Low Testosterone / Late Onset Hypogonadism Quiz

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Reduced libido

Erectile dysfunction

Shrinking testicles

Hot flashes

Reduced sex drive

No armpit hair

Poor concentration

Enlarged male breasts

Feeling depressed or fatigued

Low energy level

Difficulty maintaining an erection

Low motivation or ambition

Not seeing your symptoms? No worries!

What is Low Testosterone / Late Onset Hypogonadism?

Low testosterone, or late-onset hypogonadism, is a condition characterized by reduced levels of testosterone in aging males, leading to symptoms such as fatigue, reduced libido, depression, and decreased muscle mass.

Typical Symptoms of Low Testosterone / Late Onset Hypogonadism

Diagnostic Questions for Low Testosterone / Late Onset Hypogonadism

Your doctor may ask these questions to check for this disease:

  • Are you worried about your sexual performance because you can't get or keep an erection for sex?
  • Have you experienced a decrease in your sex drive?
  • Recently, are you more confused than before?
  • Have you been experiencing decreased motivation recently?
  • Are you experiencing mental stress and physical fatigue?

Treatment of Low Testosterone / Late Onset Hypogonadism

Treatment involves addressing symptoms and restoring testosterone levels, often through testosterone replacement therapy (TRT). Lifestyle modifications, managing underlying conditions, and periodic monitoring are essential to ensure efficacy and minimize risks.

Reviewed By:

Kenji Taylor, MD, MSc

Kenji Taylor, MD, MSc (Family Medicine, Primary Care)

Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.

Yoshinori Abe, MD

Yoshinori Abe, MD (Internal Medicine)

Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.

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Content updated on Apr 15, 2025

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Symptoms Related to Low Testosterone / Late Onset Hypogonadism

Diseases Related to Low Testosterone / Late Onset Hypogonadism

FAQs

Q.

Is Your Testosterone Low in Your 30s? Signs and Your Action Plan

A.

Low testosterone in your 30s is real but not inevitable; persistent low libido or fewer morning erections, fatigue, loss of muscle or strength with more belly fat, and mood changes are key signs, often due to fixable lifestyle or medical causes rather than normal aging. There are several factors to consider. Start by tracking symptoms and getting morning testosterone tested twice with related labs, optimize sleep, strength training, fat loss, and stress and alcohol reduction, then discuss doctor-guided options like TRT which can help but may affect fertility and requires monitoring; see complete guidance below.

References:

* Ramasamy R, et al. Hypogonadism in Young Men. Urol Clin North Am. 2018 May;45(2):161-172. PMID: 29555192.

* Yafi FA, et al. Testosterone deficiency in young and middle-aged men: is it real? Transl Androl Uurol. 2022 Jul;11(7):950-966. PMID: 35919623.

* Yafi FA, et al. Diagnosis and management of testosterone deficiency. CMAJ. 2023 Nov 6;195(43):E1471-E1479. PMID: 37913385.

* Trost L, et al. Update on the diagnosis and management of hypogonadism in men. Transl Androl Urol. 2022 Jan;11(1):153-174. PMID: 35058784.

* Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3143-3154. PMID: 30202888.

See more on Doctor's Note

Q.

Lost Your Spark? Libido Meaning & Medically Approved Next Steps

A.

Libido means your sexual desire, and if your spark feels low there are several factors to consider including hormones, stress or mental health, medications, relationship issues, and chronic conditions; see below for how these details can shape your next steps. Medically approved steps include tracking patterns, improving sleep and exercise, limiting alcohol, reviewing medications, evaluating hormones when appropriate, and addressing mental and relationship health. Seek prompt care for sudden severe changes or red flag symptoms, and find complete guidance and treatment options below.

References:

* Leung, A., & Pfaus, J. G. (2020). The Treatment of Female Hypoactive Sexual Desire Disorder: An Update on the Existing Pharmacotherapies and Future Directions. *Sexual Medicine Reviews*, *8*(3), 448–461.

