Hot flashes and related vasomotor symptoms (VMS) are common side effects in men receiving androgen deprivation therapy (ADT) for prostate cancer. Although these symptoms are widely linked to menopause in women, they also affect many men undergoing hormonal therapy.
Prostate cancer is the fourth most common cancer worldwide. With modern treatments helping men live longer, managing therapy side effects like hot flashes has become increasingly important. Reports suggest that 34% to 80% of men on ADT experience VMS, and up to 27% find it the most distressing side effect.
Some studies have tested both oral and skin patch (transdermal) forms of estrogen to reduce hot flashes. Results showed that small increases in blood estrogen levels could help control symptoms. However, transdermal estrogen was linked to a much higher rate of breast tissue enlargement (gynecomastia) compared with standard ADT therapy, and overall sexual side effects were similar. Because most studies were small, the safety of estrogen use in men is still uncertain.
Other Medication Options
Non-hormonal drugs such as selective serotonin reuptake inhibitors (SSRIs) like escitalopram and paroxetine, and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, have been used successfully to treat hot flashes in women and may also benefit men receiving ADT. Gabapentin and similar medications may help by calming overactive temperature-control mechanisms in the brain.
Newer drugs, including fezolinetant and elinzanetant, are currently being tested in breast cancer patients for hot flash control. Although not yet studied in men with low testosterone, some reports suggest that fezolinetant may help in difficult cases.
Non-Drug Therapies: Acupuncture and CBT
Acupuncture has shown some benefit for hot flashes in menopausal women, though its effects do not consistently exceed those of placebo treatments. Some studies in men with prostate cancer have tested acupuncture, but most lacked control groups, making it difficult to confirm benefits. More rigorous research is needed in this area.
Cognitive behavioral therapy (CBT) has gained attention for reducing how much hot flashes disrupt daily life. Rather than directly lowering the number of episodes, CBT helps patients manage anxiety and discomfort. In one clinical trial involving 68 men receiving ADT, those in the CBT group saw a 40% drop in hot flashes and night sweats after six weeks, compared to 12% in the untreated group. Participants also reported better mental well-being.
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