Moyad Mark A
Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0330, USA.
Urology. 2002 Apr;59(4 Suppl 1):20-33. doi: 10.1016/s0090-4295(02)01641-2.
Vasomotor hot flashes are a common problem in women who are postmenopausal or receiving antiestrogen treatment for breast cancer. Hot flashes are also a common problem after orchiectomy/luteinizing hormone-releasing hormone therapy, occurring generally in 50% to 66% of these men. Prescribed treatments for hot flashes for men on hormonal ablation treatment for prostate cancer are well documented. These conventional agents have shown good results, but their long-term efficacy, safety, and cost are still questioned. Therefore, the search for other viable agents, including nontraditional treatments, continues. Complementary/alternative treatments to alleviate hot flashes in women have generated an enormous amount of interest. However, these options have received little attention in men with hot flashes. Research with vitamin E, soy, black cohosh, red clover, and numerous other alternative treatments in women may provide some indirect but valuable insight on their potential effectiveness in men. Many of these alternatives have been a disappointment in recent randomized trials of women, and it is likely that there will be similar results with men. However, numerous supplements have yet to be tested in a clinical trial against a placebo, and clinicians should become aware of this ever-increasing list. Patients should be made aware of the primary importance of lifestyle interventions that could partially affect hot flashes and immediately affect overall health, especially during the period of androgen suppression, when it is not uncommon to observe accelerated weight changes and insulin insensitivity. Otherwise, recent research with older and newer conventional agents, such as antidepressants or estrogen/progesterone, should be emphasized at this time for moderate-to-severe hot flashes that profoundly affect daily activities and/or sleep. Antidepressant supplements (St. John's wort) or acupuncture could also be an attractive option in future investigations. Low-dose estrogen seems particularly attractive, because it is inexpensive and may simultaneously reduce hot flashes and the risk of osteoporosis in men receiving long-term androgen suppression therapy; however, the potential for cardiovascular complications must be further investigated. Ultimately, adequate research (vs placebo) should determine the fate of the alternative supplements proposed for hot flash reduction.
血管舒缩性潮热是绝经后女性或因乳腺癌接受抗雌激素治疗的女性常见的问题。潮热也是睾丸切除术后/促黄体生成素释放激素治疗后的常见问题，在这些男性中通常有50%至66%会出现。前列腺癌激素消融治疗男性潮热的规定治疗方法已有充分记录。这些传统药物已显示出良好效果，但其长期疗效、安全性和成本仍受到质疑。因此，对包括非传统治疗在内的其他可行药物的探索仍在继续。缓解女性潮热的补充/替代疗法引起了极大关注。然而，这些选择在潮热男性中很少受到关注。对女性进行的维生素E、大豆、黑升麻、红三叶草及许多其他替代疗法的研究可能会为它们在男性中的潜在有效性提供一些间接但有价值的见解。在最近针对女性的随机试验中，许多这些替代疗法都令人失望，男性可能也会有类似结果。然而，许多补充剂尚未在与安慰剂对照的临床试验中进行测试，临床医生应该了解这一不断增加的清单。应该让患者意识到生活方式干预的首要重要性，这可能会部分影响潮热并立即影响整体健康，尤其是在雄激素抑制期间，此时观察到体重加速变化和胰岛素不敏感并不罕见。否则，此时应强调对中重度潮热（严重影响日常活动和/或睡眠）使用新旧传统药物（如抗抑郁药或雌激素/孕激素）的最新研究。抗抑郁补充剂（圣约翰草）或针灸在未来研究中也可能是有吸引力的选择。低剂量雌激素似乎特别有吸引力，因为它价格低廉，并且可能同时减少潮热以及接受长期雄激素抑制治疗男性患骨质疏松症的风险；然而，心血管并发症的可能性必须进一步研究。最终，充分的研究（与安慰剂对照）应决定所提议的用于减少潮热的替代补充剂的命运。