* Dean, J. D., & McMahon, C. G. (2018). Management of Hypoactive Sexual Desire Disorder in Men. *Sexual Medicine Reviews*, *6*(3), 424–434.

* Nappi, R. E., & Martini, E. (2021). Current management of hypoactive sexual desire disorder in postmenopausal women. *Expert Review of Endocrinology & Metabolism*, *16*(2), 125–136.

* Basson, R., & W. Reignier, B. (2018). The Current Understanding of Women's Sexual Desire. *The Journal of Sexual Medicine*, *15*(4), 481–492.

* Clayton, A. H., & Miner, M. M. (2018). The Diagnosis and Management of Hypoactive Sexual Desire Disorder in Men and Women. *Current Sexual Health Reports*, *15*(2), 108–117.

See more on Doctor's Note

Q.

Feeling Drained? The Reality of Testosterone Boosters & Medical Next Steps

A.

Testosterone boosters rarely solve feeling drained: most OTC products do not meaningfully raise testosterone, and ongoing symptoms should be checked with morning blood tests because confirmed low T is best managed with supervised options like TRT alongside lifestyle changes. There are several factors to consider, from sleep, weight, and medications to look-alike conditions and safety risks; see below for the full details, red flags, and step-by-step next moves to choose the right care.

References:

* Balasubramanian A, Singh AB. Testosterone boosters: An overview of the clinical efficacy and safety of available products. Transl Androl Urol. 2018 Oct;7(5):776-782. doi: 10.21037/tau.2018.09.01. PMID: 30438125; PMCID: PMC6219973.

* Wibisono B, Wahyudi R, Wiradikusumah H. Herbal and Dietary Supplements for Testosterone Boost: A Review. Int J Gen Med. 2022 Mar 15;15:2655-2663. doi: 10.2147/IJGM.S343048. PMID: 35300649; PMCID: PMC8936662.

* Bhasin S, Pencina MJ, Jasuja GK, Travison TG, Coviello AD, Davda M, Dawson-Hughes B, Vasan RS, D'Agostino RB Sr. Diagnosis and Management of Testosterone Deficiency. Endocr Rev. 2016 Feb;37(1):68-87. doi: 10.1210/er.2015-1033. Epub 2015 Dec 1. PMID: 26620942; PMCID: PMC4740409.

* Al-Jibouri R, Al-Jibouri T, Sayer AA. Fatigue in men with testosterone deficiency: a systematic review. Andrology. 2021 May;9(3):792-800. doi: 10.1111/andr.12999. Epub 2021 Feb 15. PMID: 33580436.

* Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis AL, Matsumoto AM, Snyder PJ, Swerdloff RS, Wu FC, Yialamas MA. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2021 Apr 23;106(4):869-904. doi: 10.1210/clinem/dgab072. PMID: 33576014.

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Q.

Is it Micropenis? The Medical Reality and Your Essential Next Steps

A.

True micropenis is rare and medically defined as a normally formed penis with a stretched length under about 3.5 inches (9 cm) in adults, so most men who worry about size do not meet this definition. There are several factors to consider, including buried penis, obesity, and hormonal conditions like low testosterone; see the detailed explanation below to understand diagnosis, causes, and what it means for function and fertility. For next steps, get an accurate in-office measurement, ask for hormone testing, and consider urology or endocrinology referral, with mental health support as needed and prompt care for red flags like sudden erectile failure or severe fatigue.

References:

* Hatipoglu, N., & Kurtoglu, S. (2019). Micropenis: Etiology, diagnosis and treatment. *Journal of Clinical Research in Pediatric Endocrinology*, *11*(3), 209.

* Baş, F., & Darendeliler, F. (2020). Management of Micropenis: Current Concepts. *Journal of Clinical Research in Pediatric Endocrinology*, *12*(Suppl 1), 60–67.

