Hot Flashes

[Dok (imported)]

Dear Fellow Eunuchs,

Another problem associated with the loss of the testicles is Hot Flashes. I have been very cautious about using the Hormone Replacement Therapies (HRT) as a remedy for various problems related to castration. Only recently (for the last four months) have I started taking 25mg. of DHEA every other day. I noticed that it was getting increasingly difficult to concentrate, read, write, type [yes, I mean TYPE, I still use my faithful, old, manual typewriter; my typist, BR, takes my typed pages and puts them on her computer and disks for me to mail out to publishers and such]. I had my DHEA level tested and found it to be very low. Now, since I have been on the DHEA, there has been a noticeable improvement in my ability to continue my research. I do take a lot of supplements, but this is the only hormone that I have experimented with thus far in my 10 years as a eunuch.

Below is a section from my book, Castration: Advantages and Disadvantages, dealing with what is called “Hot Flashes.” I was able to reduce Hot Flashes through use muscular relaxation and deep breathing techniques, as well as self-talk to reduce panicky feelings. Hopeful this information will be of some assistance to you.

Also, if any of you want the unbound, loose leaf, form of my research, Castration: Advantages and Disadvantages, I would be glad to send them to you free of charge. I have been doing this for years to interested parties. Just send me an address where you want the papers sent. You can reach me through my son at [email protected] or my typist at [email protected] or you can call me at 850-243-5009. No questions asked, no data bases, no tracking. Since I have started my research I have probably given away hundreds of copies of my research. I am committed to getting the best available information out about castration and its effects, so that people can make their own informed decisions on this controversial subject.

Cordially,

Vic Cheney

mjc

(5) Hot Flashes. Long before people knew about such things as hormones, neurotransmitters, and psychobiology, writers were describing the side effects of castration known today as “hot flashes,” “hot flushes,” or “night sweats.” In 99 B.C., Ssu-ma Ch’ien (at age 46), the Grand Historian of China, wrote: “This is what makes my bowels burn within me nine times a day. Whenever I think of my shame, the sweat drenches my back.”569 Although the grand historian was describing his indignation at having been castrated by order of emperor Wu Ti as punishment for defending a disgraced army general, he was also providing a description of his hot flashes following the surgery.

The frequency, duration, and intensity of hot flashes are generally much lower for obese, atrophic, hypopituitary persons than they are for slender individuals. Some men may also have a genetic disposition for more troublesome symptoms than others.

The hot flash is described as a generalized body phenomenon; with strikingly abrupt rises in skin temperature, vasodilation, and perspiration usually in the upper body area. For some people this is a minor, scarcely noticed occurrence; but for others, they are severe 10-minute-long, heart-pounding, sweat-drenching attacks that can embarrass them or interfere with the ability to perform critical tasks. The typical duration of the hot flash is 2 to 5 minutes. About one-third of men with hot flashes report less than 5 per day, one-third report 5 to 10, and about one third report a frequency greater than 10 per day. Generally the hot flash is noticed most during the night hours.

The precise chain of interactions causing the hot flash is still unknown. It is believed to be a vascular phenomenon secondary to a vasomotor dysfunction caused by the abrupt deprivation of testosterone in men with alteration of the normal hypothalamic-pituitary-gonadal axis leading to an increased level of circulating gonadotropin. The increase in adrenal steroids affects the peripheral blood vessels in combination with an as yet unknown manner of resetting the thalamic thermal homeostatic regulatory mechanism. Two of the reasons that the exact chains of events are unproven are:

The intermittent mode of secretion of the releasing factors and their evanescent character. Gonadotropin-releasing hormone (GnRH), in particular, has a half-life of only 2 to 4 minutes. The second obstacle is the nature of the closed blood supply to the anterior pituitary gland; only a very small fraction of the GnRH secreted from the hypothalamus ever leaves this limited anatomic space. Thus GnRH level in the peripheral circulation is very low. As a result of these difficulties, scientists have used monitoring of the luteinizing hormone (LH) pulsations as an indirect assessment of the GnRH secretion.570

There is a remarkable correlation of the hot flashes with the pulsatile release of LH (this is normally every 100 to 120 minutes), although the LH pulse is not the immediate cause of the flash.571

The hypothalamus is the body’s thermostat; it’s over activity triggers the hot flash. GnRH pulses from the hypothalamus cause the LH pulses from the pituitary gland and the LH pulses normally produce the testicular and adrenal androgens, but with the removal of the testicles, there is more and more stimulation of the adrenal gland in an effort to make up for the loss of androgens from the testicles. The adrenal glands control adrenaline (also called epinephrine), cortisol, and androstenedione. Adrenalin is a vasodilator, which causes the blood vessels to dilate and increase the skin temperature and heart rate.

