93-year-old man’s hot flashes likely due to testosterone drop
DEAR DR. ROACH: Is there such a thing as male menopause, with the associated hot flashes? My problem is hot flashes. I am a 93year-old male in fairly good health; I am active, but not enough, though I maintain a year-round garden. I’ve beaten prostate cancer with a cryogenic procedure at the turn of the century and had a couple of hernia repairs, the last of which included nerve damage causing the atrophying loss of a testicle.
I have experienced an increased frequency of heat over my body most any time of the day or night the past five plus years. Lately, it has not seemed as intense, though I sweat mildly each time it occurs. At times, it will hit with a blast, while sneaking up on me at others.
I don’t seem to be able to get a straight answer from my primary doctor, a caring female. What are your thoughts?
ANSWER: 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). The fact that you have had prostate cancer and had surgical loss of a testicle raise my suspicion.
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, provided that your prostate cancer expert feels it is safe to do so (most data suggest it is, but the data aren’t settled).
If you can’t get testosterone, there are other treatments available, such as venlafaxine or gabapentin.
If your issue isn’t testosterone, then I’d be concerned about alternate causes of hot flashes, such as periodic release of chemicals from tumors that can raise blood pressure (pheochromocytoma) or dilate blood vessels (carcinoid).
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.
DEAR DR. ROACH: I am taking medication for toenail fungus, and it is working. Is there any worry about being reinfected by bare footwear such as sandals or slippers? If so, can they be treated, or must they be thrown out?
ANSWER: The toenail fungus certainly can get into footwear and can be hard to kill. The safest thing is to throw them out and buy new. However, you can try putting anti-fungal powder in your footwear daily. There also are disinfecting devices using ultraviolet light, but it appears there are significant differences among brands.
DEAR DR. ROACH: What is your opinion on screening for ovarian cancer in a woman with a family history (in my case, a sister)?
One gynecologist stressed an annual ultrasound, while the other discouraged me from doing so. I am worried that if I wait until symptoms develop, the cancer might be pretty advanced.
ANSWER: I really understand why people with increased risk for ovarian cancer are interested in screening. Unfortunately, we still don't have any screening tests, such as an ultrasound or CA-125 blood test, that are good enough to recommend yet. I hope this changes soon. Promising work is progressing.
Consider genetic testing for a familial cancer syndrome, such as BRCA or Lynch syndrome.
People with one of these cancer syndromes are at high enough risk that screening may be of benefit, and there are ongoing studies to help identify the best strategy.
Speak to your gynecologist about a referral to a genetic counselor.
If you test negative for these genetic syndromes, you are at lower risk (but unfortunately, even low-risk women still may get ovarian cancer).
You certainly should be vigilant for even mild symptoms of ovarian cancer; these are nonspecific and may include abdominal discomfort, bloating or swelling.
Urinary urgency (a sense of needing to get to the bathroom right away) also should prompt a visit to your gynecologist, more so than in people without a family history.