* Bin-Abbas, H. A., & Al-Amri, M. (2017). Micropenis: Classification, diagnosis and management. *Saudi Medical Journal*, *38*(11), 1083–1089.

* Boas, M., & Houk, C. P. (2018). Normal penile length measurements in male infants and children: A review of the literature. *Journal of Pediatric Endocrinology & Metabolism*, *31*(1), 1–8.

* Lee, P. A., & Houk, C. P. (2015). The clinical spectrum and management of the small penis. *Current Opinion in Endocrinology, Diabetes, and Obesity*, *22*(6), 492–498.

See more on Doctor's Note

Q.

Out of Control? Why Your Brain is Hypersexual & Medical Next Steps

A.

Hypersexual urges, especially when thoughts feel intrusive or impairing, can stem from dopamine reward dysregulation, bipolar mania, hormonal shifts, stress-based coping, medication side effects, or less commonly neurological disease. There are several factors to consider, and you can see below to understand more. Next steps include seeing a clinician for medication review, hormone and thyroid testing, and screening for mood disorders, with urgent evaluation warranted for severe mood swings, compulsive risky sex, sudden personality changes, or neurological signs; key details and practical strategies are outlined below.

References:

* Reay, W., et al. (2018). Neurobiological Aspects of Hypersexual Behavior: A Systematic Review. *Current Sexual Health Reports*, 10(2), 65-74.

* Ley, P., et al. (2019). Neurobiological Correlates of Compulsive Sexual Behavior. *Current Sexual Health Reports*, 11(4), 312-321.

* Barth, J. P., et al. (2020). Pharmacological and Psychological Treatment Options for Compulsive Sexual Behavior Disorder: A Review. *Current Psychiatry Reports*, 22(2), 8.

* Gola, M., et al. (2021). The Neurobiology of Compulsive Sexual Behavior: A Narrative Review. *Sexual Medicine Reviews*, 9(4), 515-525.

* Brand, M., et al. (2018). Functional Neuroimaging of Compulsive Sexual Behavior: A Systematic Review. *Sexual Addiction & Compulsivity*, 25(2), 99-122.

See more on Doctor's Note

Q.

Always Tired? Why Your T-Levels Are Crashing & Medically Approved TRT Next Steps

A.

There are several factors to consider: age-related decline, chronic stress, poor sleep or sleep apnea, excess weight, certain medical conditions, and overtraining can crash testosterone, causing persistent fatigue, low sex drive, brain fog, and loss of muscle. Accurate diagnosis needs morning blood tests on two occasions plus symptoms, and medically supervised TRT can help when appropriate but requires individualized dosing, fertility counseling, and regular safety labs; see below for red flags, lifestyle steps to try first, who should avoid TRT, treatment options, and an exact step-by-step plan.

References:

* Molina-Borja M, Flores-Vivar K, Arana-Arana C, Soldevilla-Melgarejo M, Villacís-Salcedo C, Gavidia-Valiente M, Velasco-Arregui B, Gil-Hernández R, Priego-González D, De-Pablos-Velasco P. Testosterone replacement therapy improves fatigue, mood, and cognitive function in men with hypogonadism: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023 Feb 1;14:1107297. doi: 10.3389/fendo.2023.1107297. PMID: 36798055; PMCID: PMC9929252.

* Bassil N, Morley JE, Kim MJ, Malozowski S. Male hypogonadism: an update on diagnosis and management. Ther Adv Endocrinol Metab. 2020 Jun 25;11:2042018820932262. doi: 10.1177/2042018820932262. PMID: 32670559; PMCID: PMC7333010.

* Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Ikegami H, Mokshagundam S, Nathan DM, Stuenkel CA, Vijayanarayana K, Winters SJ, Ybarra J. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2023 Dec 15;108(12):2819-2834. doi: 10.1210/clinem/dgad264. PMID: 37397738; PMCID: PMC10723223.

