BPH medication: What works, what to expect
If your urinary flow is slowing or you wake at night to pee, BPH meds can help. Benign prostatic hyperplasia (BPH) is common in men over 50, and medication often reduces symptoms without surgery. I'll walk you through the main drug types, what they do, likely side effects, and simple rules to pick what's right with your doctor.
How the main drug types work
Alpha-blockers (tamsulosin, alfuzosin, doxazosin) relax the muscle around the prostate and bladder neck. Expect faster relief - usually within days to weeks - but they don't shrink the prostate. Common side effects include dizziness, low blood pressure, and ejaculation changes.
5-alpha-reductase inhibitors (finasteride, dutasteride) shrink prostate tissue by blocking hormone conversion. They take months to work but lower long-term risk of needing surgery. Sexual side effects like lower libido or erectile problems affect a minority but can persist after stopping in rare cases.
Combination therapy pairs an alpha-blocker with a 5-alpha-reductase inhibitor. Big trials, such as MTOPS, found combo treatment reduces symptom progression and the need for surgery more than either drug alone. Doctors often choose this when you have significant symptoms and an enlarged prostate on exam or imaging.
Tadalafil, known for erectile dysfunction, also helps urinary symptoms at a daily low dose. It's a good option if you have both ED and BPH, though it can cause headache or flushing.
Practical tips when taking BPH meds
Start with clear goals: ask your doctor whether the priority is quick symptom relief or lowering long-term progression risk. If you're over 60 with a large prostate, a 5-alpha-reductase inhibitor or combination therapy makes sense. If the main problem is slow stream or frequent urination and you want fast relief, an alpha-blocker is often first-line.
Watch for side effects: stand up slowly to avoid dizziness, report any persistent sexual changes, and tell your prescriber about blood pressure meds or nitrates before using tadalafil. Get PSA blood tests regularly if you're on finasteride or dutasteride - these drugs lower PSA, but doctors adjust the reading.
Herbal remedies like saw palmetto are popular, but most quality trials show limited benefit compared with placebo. If you try an over-the-counter supplement, keep using it only with your doctor's knowledge so it doesn't delay effective treatment.
Follow-up matters. If symptoms don't improve in a few months, or you have recurrent urinary retention, infection, or blood in urine, your doctor may suggest surgery such as TURP or newer minimally invasive options. Monitoring helps you avoid unnecessary procedures while keeping quality of life high.
Use reliable sources for buying meds. If ordering online, pick licensed pharmacies and keep prescriptions current. Ask your doctor or pharmacist if a generic version is appropriate—generics are usually cheaper and just as effective.
If side effects become intolerable, switching drugs or adjusting dose often fixes it. Don't stop suddenly without medical advice. Keep a symptom diary - times you pee, flow, urgency - and bring it to appointments. That small record helps tailor treatment faster and avoids guesswork. Ask questions until you understand.