Androstenedione and some of the other hormones are predominantly converted in the peripheral tissues. Since the adipose tissues are larger in obese persons than in slender ones, the conversion is greater and they are less troubled by the hot flashes.

Dr. Huggins, et al., noted that hot flashes occurred in 43% of his cases of elderly men who were castrated for treatment in prostate cancer:

. . . beginning two to six weeks after orchidectomy, and resembled those experienced by women after menopause. The hot flashes were associated with profuse perspiration and often occurred at night, forcing the patient to throw off the bed covers. The hot flashes were mitigated for many weeks by oral or subcutaneous administration of 1 mg of stilbestrol daily for five days.572

Dr. Huggins concluded that development of hot flashes was one of the “untoward” effects of castration.

In my own survey of 27 men, ages 55 to 85, who were castrated in treatment for prostate cancer, the heaviest were bothered least by the hot flashes. Two of the men in the heaviest group had not been bothered by hot flashes at all. One of the men in this group noted that the flashes were worst in the summer time. There was also a surprising tendency for the men in the group, ages 71 to 85, to be bothered less from the hot flashes than the younger men. About 30% of these younger men were still reporting flashes of medium to low intensity 3 years after their surgery.

In the control of the pulses of hormones, it has been repeatedly demonstrated that the circadian (daily) central pacemaker in mammals is located in the paired suprachiasmic nucleus of the hypothalamus.

There are a wide variety of ultradian (1 to 4 hours) rhythms in man and other mammals, governing periods ranging from fractions of hours to several hours. . . .one of the most prominent ultradian rhythms is the alternation of the rapid eye movement (REM) and non-REM periods during sleep. . .the approximately 90-minute REM-Non-REM cycle is accompanied by similar periodicity of dreaming, penile erections, cardiac irregularity and heavy breathing.573

The magnitude of the hormonal secretory pulses is also modulated by the circadian system. The interval of recurrence varies from hormone to hormone. The fastest LH pulse frequency varies from ultra-fast oscillations to diurnal to hourly rhymicity, to monthly and seasonal. In men it tends to be highest in the autumn.574 During the daily cycle, LH peaks between midnight and 4 a.m. and many men experience their “night sweats” during these hours. This can change, however, with various conditions such as rapid time-zone-travel and disease conditions like diabetes, thyroid trouble, anorexia nervosa, acromegaly, depression, etc. Besides the body’s clock mechanism, there are other conditions that bring on hot flashes such as heat stress (abrupt changes in ambient temperature) and emotional stress (from anger, threats, danger, pain, illness, injury, surprises, death of spouse, divorce, etc.). In other words, hot flashes can be triggered by a variety of outside stressors or they can occur spontaneously from the action of the body’s own internal clock mechanisms.

Hot flashes can be abolished by treatment with artificial compounds of androgens and estrogens, but in the case of prostate cancer patients or sex offenders, this would be counterproductive since the reason for the castration treatment is to reduce these same hormones. Also, many of the estrogen compounds have been associated with an increased risk of heart disease. Several other remedies have been employed to minimize the effect of the hot flashes with varying success in different individuals. Acupuncture has also provided significant relief of hot flashes in some men and women.

One of the treatments has been Clonidine or Catapres. These can be conveniently applied as an adhesive patch on the skin once weekly. Parra and Gregory (1990) found that Clonidine patches resolved the hot flash problem in 43% of their cases and improved it in the remainder. But Levy claims it was little better than a placebo.575 Megestrol acetate (megace) (20 mg tablets 2 times daily) are synthetic progesterone576 compounds, which reduce the LH pulse and the resulting hot flashes in more than 70% of the cases. Bellergal-S is another tablet, which is sometimes prescribed for hot flashes. It contains phenobarbital, ergotamine tartrate, and alkaloids of belladonna and may become habit forming. Bellergal is helpful during times of heavy stress, but should not be used over a long period of time. Medroxy-progesterone Acetate has been used (5 mg twice daily) with encouraging results in some patients. Cyproterone Acetate is another antiandrogen that has been used (100 mg three times daily orally), but it is expensive and not yet approved for general use in the US. Ginseng root (560 mg twice daily) has been recommended and is relatively inexpensive. Another inexpensive palliative for hot flashes is vitamin B-6 (60 mg once daily, preferably in the evening). Calcium supplements have been prescribed to counteract the increased calcium loss that occurs after gonadectomy and menopause. Drysol, a prescription antiperspirant, has been used with good effects to reduce the amount of sweat. Flax seed oil, wild yam, and vitamin C have also been used as palliatives, but should not be used without consulting a physician or herbalist.