* Morgentaler A, Miner MM, Dhindsa S, Khera M. Testosterone replacement therapy: an update on risks and benefits. Ther Adv Urol. 2020 Feb 28;12:1756287220904815. doi: 10.1177/1756287220904815. PMID: 32174828; PMCID: PMC7050302.

* Bassil N, Kim MJ, Morley JE. Laboratory diagnosis of testosterone deficiency. Front Horm Res. 2020;53:112-125. doi: 10.1159/000502758. Epub 2020 Feb 21. PMID: 32092823.

See more on Doctor's Note

Q.

Libido Crashing? Why Maca Root Works and Medically Approved Next Steps

A.

There are several factors to consider. Maca root is one of the better-studied natural options for a crashing libido, with modest benefits for desire, mood, and mild ED after 6 to 12 weeks via non-hormonal pathways, but it is not a replacement for testosterone therapy; dosing, safety, and who should avoid it are detailed below. Medically approved next steps include optimizing sleep, strength training, stress, diet, and alcohol, then a monitored maca trial, and seeking medical evaluation for red flags or persistent symptoms with labs like testosterone, thyroid, prolactin, glucose, and lipids; important nuances that could change your next step are outlined below.

References:

* Dording CM, Schettler K, Rosenbaum JF, Fava M, Jellinek D, Rosenbaum JF, Alpert JE, Fava M. Maca (Lepidium meyenii) for treatment of sexual dysfunction in women with antidepressant-induced sexual dysfunction. CNS Neurosci Ther. 2008 Fall;14(3):182-91. doi: 10.1111/j.1755-5949.2008.00052.x. PMID: 18784609.

* Gonzales GF. Maca (Lepidium meyenii) and male sexual dysfunction. Andrologia. 2012 Nov;44 Suppl 1:178-83. doi: 10.1111/j.1439-0272.2011.01162.x. PMID: 22099419.

* Meissner HO, Reich-Meissner H, Reich-Meissner H, et al. Prospective randomized, placebo-controlled study of Maca (Lepidium meyenii) on sexual desire and mood in postmenopausal women. Maturitas. 2006 Nov 20;55(3):356-62. doi: 10.1016/j.maturitas.2006.07.009. Epub 2006 Oct 2. PMID: 17007998.

* Nappi RE, Nappi C, Nappi F, Nappi M. Update on the pharmacologic treatment of female sexual dysfunction. Ther Adv Urol. 2019 Aug 26;11:1756287219871147. doi: 10.1177/1756287219871147. eCollection 2019. PMID: 31481977.

* McMahon CN, Lakin MM. Current and emerging therapeutic approaches for male sexual dysfunction. J Sex Med. 2018 Jan;15(1):15-28. doi: 10.1016/j.jsm.2017.11.002. Epub 2017 Dec 1. PMID: 29203108.

See more on Doctor's Note

Q.

Low Libido? Why Your Drive Is Gone & Medically Approved Next Steps

A.

Low libido is common and often reversible; causes include hormonal shifts like low testosterone or menopause, stress, depression or anxiety, poor sleep, relationship issues, medications, and chronic illnesses, with certain red flags needing prompt care. There are several factors to consider and medically approved next steps, from tracking symptoms and targeted blood tests to lifestyle changes, therapy, and carefully selected hormone treatment; see below for the full details and guidance that could change which steps you take next.

References:

* Shifren JL, Parish SJ, Simon JA. Sexual dysfunction in women: Diagnosis and treatment. Am J Obstet Gynecol. 2020 Dec;223(6):830-840. doi: 10.1016/j.ajog.2020.04.032. Epub 2020 May 13. PMID: 32410769.

* Clayton AH, Goldstein I, Kim NN, Jordan R, DeRogatis LR, O'Donovan C. Hypoactive Sexual Desire Disorder in Women: A Review of Epidemiology, Pathophysiology, Diagnosis, and Treatment. J Sex Med. 2018 Apr;15(4):453-472. doi: 10.1016/j.jsm.2018.01.018. Epub 2018 Feb 28. PMID: 29505872.

