Men's hot flashes: Andropause?

Originally Published: December 19, 2003
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Dear Alice,

This may sound weird, but I feel like I am having hot flashes. I start to feel very warm, even when the room is not. The feeling lasts about an hour, then goes away, and returns, sometimes several times a day. Can a guy in his twenties, or any guy for that matter, have them?

Dear Reader,

While most twenty-something men are fully comfortable getting hot and sweaty in the gym or elsewhere, experiencing the types of heat waves typically associated with fifty-something women can be upsetting for them. And so, it's understandable that you are concerned about this shift in your internal thermometer.

It is indeed possible for a guy in his twenties to experience hot flashes. A number of conditions cause hot flashes, including hyperthyroidism (an over-active thyroid), too low blood pressure, and hypoglycemia (low blood sugar). Also, men who have had their prostate removed can experience hot flashes, as a result of the decreased testosterone levels. In all of these cases, the conditions would have existed prior to your experiencing the hot flashes. If things have seemed normal up to this point, it is possible you are experiencing a male version of menopause, or andropause.

Whether or not andropause even exists is still a hotly debated topic among endocrinologists, psychologists, and andrologists (docs who specialize in men's health). What has been definitively confirmed is that the free active testosterone (FAT) level of a man at 18 is very different from that of a man at 80 years. Some hold that a change known as andropause exists, and — although it differs from menopause — it shares a number of symptoms. The following table clarifies some of the differences between menopause and andropause:

Menopause Andropause
Affects all women Affects only some men
Ability to reproduce ceases No change in reproductive ability
A sharp drop in estrogen levels that occurs sometime in a woman's forties or fifties A gradual decline in testosterone that can start as early as the late twenties or as late as age sixty

In spite of these physiological differences, the effects of decreased hormone levels affect men and women similarly. Both can bring on emotional changes, including depression, lethargy, increased irritability, memory problems, and the like. Additionally, both menopause and andropause often alter a person's sexual life. Both can lead to decreased sex drive and difficulty being aroused (marked by vaginal dryness in women and weaker erections in men).

Physical signs of low testosterone levels include decreased beard growth, increased fat, decreased muscle and bone mass, and breast enlargement or tenderness. If the hot flashes do not subside or you are experiencing any of the symptoms above, it is important to speak with a health care provider who can either diagnose the cause and suggest treatment options, or refer you to another kind of provider.  Students at Columbia can make an appointment by logging into Open Communicator or by calling 4-2284. 

All the best as you figure out why you are so "hot."

Alice