Reason for hot flashes not male ‘menopause’

Q: Is there such a thing as male menopause? I am a 93-year-old male in fairly good health. I've beaten prostate cancer and had a couple of hernia repairs, the last of which included nerve damage that caused the atrophying loss of a testicle.

I have experienced an increased frequency of heat over my body the past five-plus years. I don't seem to be able to get a straight answer from my female primary-care doctor.

A: The term "male menopause" is sometimes used to describe the symptoms that might happen to men in middle- and older age as testosterone levels decrease. But calling it "menopause" is incorrect: That term literally means the cessation of monthly menstruation, and the alternative "andropause" suggests that one stops being a man when hormone levels decrease.

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 more that testosterone levels drop, the more prominent the symptoms are likely to be.

Hot flashes generally happen only when the testosterone drop is sudden and extreme, such as from surgical 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 the loss of a testicle raises my suspicion.

Your doctor already might have checked your testosterone level; if not, you should talk to her about it. If your testosterone is very low, treatment could solve your hot flashes, provided that your prostate cancer expert feels it is safe to do so. If you can't get testosterone, there are other treatments available, such as venlafaxine or gabapentin.

If your issue isn't testosterone, then I would be concerned about other reasons for the hot flashes, such as periodic release of chemicals from tumors that can raise blood pressure (pheochromocytoma) or dilate blood vessels (carcinoid).

— Dr. Keith Roach Readers may email Dr. Keith Roach questions at toyourgoodhealth@med.cornell.edu.