* Shoskes JJ, Shoskes D, Shoskes DA. Evaluation and Management of Decreased Libido in Men. J Sex Med. 2019 Sep;16(9):1326-1331. doi: 10.1016/j.jsm.2019.05.021. Epub 2019 Jul 20. PMID: 31336440.

* Dean JD. Management of Male Sexual Dysfunction. N Engl J Med. 2020 Oct 29;383(18):1762-1772. doi: 10.1056/NEJMcp2002379. PMID: 33139049.

* Rastrelli G, Corona G, Maggi M. Endocrinology of sexual function in men and women. Horm Mol Biol Clin Investig. 2019 Dec 11;41(1):20190059. doi: 10.1515/hmbci-2019-0059. PMID: 31412999.

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Q.

Losing Your Edge? Why Your Internal Engine Is Stalling & Medically-Backed Steps

A.

Low testosterone is a common, often overlooked reason your internal engine feels stalled, causing fatigue, lower libido, weaker workouts, brain fog, and mood changes, though sleep loss, stress, thyroid disease, diabetes, and heart issues can cause similar symptoms. Proper diagnosis requires morning blood tests on two separate days and evaluation for underlying causes, and many men can raise levels with better sleep, fat loss, strength training, stress control, adequate vitamin D, zinc and magnesium, and less alcohol, while testosterone therapy may help select patients but can suppress fertility and needs monitoring. There are several factors to consider, including urgent red flags that change next steps, so see the complete, medically-backed guidance below.

References:

* Konopka AR, Harber MP. Lifestyle interventions for improving mitochondrial function in health and disease. FASEB J. 2020 May;34(5):6033-6047. doi: 10.1096/fj.201902996RR. Epub 2020 Mar 19. PMID: 32188220.

* López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. Mitochondrial dysfunction and the aging process. Cell. 2018 Jul 26;174(3):511-522. doi: 10.1016/j.cell.2018.07.014. PMID: 30048126.

* Missailidis C, Annesley SJ, Fisher-Carroll L, Barnden LR, Staines DR, Marshall-Gradisnik SM, Eaton N, Newton JL, Smith PM. Metabolic features of myalgic encephalomyelitis/chronic fatigue syndrome. Curr Rheumatol Rep. 2018 Mar 12;20(5):26. doi: 10.1007/s11926-018-0731-y. PMID: 29530467.

* Milanese C, Di Nunzio M, Lattanzio F, D'Antona G. Exercise and metabolic health in aging. Curr Opin Clin Nutr Metab Care. 2019 Jan;22(1):31-37. doi: 10.1097/MCO.0000000000000529. PMID: 30419163.

* da Cruz Gouveia E, Paes F, Machado S, Nardi AE, Rocha NB. Nutrition, physical activity, and sleep: three pillars of aging well. Int J Environ Res Public Health. 2021 Jun 28;18(13):6903. doi: 10.3390/ijerph18136903. PMID: 34208460; PMCID: PMC8297746.

See more on Doctor's Note

Q.

Silent Struggle? Why Your Anatomy Is Misfiring + Medically Approved Next Steps

A.

Fatigue, low libido, brain fog, and slower recovery can reflect connected anatomy misfires, often from hormonal imbalance like late-onset low testosterone, and they warrant attention because untreated issues can affect bones, heart, mood, and metabolism. There are several factors to consider, and medically approved next steps include structured symptom checks, a doctor visit with morning labs to confirm and rule out other causes, lifestyle treatment first, and carefully monitored testosterone therapy when appropriate; see the complete guidance below because key details there can change which next step is right for you.

References:

* Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002 Oct-Dec;37(4):460-70. PMID: 12937402; PMCID: PMC164390.

* Cook C, Hegedus EJ. Diagnostic and Treatment Pathways for Musculoskeletal Disorders. Orthop J Sports Med. 2017 Apr 26;5(4):2325967117705191. doi: 10.1177/2325967117705191. PMID: 28480287; PMCID: PMC5410931.

