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Hot flashes, a sudden feeling of warmth often followed by sweating and sometimes associated with facial flushing, nausea, anxiety, or irritability, are frequently a side effect of treatment with hormone ablation therapy or orchiectomy in patients undergoing treatment for prostate cancer (Higano, 2006). Hot flashes occur in about two-thirds of men treated with testosterone reduction (Baum, 2003).
The pathophysiology of hot flashes is complicated and not fully understood. Although research in women and hot flashes has received much attention, very little has been studied in the male population. It is thought that thermoregulatory centers in the hypothalamus control the vasomotor symptoms involved with hot flashes and that these are regulated by neurotransmitters, including norepinephrine, estrogen, testosterone, serotonin, and endorphins. Changes in levels of the neurotransmitters and hormones, including testosterone, can cause dysregulation of the thermoregulatory centers (Thompson, Tait, Shanafelt, & Loprinzi, 2003). For those men unable to tolerate hot flashes, researchers have validated that low-dose megestrol acetate (Megace®) 20 mg every day or twice daily is well tolerated and can substantially decrease the frequency of hot flashes in men (Loprinzi et al., 1994; Quella et al., 1998). Megestrol acetate for treatment of hot flashes in men and women is considered an off-label use.
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Megestrol acetate is a synthetic...