Lifestyle changes in diet, exercise and the environment may help to prevent or ameliorate
hot flashes and
low bone density in men and women after surgical
castration. Conventional medications, including
megestrol acetate,
SSRIs or
clonidine, may improve
hot flashes but may have limiting side effects. Some complementary and alternative approaches, including black cohosh,
vitamin E, and soy products, work as well as placebo to decrease
hot flashes and may be helpful, because they have low toxicity. Acupuncture and
neurontin are promising but must be studied further. With regards to the prevention of
osteoporosis and fractures in men and women,
bisphosphonates are the most potent of the currently available agents;
calcitonin is less effective. PTH has a large beneficial effect but is not yet available and is less well studied. In women, continued sexual intercourse and use of vaginal
lubricants and moisturizers help to minimize symptoms of vaginal
atrophy but do not ameliorate urinary symptoms. Low dose local
estrogen treatment is a promising approach for the latter complaints.