Hot Flashes and Night Sweats
What causes it: Hot flashes (also called hot flushes) are a sudden feeling of intense heat, often with sweating and flushing of the skin. In men with prostate cancer, hot flashes are usually caused by hormone therapy. About 70–80% of men on ADT (especially with LHRH agonist injections like leuprolide) experience hot flashes. When testosterone levels drop, it throws off the body’s temperature regulation. The mechanism is similar to what women experience in menopause – the lack of sex hormones tricks your brain’s thermostat (the hypothalamus) into thinking you’re overheated, triggering a burst of sweating and blood vessel dilation to cool you down. Hot flashes can also occur after surgical castration. They might start within weeks of beginning hormone therapy. Each episode can last from a few seconds to several minutes or longer. They often come unexpectedly, but sometimes triggers like stress, hot drinks, alcohol, or a warm room can set them off. At night, these hormone-induced temperature swings can cause drenching night sweats.
How it affects daily life: Hot flashes can range from a mild warm feeling to drenching sweat that soaks your shirt. You might feel your face, neck, and chest get very hot and red. Some men describe a flash as a wave of heat that leaves them feeling chilled or exhausted afterward. During a severe hot flash, you may need to stop what you’re doing, loosen clothing, or find a source of cool air. Night sweats can disrupt your sleep, waking you up multiple times a night and leaving your sheets damp. This lack of sleep can lead to daytime fatigue and irritability. In public or at work, a sudden sweat attack might be uncomfortable or embarrassing. You might always want to dress in layers so you can remove a layer when a flash hits. Emotionally, frequent hot flashes can be distressing because they are a visible reminder of the cancer treatment. However, some men find that hot flashes become less frequent or less intense over time, as the body adjusts. Others continue to have them for as long as they are on hormone therapy.
Ways to manage or reduce it: There are both lifestyle approaches and medical treatments to manage hot flashes. On the lifestyle side, identify and avoid triggers that make your hot flashes worse – common triggers include stress, spicy foods, hot beverages, caffeine, alcohol, and warm environments. Keeping cool can help: dress in lightweight, breathable clothes and use layers; keep a fan or cold water spray handy; at night, use light bedding and consider cooling pillows or a fan by your bed. When a flash starts, slow deep breathing can sometimes lessen the intensity. If hot flashes are frequent and bothersome, talk to your doctor about medications that can help.
Certain drugs originally for other uses have been found to reduce hot flashes. One option is a low-dose female hormone (medroxyprogesterone, a progesterone, or even a small dose of estrogen patch in some cases) which can cut down hot flash frequency. Another option are certain antidepressants like venlafaxine or paroxetine; these can modestly reduce hot flashes for some men. There’s also gabapentin (a nerve pain medication) which has been used to ease hot flashes. These medicines might not eliminate flashes completely but can make them more tolerable. Always discuss the benefits and side effects with your doctor (for example, some antidepressants might not be suitable if you have certain health issues).
Non-medical therapies have mixed evidence but might be worth trying: some men report acupuncture or hypnotherapy helped their hot flashes, and a form of talk therapy known as cognitive behavioral therapy (CBT) has shown promise for managing the stress related to flashes. Herbal supplements (like sage, soy, or black cohosh) are sometimes tried, but there’s no strong evidence they work, and they can have risks, so always check with your doctor before using supplements. If you experience hot flashes, know that you’re not alone – it’s a very common side effect of hormone treatment. With some trial and error, you can find a combination of strategies (cooling techniques, trigger avoidance, and possibly medication) to help keep them under control.