Question: I'm a 61-year-old man. I have psoriasis, arthritis, and according to the doctor a "slight case of emphysema." If the outside temperature reaches 70, I begin to get extremely uncomfortable. Mild activity like cleaning house causes me to break out in a profuse sweat. I have a sedentary job and, at times, I can begin sweating just sitting at my desk. I get monthly testosterone injections that don't seem to be doing any good.

I recently heard a woman describing her hot flashes as "my inner child keeps playing with matches." My inner child seems to be playing with flame throwers.

Is there anything that can be done?

Dr. Hibberd's Answer:

Heat intolerance may be related to undiagnosed or undertreated hyperthyroidism. Have your doctor evaluate you for this and evaluate whether this "heat" you feel is related to an endocrine disorder (hormone-related as in hyperthyroidism, multiple endocrine neoplasia, etc.), or whether it actually is a consequence of your testosterone supplementation, or some other underlying condition you are not yet aware of (such malignancy, cardiovascular/pulmonary deterioration, etc.).

Usually, testosterone therapy in men is associated with problems because the available tests do not adequately assess free testosterone levels. With the exception of a free testosterone by dialysis assay (which is usually used only in research settings), free testosterone assays are limited and can be inaccurate. I therefore recommend measuring total testosterone on two separate mornings for more reliable information. The goal testosterone level for a man of your age is 400 ng/ml. I also recommend following the Endocrine Society Clinical Practice Guideline published in 2006 regarding safety monitoring of patients on testosterone supplementation.

You should know that testosterone is actually converted into estrogen in the brain and other organs through the actions of an enzyme called aromatase (estrogen synthetase). Aromatase is found in many tissues, including gonads, brain, adipose tissue (fat), blood vessels, skin, bone, as well as in women's placenta, endometrium, uterine fibroids, and endometriosis tissue, as well as in breast and endometrial malignancy. So perhaps your analogy with the flushes women complain of is not so far off base after all! See your doctor for a complete re-evaluation. Listen to your body. It will often tell more than any routine lab test can, and you will be healthier not ignoring new and unwelcome symptoms.