On the myth of male menopause

Dear Dr. Roach: Is there such a thing as male menopause, with the associated hot flashes?

My problem is hot flashes. I am a 93-year-old male in fairly good health; I am active, but not enough, though I maintain a year-round garden.

I don’t seem to be able to get a straight answer from my primary, a caring female. What are your thoughts, please? — E.J.

The term “male menopause” is sometimes used to describe the symptoms that may happen to men in middle and older age as testosterone levels decrease. “Menopause” is incorrect: It means literally the cessation of monthly menstruation, and the alternative “andropause” suggests that one stops being a man when hormone levels decrease, so I will just refer to these symptoms as due to low testosterone.

Symptoms of low testosterone include less energy and vigor; decreased sexual interest; higher risk of depression; and less body hair and muscle mass. The faster and further the testosterone level drops, the more prominent the symptoms are likely to be.

Hot flashes generally happen only when the testosterone drop is sudden and extreme, such as in surgery (removal of both testicles) or with hormonal treatment of prostate cancer (Lupron is the most common).

Your doctor already may have checked your testosterone level; if not, you probably should talk to her about it. If your testosterone is very low, treatment may solve your hot flashes.

Hot flashes in men are not common and deserve a more thorough evaluation than it seems you have had. That is not because your physician is a female: Evaluation of symptoms of low testosterone often requires consultation with an expert.