gabapentin.[22,26]

Complementary and alternative therapies, such as acupuncture and over-the-counter supplements, have had mixed results in efficacy.[16,30]  Lifestyle modifications such as yoga, exercise, and relaxation techniques may be beneficial, although the data is mixed.[22]  Other coping strategies include wearing layers, wearing neutral fabrics, and cooling techniques such as fans, cooling pads, and sipping cold fluids.[12]

Preventative Measures

For men who are starting androgen deprivation therapy, starting medications to help prevent hot flashes may be beneficial.  One study showed that a progesterone called megestrol acetate may benefit this subset of patients.[17]

Regular medical checkups are important to overall health and may help catch problems early.  It is important to discuss routine recommended screening tests for various conditions.[14]  There is currently no recommendation for checking testosterone in men who do not have symptoms of low testosterone.[24]

Other preventative measures to prevent hot flashes in men include preventing low testosterone through lifestyle modifications.  When possible, avoid medications known to lower testosterone levels.  Maintaining a healthy diet and exercising regularly can help prevent low testosterone and maintain a healthy weight.[18]  It is also essential to stop smoking and avoid excessive use of alcohol or drugs.  

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Key Takeaways

• Hot flashes are underrecognized in men.
• Hot flashes in men are most common in men on certain medications to treat prostate cancer.
• Hot flashes can be diagnosed by history.
• Treatments include testosterone replacement therapy in men who don’t have prostate cancer and other medication options.
• Lifestyle modifications may help prevent or treat symptoms.
• Routine medical care is important for preventing health conditions.

If you are experiencing symptoms of low testosterone, you should seek care from a medical provider.