BPH, (Benign Prostatic Hyperplasia), or an enlarged prostate is a nearly ubiquitous condition; estimates suggest that 90% of all men who live to 85 will suffer from BPH.
A few decades ago if you had prostate problems or benign prostatic hyperplasia, the only conventional medical approach would have been surgery.
However, over the last few decades, drugmakers have created more and more pharmaceutical options to “treat” BPH and shrink the prostate.
This new abundance of options can often be confusing. Many men are left questioning “which medication is right for me?” Or “is this pill safe, does it work, what are the side-effects?”.
This article will provide you with a complete, easy to understand break down of all of the commonly prescribed benign prostatic hyperplasia medications.
We will address the safety, efficacy, speed of results and long term side-effects of each drug. We will also look at the most common alternative, natural & herbal treatments to help men with mild to severe BPH.
This article also contains a printable checklist that you can use to help you talk to your doctor about which medication may be best for you.
Different types of BPH drugs
The following is a quote from a 2007 Harvard medical panel discussion on the state of prostate medications.
“One of the most vexing issues for people with BPH is deciding whether to begin treatment for urinary difficulties and other symptoms. Studies of the natural history of BPH for up to five years show that, even without treatment, symptoms will not worsen in 16% of men, and they will actually improve in 38% of men.”
Let’s do the math: in the majority of cases (54%), men will either see no worsening symptoms or see an improvement in their symptoms, without taking prescription prostate medications.
While that is a majority of men, it is only a slim one, and it still leaves 46% of men who will see their health decline if they take no action. So what are their options?
Currently, there are three distinct types of prescription prostate drugs prescribed: 5-alpha-reductase inhibitors, alpha blockers, and phosphodiesterase-5 Inhibitors.
5-alpha-reductase inhibitors work by interfering with an enzyme called 5-alpha-reductase. This enzyme is primarily responsible for converting testosterone to dihydrotestosterone (DHT). DHT is the hormone that causes the growth of prostatic tissue and BPH.
As a category of drugs 5-alpha-reductase inhibitors generally, have more sexual side effects than other prostate medications. They can cause decreased libido, erectile dysfunction, ejaculation problems as well as male breast and various effects on mood, which is probably due to the way the drug interacts with testosterone levels.
It is worth noting that not all 5-alpha-reductase inhibitors are as likely to cause these side effects. Nor would all men experience them, if you are experiencing side effects with one medication then you may wish to talk to your doctor about changing to a different drug.
One significant advantage of 5-alpha-reductase inhibitors as a drug type is that they do affect prostate size. Whereas the other commonly prescribed drug type, (Alpha Blockers) reduce the symptoms, of BPH without shrinking the prostate.
Notably, alpha-blockers do not directly affect the prostate in any way. Instead, they work by preventing the muscles in your bladder and prostate from clenching. They hold the bladder sphincter in a permanently relaxed state, allowing you to pass urine with greater ease.
The upside of alpha blockers is that they work faster than 5-alpha-reductase inhibitors. You can experience relief from symptoms in a matter of days or weeks. Whereas 5–alpha-reductase inhibitors, on the other hand, take effect slower, on average about three to six months to start working.
Additionally, it’s worth noting that some studies have shown that alpha blockers are ineffective once the prostate gets over 40-50 grams, which means that alpha blockers may not be suitable for men with more severe cases of BPH.
There currently is only one phosphodiesterase-5 Inhibitor approved by the FDA to treat BPH, Cialis. If you are struggling with ED and an enlarged prostate that your doctor may prescribe you Cialis instead of the more common prostate medications.
Commonly prescribed prostate medicines
Finasteride is a 5-alpha-reductase inhibitor, meaning it prevents the enzyme 5-alpha-reductase from converting testosterone into DHT. Prostate growth and size is dependent mainly on DHT levels.
Studies have revealed that Finasteride reduces intraprostatic DHT level by 91.4%. Making it the most effective of the 5-alpha-reductase inhibitors currently available on the market. However, it may also be the reason that Finasteride has such severe sexual side effects.
By lowering DHT levels, Finasteride actively decreases the size of the prostate. However, this process takes at least three to six months before the clinical effects kick in and the prostate reduces in size. Therefore the efficacy of finasteride and 5-alpha-reductase inhibitors cannot be felt till a patient has been on the medication for a substantial amount of time.
Unfortunately, despite you having to be on the drug for six months until you can experience any relief, side effects can begin to manifest in a matter of days or weeks and can get worse over time.
In a 4-year placebo-controlled study of 1,524 patients treated with Finasteride and 1516 patients treated with placebo were followed over a period of 4 years.
The most frequently reported adverse reactions were related to sexual function:
- 8.1 % of men reported regular impotence
- 6.4 % of men reported decreased libido
- 3.7% of men saw a reduced volume of ejaculate
Less common side effects included: the growth of male breasts; tenderness, soreness, and pain in male breasts; rashes, allergic reactions, itching, hives, and swelling of the lips and face.
