There are many areas that can be affected by changes in hormone levels. They are listed below with their definition and each will be covered in the Manage section.

Symptoms experienced by both men and women

Temperature regulation (hot flashes)

Most of the time, a hot flash is a short-lived event that begins with a sense of heat and growing redness that starts at the head and neck and can go all the way to the toes. Hot flashes are frequently followed by chilling episodes. Both men and women have described hot flashes in this way. Some people also describe their hot flashes as a feeling that their body is always running several degrees higher, that they experience a constant sensation of being hot and not something that comes and goes. Hot flashes can be accompanied by a small or large amount of sweating. Both men and women experiencing hot flashes may notice numerous emotions, including tension, anxiety and embarrassment.^{3 11}

What is happening to your body

Scientists do not completely understand what happens in the body during a hot flash. However, researchers have learned the following.

1. Hot flashes occur due to a loss of estrogen in women and a loss of testosterone in men. Women must be exposed to estrogen and have it taken away in order to experience hot flashes. Women with diseases in which they have always had a loss of estrogen do not experience hot flashes. Men must experience a sharp decrease in their testosterone levels³⁵ in order to experience a hot flash.
2. Core body temperature (internal body temperature) goes up just before a hot flash.¹²
3. There is probably a central mechanism for triggering hot flashes that involves the brain and neurotransmitters ("chemicals in the brain") such as serotonin or norepinephrine². Both estrogen and testosterone interact with these brain chemicals.

Mood - Irritability

For Women
Researchers have been trying to identify a link between depression and female menopause for some time. To date, no such relationship has been found. Women who experience symptoms of menopause tend to have a decreased ability to cope with stress, may experience more negative mood swings, and a decreased perception of mental well being.^{9 29} This is, however, not the same as depression.

In studies where menopause symptoms were treated, women reported better quality of life and improved mood. There are many things that can contribute to difficulty coping and increased irritability and anxiety around the time of menopause¹. Significant life changes such as children becoming truly independent and away from home, lack of adequate sleep, and decreased vigorous activity can all play a role besides the experience of physical symptoms of menopause.

For Men
For men experiencing treatment for prostate cancer, little research has been done regarding the broad possible scope of side effects. However, in related literature, it is clear that there is a link between low testosterone levels and decreased mood or depression.⁸ In men with low testosterone levels, studies have shown that testosterone supplements led to improved mood.²² However, there is not much information about the specific effects on mood in men receiving treatment for cancer.

What is happening to your body
There are receptors (connecting points) for sex steroids (estrogen, progesterone and testosterone) in the brain and there is an interaction (talking) between neurotransmitters, such as serotonin, and these hormones. All of this occurs in your brain automatically without you ever knowing or feeling it. However, the relationships and any possible important effect on mood is not known.²³

Bones - Osteoporosis

Osteoporosis is a condition whereby the bones lose their mass (size) and become more porous (pock- like, or full of tiny holes like Swiss cheese). This puts men and women at risk for developing shorter stature, a rounded spine/back, fractures and can be associated with an increased death rate (mostly due to hip fractures). Osteopenia is a condition of bone thinning, but it is not as severe as osteoporosis. Bone loss is measured with a bone mineral density test, which is like an x-ray. Measures of bone density are taken typically at the spine and femur at the hip. Osteoporosis is commonly defined as a femoral measure greater than 2.5 standard deviations below the average expected of a young, healthy, white woman or man.³⁰ This is shown in the table below.

There is some bone loss expected as a result of normal aging. For men and women, this bone loss is thought to be .4 to 1.3% per year beginning at age 40 through age 80.⁷ Chemotherapy and androgen deprivation therapy have been shown to speed up this bone loss in women and men. ^{36 10} In addition to chemotherapy or androgen deprivation therapy, tamoxifen can affect the bone. In post menopausal women, tamoxifen can slow down bone loss. In premenopausal women, tamoxifen can speed up bone loss.³² Some studies have reported rates of bone loss in men on androgen deprivation therapy to be from 2 to 8% in the lumbar (lower) spine over a year.¹⁰

Behaviors that can increase bone loss in both men and women include smoking, drinking too much alcohol (more than 2 drinks per day), taking in too little calcium, and not being physically active.⁷

What is happening in your body
Normally, bone is being formed and dissolved all of the time. There are cells that dissolve bone called osteoclasts and cells that make bone called osteoblasts. Collagen is needed to make bone.