* Hodges PW, Smeets RJ. Interaction between pain, movement, and motor control in musculoskeletal pain disorders: Implications for treatment. Phys Ther. 2015 Feb;95(2):273-87. doi: 10.2522/ptj.20140060. Epub 2014 Aug 21. PMID: 25147253.

* Saragiotto BT, Machado LF, Verhagen AP, van Tulder MW, Koes BW, Rzewuska M, Maher CG. Exercise therapy for patients with nonspecific low back pain: A systematic review and meta-analysis of randomized controlled trials. J Orthop Sports Phys Ther. 2016 May;46(5):372-88. doi: 10.2519/jospt.2016.6473. Epub 2016 Mar 23. PMID: 27008493.

* Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports Health. 2013 Nov;5(6):514-22. doi: 10.1177/1941738113482637. PMID: 24427426; PMCID: PMC3820252.

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Q.

What are some effective ways to stop hot flashes quickly in men?

A.

To stop a hot flash quickly, men can cool down their body with immediate measures like a cold shower or cool compress, and in some cases, medications such as megestrol acetate may be used under a doctor's supervision.

References:

Loprinzi CL, Michalak JC, Quella SK, O'Fallon JR, Hatfield AK, Nelimark RA, Dose AM, Fischer T, Johnson C, Klatt NE, et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med. 1994 Aug 11;331(6):347-52. doi: 10.1056/NEJM199408113310602. PMID: 8028614.

Mohile SG, Mustian K, Bylow K, Hall W, Dale W. Management of complications of androgen deprivation therapy in the older man. Crit Rev Oncol Hematol. 2009 Jun;70(3):235-55. doi: 10.1016/j.critrevonc.2008.09.004. Epub 2008 Oct 25. PMID: 18952456; PMCID: PMC3074615.

Witkowski S, Evard R, Rickson JJ, White Q, Sievert LL. Physical activity and exercise for hot flashes: trigger or treatment? Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7. PMID: 36696647; PMCID: PMC9886316.

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Q.

What self-care strategies can help manage erectile dysfunction?

A.

Self-care strategies to help manage erectile dysfunction include lifestyle changes like regular exercise, healthy eating, stress reduction, and avoiding smoking and excessive alcohol. These practices may improve blood flow and overall health, which can support better erectile function.

References:

Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl. 2015 Jan-Feb;17(1):5-10. doi: 10.4103/1008-682X.137687. PMID: 25248655; PMCID: PMC4291878.

Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med. 2018 Jun;6(2):75-89. doi: 10.1016/j.esxm.2018.02.001. Epub 2018 Apr 13. PMID: 29661646; PMCID: PMC5960035.

Lowy M, Ramanathan V. Erectile dysfunction: causes, assessment and management options. Aust Prescr. 2022 Oct;45(5):159-161. doi: 10.18773/austprescr.2022.051. Epub 2022 Oct 4. PMID: 36382171; PMCID: PMC9584785.

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Q.

Why do hot flashes often occur at night, and how can they be managed?

A.

Hot flashes often happen at night because our body’s temperature control becomes more sensitive during sleep, and they can be managed with lifestyle adjustments and sometimes medications.

References:

Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK65717/

https://www.ncbi.nlm.nih.gov/books/NBK65717/

Morrow PK, Mattair DN, Hortobagyi GN. Hot flashes: a review of pathophysiology and treatment modalities. Oncologist. 2011;16(11):1658-64. doi: 10.1634/theoncologist.2011-0174. Epub 2011 Oct 31. PMID: 22042786; PMCID: PMC3233302.

Thurston RC, Chang Y, Buysse DJ, Hall MH, Matthews KA. Hot flashes and awakenings among midlife women. Sleep. 2019 Sep 6;42(9):zsz131. doi: 10.1093/sleep/zsz131. PMID: 31152182; PMCID: PMC7368339.

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