Men's hot flashes: Hypnotic relaxation may ease the discomfort men don't talk about
Men who experience hot flashes are unlikely to talk much about it, but they may find relief from their silent suffering if they are willing to try an unusual treatment, according to findings from a Baylor University case study.
After seven weeks of hypnotic relaxation therapy, a 69-year-old man who had uncontrolled hot flashes following prostate cancer surgery showed a drastic decrease not only in hot flashes but also an impressive improvement in sleep quality, according to the study.
The Baylor study—funded by the National Institutes of Health—is published in the International Journal of Clinical and Experimental Hypnosis.
"Men are more reluctant to report hot flashes, and it's not as prevalent. There are fewer ways to deal with it," said study author Gary Elkins, Ph.D., director of Baylor's Mind-Body Medicine Research Laboratory and a professor of psychology and neuroscience in Baylor's College of Arts & Sciences. "If a guy has hot flashes, you can't say, 'Well, why don't we put you on estrogen?' But it's a pressing problem."
Men's hot flashes are, of course, not related to estrogen, the primary female sex hormone, Elkins said. They occur in men with a history of prostate cancer—the second most common malignancy in men—or another disorder causing a testosterone deficiency.
Up to 80 percent of prostate survivors experience hot flashes, and about 50 percent of those experience them as severe and needing treatment. What's more, hot flashes due to prostate cancer tend to be more frequent, more severe and more prolonged than those women experience. Elkins has done extensive research showing that hypnotic relaxation therapy greatly benefits postmenopausal women and breast cancer survivors who suffer from hot flashes.
Current treatments for men are varied, ranging from hormone therapy to acupuncture, but outcomes have been mixed—and safety of some treatments remains in question, Elkins said.
The man in the Baylor study—referred to as "Mr. W"—was a married African African-American who suffered nightly hot flashes in 1999 because of androgen deficiency. He found some relief through testosterone injections—but in 2010, he was diagnosed with prostate cancer and forced to discontinue hormone therapy. Shortly after his prostate was surgically removed, he again began suffering hot flashes.
He underwent seven weeks of drug-free, hypnotic relaxation therapy involving clinically trained therapists and introducing self-hypnosis, with results measured in self-reporting and physiological testing done through wearing skin monitors with electrodes, Elkins said. By treatment's end, he experienced a 94 percent reduction in hot flashes. His sleep quality improved by 87 percent, measured by a standardized test, and although the sleep quality had dropped at a 12-week follow-up, it remained in the "good quality of sleep" range, according to the study.
In an audio recorded interview with Elkins after several weeks of the therapy, "Mr. W" said he was at first skeptical and apprehensive, but "my wife said, 'Try it. What have you got to lose?' . . . It has helped tremendously. One time, I got so relaxed I thought I could hear myself snoring, but I could hear the young lady that was taking me through the steps of hypnosis of where I'd go to be most comfortable."
As part of the process, he kept a diary, initially chronicling up to 160 flashes a week—a "tremendous heat" and profuse sweating. But over the course of the treatment, those dropped to about 15 a week, he said in the interview.
Besides being guided through steps by a therapist, he took part through self-hypnosis, visualizing fishing at his favorite Texas lake. He donned imaginary rubber boots, waded into the water and enjoyed a cool breeze as he cast a line and fish began to nibble.
The therapy "eliminated the flashes, calmed me down, cooled my body off," he said. "During one session, I needed a blanket . . . The self-hypnosis was empowering."
The new research follows previous published studies by Elkins that found a marked decrease in hot flashes among postmenopausal women and also among breast cancer survivors who have undergone hypnotic relaxation therapy. It reduced hot flashes by as much as 80 percent, and research findings by clinically trained therapists show it also improved participants' quality of life and lessened anxiety and depression. (Quality of life included such issues as work, sexuality, social and leisure activities, mood and concentration.)
"And that's all without the increased risk of breast cancer or heart disease associated with hormone treatments such as estrogen or progestin," Elkins said.
The weekly sessions of hypnosis of 187 women over a five-week period involved hypnosis by clinically trained therapists. The women also practiced self-hypnosis using audio recordings to visualize a snowy path or cool mountain creek. During the treatments, the women wore skin monitors with electrodes and kept diaries of when they had hot flashes, how often, how severe they were, and what might have triggered flashes, such as stress, spicy foods or being in a hot room.
Women also were encouraged to individualize their therapy. An example: One woman's imagery was walking to a lake from her porch to sit on lawn chairs with her family at sunset.
Previous research has shown that people vary when it comes to being "hypnotizable"—responsive to hypnosis—but the consensus is that most people are at least moderately so.
Besides having few or no side effects, hypnotic relaxation therapy is cost-saving and allows patients to be involved in their own healing.
"There's no 'One size fits all,' '' Elkins said, noting that for women, hormone replacement therapy improves bone health and lowers the risk of some types of colon cancer. "But hypnotic relaxation therapy has been shown to be the most effective drug-free option – as well as having few or no side effects."