Some men reported testicular pain, and there was a weak link to increased risk of developing male breast cancer.
More recent research also shows that the sexual and cognitive side effects of finasteride can persist for as long as ten years after men stopped taking the drug.
A 2014 meta-study coined the phrase “Post Finasteride Syndrome,” and noted that:
“Many clinicians are unaware of the scope of the persistent physical and psychological adverse effects of finasteride. Symptoms range from minor to severe.”
The meta-study examined 12 research papers that all showed high percentages (80-90+ percent) showing persistent and long-lasting sexual and psychological side effects.
A 2011 research paper had the highest percentages:
“96% of the men in the study who took finasteride experienced sexual problems lasting for more than a year after they stopped taking the drug.”
In another large scale drug report from 2017, 103 young men (16-42 years old) who were taking low dose finasteride for hair loss developed ED. In a third of them (33%), ED persisted after stopping the medication.
The study also noted that the longer men took finasteride or dutasteride, the higher their risk. Men who had taken finasteride for a period of 205 days had a 4.9-fold higher risk of Persistent Erectile Dysfunction (PED) than men with shorter exposure.
The sexual side effects of Finasteride is often the primary concern for men. However, there is also a potential risk of more aggressive prostate cancer that may be associated with Finasteride.
Multiple studies have now reported that Finasteride may reduce the incidence of prostate cancer, although these are controversial results. It appears that Finasteride may lower your risk of developing slow-growing prostate cancers while increasing your risk of aggressive prostate cancer.
The largest study investigating prostate cancer prevention with Finasteride was published in 2003. It found a 24.8% risk reduction in the prevalence of prostate cancer over seven years.
However, it also noted an alarming increase in high-grade 7 or above tumors in the Finasteride group (37%) versus the placebo group (22%).
Despite the risks and potential side effects of Finasteride, many men still choose to take it, due to its proven efficacy.
Just after the FDA approved Finasteride, a large scale study was conducted examining its efficacy.
Eight hundred ninety-five subjects with BPH were randomized to receive placebo or 1mg or 5 mg of Finasteride over one year (Gormley, 1992). The primary outcome measures consisted of a symptom score and a peak flow rate, although measurements of prostate size were also recorded.
The symptom score measures the total scores of nine symptoms: decreased urinary stream, dribbling, interruption in the stream, hesitancy, feeling of incomplete emptying, straining to initiate flow, urgency, incontinence, and dysuria.
The group taking the 5 mg oral dose of finasteride per day showed a statistical improvement in symptoms (21% improvement) compared with the placebo group (just 2%). Another group taking a lower dose of finasteride (1mg oral per day) saw no statistical improvement in symptoms over the placebo group.
Further studies have demonstrated that this response is associated with prostate size at the beginning of the treatment. Boyle et al., 1996, undertook a meta-analysis of six randomized, placebo-controlled clinical trials to provide a more thorough consensus.
The conclusion was that men with smaller prostate saw little-to-no symptomatic relief when compared to men with larger prostates.
Approximately 80% of the variation in treatment effect between studies was attributed to differences in mean prostate size. The beneficial effects are most pronounced in men with enlarged prostates (>25 mL).
In general, Finasteride seems to cause a modest improvement to BPH symptoms after being taken for 12 months.
As with all drugs, your body will react differently to other men. You may experience many or only a few side effects, or you may have a severe reaction.
You should consider the following factors when deciding whether or not to take Finasteride; Firstly prostate size, as that is the most significant factor in determining whether or not Finasteride is going to be effective.
Second, you should consider whether or not you can wait 6-12 months for an average 20% reduction in symptoms. Next, the decreased risk of less aggressive cancers versus the increased risk of more aggressive cancers should be considered. Then the mental side effects on mood and cognitive decline.
Finally, based on feedback from our customer support team, the primary complaint and regret from men who take Finasteride are the sexual side effects. Studies have shown that Finasteride induced sexual dysfunction can last for many months or even years before you would regain full or even partial sexual function.
GlaxoSmithKline developed dutasteride as a competitor to Finasteride. It was patented in 1996 and approved in 2000 to treat BPH. They began selling it under the brand name Avodart.
Like Finasteride, Dutasteride is a 5-alpha-reductase inhibitor. However, whereas Finasteride stops only Type two 5-alpha-reductase (the alpha reductase enzyme in the prostate), Dutasteride is a dual inhibitor. Meaning it affects both type one and type two 5-alpha- reductase. (Type 1 is created outside of the prostate, type 2 is produced inside of the prostate).
Dutasteride is also a more potent inhibitor of Type-2 than Finasteride. Resulting in near-complete suppression of serum DHT in men who take this drug.
