Prostate Medications

There are various medication to help men with urinary symptoms that are likely related to prostate gland changes due to age (see Benign Prostatic Hypertrophy).  Generic names (brand names in parentheses) include:

1.ย  Alpha-Blockers — The most common ones are Tamsulosin (Flomaxยฎ), Terazosin (Hytrinยฎ), Doxazosin (Carduraยฎ), and Alfuzosin (Uroxatralยฎ).ย  Side effects may include dizziness upon standing (especially with the first dose, or if dosage is increased), decrease in orgasm pleasure, and retrograde ejaculation.ย  The latter is least important but may be most startling — no ejaculate comes out with orgasm.ย  The reason is that it’s expelled backwards, into the bladder.ย  This is harmless, and only a problem for men attempting to conceive a child. Some people however remain dismayed by it.

2.  5-Alpha-Reductase Inhibitors  —  These include Finasteride (Proscarยฎ) and Dutasteride (Avodartยฎ).  They shrink the prostate, but may take 6-12 months for full effect.  Men who have incomplete symptom relief from Alpha-Blockers, then feel lots better on these medications, can often stop taking the former without problem.  The main side effect of this medication is decreased interest in sex.

Clinicians should be careful prescribing this class of medications to men who might happen to conceive a child.  It could cause birth defects, even up to 6 months after stopping it.  In general, it’s mostly older men who experience prostate symptoms, & may happen to not be likely to want or have more children.  But I see lots of younger men with various urinary symptoms, which are sometimes psychological; I avoid this medication for them. Especially since they invariably have normal prostate glands.

3.  Anticholinergics —  The main one prescribed is oxybutynin (Oxytrolยฎ, Ditropanยฎ, etc.).  This is mainly for those who wake up a lot at night to urinate.  The problem here is that the med works on the bladder, not the prostate, & carries a risk of stopping up urination altogether in men with large prostates.  It’s OK to try, but any man who finds it harder to pee should stop the med.

4.  Phosphodiesterase-5 Inhibitors:  These medications are famously prescribed for men with erectile dysfunction (impotence, of varying degrees).  One of them, Tadalafil (Cialisยฎ) can help with prostate symptoms when taken daily at a low dose.  Other prostate medications work better, but if a man has both conditions, this could possibly be a logical treatment.

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