In women, low estrogen is tied to bone loss because the bone dissolving cells are more active than the bone making cells. In other words, bone is dissolved at a rate faster than it is being formed or remodeled. One reason is that decreased estrogen is associated with decreased collagen (less ability to form bone). Within a few years after menopause, it is thought that women will have lost 50% of their lifetime spinal bone loss. After estrogen loss, it is also thought that the help people get for their bones by taking calcium and vitamin D is a little less.

In men, androgens can connect to the cells that make bone, osteoblasts. Testosterone may also be responsible for making bone larger and thicker directly. With lowered levels of testosterone, men also have less estrogen. Having lower levels of both testosterone and estrogen can cause less bone making and more bone destroying action in men.¹⁵

Sleep and Rest - Sleep Disturbance

A diagnosis of cancer has been shown to impact both sleep and fatigue in many people, both men and women. Likewise, the process of aging has been associated with decreased sleep, with older people sleeping less during the night. In addition, sleep disturbance is associated with the onset of menopause. Sleep disturbances may include problems falling asleep, problems staying asleep or problems waking up too early. In addition, you may wake from sleeping all night but not feel rested, due to poor quality sleep. Problems with sleep may be attributed to being awakened at night from hot flashes, night sweats or the need to go to the bathroom. You may experience sleep issues regardless of any other symptom or your problems with sleep may be tied to the symptoms of fatigue and depression ^{4 37 6}

What is happening to your body
Very little is known about how sleep may be affected by hormone disturbances. Interestingly, one theory about how hormones affect sleep involves the same neurotransmitters in your brain, serotonin and norepinephrine, that seem to have a role in hot flashes. Both serotonin and norepinephrine help to regulate sleep. It may be the change in relationship between estrogen, testosterone, and these neurotransmitters that cause sleep issues in women and men with changing hormones.

Another theory is that estrogen and progesterone help keep our circadian rhythms intact. By experiencing a decrease in estrogen and progesterone, all of the neuroendocrine substances our body produces that help us have normal wake and sleep cycles may be altered. In many studies, hot flashes and night sweats are linked to sleep awakenings.³⁷

Heart - Cardiovascular Disease

The risk for development of cardiovascular (heart and blood vessels) disease as a result of decreased hormones in men and women is not clearly defined. However, some research studies have reported that cardiovascular disease in women who are postmenopausal is higher than in women of similar ages who are premenopausal. In most studies, age and smoking increased the risk for heart disease. There are studies that also connect hormone changes (both estrogen and testosterone) with changes in the types of fats our body makes (lipid profiles). Therefore, the combination of age, smoking and hormone changes may combine to increase the risk of heart disease. However, there are no studies that have proven a decrease in estrogen or testosterone is directly responsible for deaths due to heart disease.

What is happening to your body
There are estrogen, progesterone and testosterone receptors in vascular tissue, including the arteries of the heart. With decreases in these hormones, cardiac arteries become less flexible and lipids (fats) that move through the blood become less dense (lighter) (low density lipids increase), all of which increases the risk of cardiac disease. Studies show that total cholesterol increases more quickly after menopause. Many people experience weight gain, particularly in the abdomen, which increases the risk of heart disease in both men and women.^{23 29} In men, some studies have shown giving testosterone lowers total cholesterol and the unwanted low density lipids.⁴⁰

Skin - Dry and Elasticity Changes

You may notice that your skin suddenly becomes excessively dry, or you may notice some sagging (particularly on the face at the chin, neck and cheeks) and the appearance of wrinkles. Skin may also take on the appearance of being more thin, less full and smooth looking. You might also notice that effects of the sun and wind or extremes in temperature take more of a toll on the skin, with less ability to "recover".³⁸

What is happening to your body
Decreases in estrogen are associated with a decrease in collagen and elastin (substances in your skin) that gives the skin flexibility and prevents the sagging and wrinkling. Oil and sweat glands are less active, which contributes to the dryness of the skin. There is also reduced blood flow to the skin, causing a more pale appearance. Additionally, as a result of decreased blood flow, the skin develops blood vessels near the surface, which can lead to increased bruising.³⁸

Men have similar changes in their skin. Oil and sweat glands are less active as a result of less testosterone. In addition, men may also have decreases in collagen as a result of less estrogen. Testosterone can be made into estrogen by the body and estrogen has effects in the male body to a lesser degree but still having potentially important effects.¹⁵