For troublesome hot flashes, as with any disease, we must not forget the healing power of prayer. Christian Science and most other religions teach us that prayer to a Higher Power during any health problem does help. Doctor Larry Dossey, of Santa Fe, New Mexico, writes that prayers for health problems are answered and: “I base this answer not just on faith, but on the outcomes of scores – 130 – of scientific studies. . .about a ton of data.”577 There is additional strength in numbers, if you get other people to pray with you, it is better than solitary prayer. Jesus said, “Again, truly I tell you, if two of you agree on earth about anything you ask, it will be done for you by my Father in heaven” (Matthew 18:19).

Since stress is one of the precipitating factors in hot flashes, any of the many techniques for reducing harmful body reactions to stress should be helpful. Tai Chi, relaxation and meditation exercises, sensate focus therapy, and many psychiatrist-assisted stress reduction techniques are available. Diet always should be considered in any illness and adequate amounts of protein (55 grams per day), potassium (2,000 - 5,000 milligrams), calcium (1,000 mg), and vitamins B (20 mg) and C (100 mg) must be consumed.578 “Hot flash exacerbators” such as spicy food should be identified and avoided.

Two studies presented at the March 1995 British Psychological Society’s Annual Conference indicated that a person’s attitude can have a significant impact on hot flash symptoms. By learning muscular relaxation and deep breathing techniques, as well as self-talk to reduce panicky feelings, the women in the two studies reduced the frequency of hot flashes by 50% and after 3 months, 25% of the women had no flashes at all.579 My own experience of 2 years of hot flashes after orchiectomy was sharply reduced the very first day that I tried these techniques.

Footnotes

569

Anderson, Mary M. (1990). Hidden Power: The Palace Eunuchs of Imperial China. Buffalo: Prometheus Books, p. 58.

570

Crowley, William F., and Whitcomb, Randall (1990). Gonadotropin-releasing Hormone Deficiency in Men. American Journal of Obstetric Gynecology, 163(5), Part 2, pp. 1752-1758.

571

DeGroot, Leslie J. (Ed.). 1989. Endocrinology. Philadelphia: W. B. Saunders Co., pp. 2012, 2674, 2691.

572

Huggins, C., Stevens, R. E., and Hodges, C. V. (August 1941). Studies on Prostatic Cancer the Effects of Castration on Advanced Carcinoma of the Prostate Gland. Archives of Surgery, 43(2). Chicago: American Medical Association, pp. 218, 223.

573

DeGroot, Leslie J. (Ed.). (1989). Endocrinology. Philadelphia: W. B. Saunders Co., pp. 2012, 2674, 2691.

574

DeGroot, Leslie J. (Ed.). (1989). Endocrinology. Philadelphia: W. B. Saunders Co., p. 2691.

575

Levy, A. (1996). Why Flush? The Lancet, 347(8994), pp. 73-74.

576

Labrie, F., Belanger, A., Dupont, A., Van Luu, The, Simard, J., and Labrie, C. (1993). Science Behind Total Androgen Blockade: From Gene to Combination Therapy. Clinical Invest. Med., 16(6), p. 484 says: “ . . . .synthetic progestins (Megace) exert a significant and sometimes potent stimulation for the growth of androgen-sensitive tumors both in vitro and in vivo.”

577

Dossey, Larry. (1993). The Power of Prayer and the Practice of Medicine. Harper Collins.

578

Morgan, Brian, & Morgan, Roberta. (1987). Brainfood. Tucson: The Body Press, p. 49.

579

Mental Medicine Update C The Mind/Body Medicine Newsletter. Volume IV, No. 3, 1995. Los Altos, CA: Institute for the Study of Human Knowledge, Center for Health Science