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Hot flushes on ADT: what helps

Reviewed October 2026

Hot flushes and night sweats affect up to 80% of men on ADT. They can disrupt sleep and mood, and they can last for years (MANCAN). They happen because low testosterone affects the brain’s temperature control.

Practical tips

• Layer up so you can strip off quickly, and wear breathable fabrics.
• Keep cool at night with a fan, light bedding and a cool room.
• Notice your triggers. Hot drinks, alcohol, spicy food and stress are common ones.
• Slow breathing. When a flush starts, breathe slowly and deeply (around 6–8 breaths a minute) until it passes.
• Stay active. Exercise helps fatigue and sleep on ADT.

What the evidence says about CBT

Cognitive behavioural therapy (CBT) helps you change how you respond to flushes and reduces how bothersome they feel.

• In the MANCAN trial, a 4-week guided self-help CBT program (booklet, audio and phone support) significantly reduced how bothersome flushes were, and how often they occurred, at 6 weeks (Stefanopoulou et al. 2015).
• A larger follow-up trial, MANCAN2, confirmed short-term benefit but found no lasting difference at 6 months (British Journal of Cancer, 2026).
• Our take: these skills help, and they work best if you keep practising them.

Medication: a conversation for your doctor

If flushes are severe or don’t settle, ask your doctor about medication.

• A large randomised trial found medroxyprogesterone and cyproterone reduced flushes more than venlafaxine (Irani et al. 2010).
• UK NICE guidance recommends medroxyprogesterone as a first option (via MANCAN2).
• Every medicine has pros and cons, and only your team can say what suits you.

Ask your doctor: “My hot flushes are affecting my sleep and daily life. What are my options?”