Hot Flashes: What men need to know

If you’re new to my Substack I’m a stage 4 prostate cancer patient receiving treatment with drugs that cause side effects that mimic those of menopause. I’m in the unique position of being a biological man who understands the challenges that women can experience in menopause. My mission is to educate men how and why they can and should support their female partners from peri-menopause through post-menopause. If you’re a woman on a journey through menopause, I hope you consider printing out this post, and sharing it with your male partner. It might help you! Also, please consider sharing this post with a friend or re-Stacking it. I would be honored if you would do so.

Where’s the thermostat?

Since I’m not a medical professional, just a retired engineer and scientist with a fairly decent understanding of how many things work, let’s just take a 30,000 foot view of how the body regulates temperature. First of all, we have the biological equivalent of a thermostat. It’s called the hypothalamus and is located in our brain. It tells our body what to do to warm up or to cool off. When we are cold, this bio-thermostat tells our muscles to rapidly contract and relax, thereby creating heat in the process to help warm us up. Our blood vessels narrow so that we don’t lose as much heat through our skin. We also might get goosebumps which help provide an insulating warm layer of air around our body either where we have body hair or have clothing in close contact. When we are hot, our blood vessels dilate sending blood from our inner core towards our skin where it can theoretically be cooled by contact with ambient air. Sounds good, huh? Well, everything is dandy until hormone levels, particularly estrogen dip, causing the bio-thermostat to not work quite as well. In a hot flash, the hypothalamus decides that our core is overheating and goes into panic mode to move as much blood from our core to our skin to dissipate heat. The problem is, there’s no reason to do this, but the effect is a hot flash, or as they say in some countries, a hot flush.

Hot Flashes are real

Most men don’t have a clue what hot flashes are. I was one of them until I experienced one for myself. Some men are of the belief that hot flashes are a figment of their partner’s imagination or a bid for attention, or maybe even an attempt to get out of work. They do not understand that they are genuine physiologic events and why they are so disruptive to a woman’s life. During peri-menopause, menopause, and post menopause, a woman’s estrogen level may fall to a level that creates a lot of ills that include hot flashes. I’m on mission to educate men as to what their partners go through. The drugs that that I’m on to keep my advanced prostate cancer in check by lowering my testosterone to about 1% of what it should be. “So what does that have to do with menopause?” you might ask. Well men also have a small amount of estrogen and that amount is proportionally related to the amount of testosterone in the body. Near zero testosterone typically means zero estrogen and estrogen helps the body control temperature amongst other things in both biological males and females. As a result of having near zero estrogen I routinely experience up to 30 hot flashes a day so God knows I understand what some women go through. It can be hell. Real hell. Effing hell!

Hot stuff! Can you relate?

If you live in a climate where summertime temperatures can reach over 90°F, 32.3°C you’ve probably left your car parked in the sun with the windows rolled up. You’ve returned to the car, opened the doors, gotten in, and experienced stifling heat. If you’ve left that car parked for an over an hour, the temperature inside could easily have reached over 120°F, 49°C. You probably experienced sweat running down your face, down your back and other places I won’t mention and you haven’t been able to roll down the windows fast enough. Lucky you, you can start the car, lower the windows and put the AC on high to cool off. That’s not an option with a hot flash. You’re trapped in that hot car until the hot flash passes. The best one can do is start stripping off layers of clothes until one can’t remove what’s left without embarrassment or fear of arrest. Hot flashes can last anywhere from 30 seconds to five minutes and when it’s over, the person that had the hot flash may look like a drowned rat from persperation. Hot flashes can happen anytime and anywhere, and often happen at the worst possible time and in the worst possible place.

What happened to a good night sleep?

Before I wrote this Substack post, I reached out to some of my friends who are women and asked them what experiences they’ve had with hot flashes that I could share anonymously and which of them had that have bothered them the most. The number one thing that I heard was that they sometimes experienced a hot flash while they were sleeping and woke up soaked with sweat. They had to get up, change their clothes and then try to fall back asleep. That sometimes happened once per night but could happen times two or more times in the same night. I think it’s pretty easy to understand that if one doesn’t get a good night sleep, it’s hard to have a good day.

Hot flashes in the workplace

Some years ago I was Director of Operations at a private company and our workforce was predominantly staffed with women. The factory floor was climate controlled year round to about 70°F, 21.1°C but that never stopped women from experiencing hot flashes that sometimes impacted the job that they had to do. The floor supervisor had the wisdom to set up the first aid room as a cooling station for anyone having a hot flash. I never appreciated the value of that cooler temperature until now. Kudos Jarmila!

Can I get a Hot Flash to go?

I live in the US near Chicago which has cold winters. It’s very common for temperatures to drop below 32°F, 0°C when the days are short. We scurry from our homes or businesses to our cars with heavy coats on. Just about the time that our automobile interiors are warm enough to be comfortable is also the perfect time for a hot flash to come on with no room for the hot flash victim to be able to remove her coat while driving. If it’s not snowing, you might see both passenger windows come down and perhaps even the sunroof open. The woman having the high flash is often soaked with sweat which makes getting out of the car into the cold winter air terribly unpleasant. I can sympathize.

I was flying a small plane last week and I experienced a hot flash when I was at the controls. The outside air temperature was close to freezing, so I had a heavy winter coat on and left it on when I got in the plane. I’m a rather large fellow and the passenger compartment is tight so there was no room to take off my coat. There was no window to open, just a small vent about the size of a large coin which I opened and hoped to cool off. By the time the hot flash passed, I looked like the character Ted Striker from the 1980 comedy movie “Airplane” when he had to fly the jet and save the passengers and crew from crashing. The movie was funny. My hot flash was not.

Hot sex? No thanks!

Almost every woman I spoke to about menopause told me that at least once they had a hot flash in the throws of passion. We had a chuckle because honestly at the risk of a little TMI I have experienced that too. A hot flash DOES NOT make the experience better. Trust me. In fact the fear of having a hot flash during intimacy can make one wary of starting something that one may not want to finish.

So what’s the answer?

I am not a medical expert and I’m not giving medical advice. From what I’ve read from menopause experts Dr. Lauren Streicher and Dr. Kelly Casperson one answer might be estrogen replacement therapy. It can be in the form of a pill, a transdermal patch, a gel and may additionally require progesterone. Estrogen cannot be purchased over the counter. It has to be prescribed by a medical clinician and it can make a difference in the quality of life for many women experiencing hot flashes. Estrogen replacement might help me too and my oncologist has offered the trial of a a transdermal version to help make my hot flashes more manageable for the remaining months that I have to receive treatment.

What you can do

The first challenge for you is to be understanding when your partner has a hot flash. They are nothing to laugh at or make fun of. Ask what you can do to help like open a window, turn on a fan or get a cold beverage for her. Be supportive! You might also help your wife or partner find a clinician that doesn’t write off her symptoms and quality of life issues as “just a part of aging that is natural”. Be an advocate for your partner.

You can do this!