There are two notable differences between Dutasteride and Finasteride. Firstly, as a result of being a dual, high potency inhibitor, Dutasteride works a little quicker than Finasteride. Meaning you should expect to see results sooner, (after 1 month rather than after 3).
Secondly, Dutasteride has a longer serum half-life than Finasteride, (3 to 16 hours for Finasteride and 5 weeks for Dutasteride). The longer half-life may cause additional, adverse effects and may cause those side effects to persist for long after discontinuing the drug.
The concerns about Dutasteride are mostly the same as the concerns about Finasteride. The primary concern about both 5 alpha-reductase inhibitors are the persistent sexual side effects and the increased risk of developing certain rare but aggressive forms of prostate cancer.
A trial by REDUCE to study Dutasteride and Prostate Cancer concluded that there was an increased incidence of Gleason score 8-10 (high-grade) prostate cancer compared with men taking the placebo (1.0% versus the placebo group 0.5%).
In another 7-year placebo-controlled clinical trial with men taking a 5mg dose of Finasteride, similar results for Gleason score 8-10 prostate cancer were observed. They concluded that both 5 alpha-reductase inhibitors might increase the risk of development of high-grade prostate cancer.
In terms of sexual side effects, there is no evidence of any difference in frequency or severity of sexual side effects. Similar percentages of men report regular impotence, decreased libido and decreased volume of ejaculate for both 5-alpha-reductase inhibitors.
A 2017 study in the Hormone Molecular Biology and Clinical Investigation stated:
“Findings suggest that long-term dutasteride therapy produces worsening of ED, reduced T levels and increased glucose, HbA1c and alters lipid profiles, suggesting [an] induced imbalance in metabolic function. We strongly recommend that physicians discuss with their patients these potentially serious adverse effects of long-term dutasteride therapy before instituting this form of treatment.”
Despite the risk of side effects, many doctors continue to prescribe Dutasteride and many men continue to see improvements when they take it. A 2002 study looked at the efficacy of Dutasteride at a dose of 0.5 mg taken orally per day (this is the standard dose).
This study compared 4,325 patients from three randomized, placebo-controlled trials (ARIA 3001 [United States], ARIA 3002 [United States], and ARIA 3003 [19 countries]) covering 400 sites in total.
The research concluded that the patient’s symptoms started to improve at 3 months, with significant improvements for most patients pooling around the 6 months mark. An average 21.4% improvement in symptoms was noted at 24 months. This is in line with the 21% improvement reported at 3 years in the large scale Finasteride study mentioned earlier in this article.
The faster results may be due to the increased strength of the 5 alpha-reductase inhibiting properties of Dutasteride over Finasteride. The study also noted a 57% reduced risk of acute urinary retention at 24 months, and the risk of BPH-related surgical interventions was 48% lower than a placebo control group.
A 2005 study also concluded that Dutasteride was effective, at shrinking the prostate. Noting that it reduces serum DHT levels by more than 90% in 2 weeks and significantly reduces prostate size in only 1 month, producing a 25% reduction in size over 2 years.
In addition, Dutasteride decreased total PSA levels by approximately 40% after 3 months of treatment and approximately 50% after 24 months of treatment.
As Finasteride and Dutasteride are both 5 alpha-reductase inhibitors, there are similar factors to consider. Firstly, prostate size, given this is the most significant indicator of whether or not a 5 alpha-reductase inhibitor is going to be useful for you.
While it is faster working than Finasteride, you will still have to wait three months before seeing any symptomatic relief. You can expect an average 21% reduction in symptoms over two years. It also has several unpleasant quality of life side effects, primarily sexual in nature.
Men considering taking Dutasteride should consult their doctor and then the way the potential side effects might impact their lives. They may also want to consider other natural alternatives that have fewer side effects.
Terazosin is a targeted alpha-blocker drug that was discovered in 1977 by Jaroslav Kyncl and his associates at Abbott Laboratories in Chicago.
Alpha-blocker medications work by binding to alpha-adrenergic receptors which prevent the receptor from being stimulated. This prevents the transmission of nerve impulses and forces the smooth muscles in the prostate, bladder to relax.
Because it is targeted, Terazosin should only affect the smooth muscles around the bladder and prostate. Allowing for greater amounts of urine to flow more freely, however, it does nothing to shrink or heal the enlarged prostate.
There are a number of side effects associated with Terazosin, hypotension, syncope, priapism and floppy iris syndrome.
The combined data from six placebo-controlled trials involving once-a-day administration of Terazosin at doses ranging from 1 to 20 mg reveals that despite its targeted nature, Terazosin still causes a marked lowering of blood pressure.
This can manifest as postural hypotension, and syncope (sudden loss of consciousness). Losing consciousness as a result of low blood pressure is most likely due to rapid dosage increases or the introduction of another antihypertensive drug. However, it can happen as a regular side effect of the medication, with no clear catalyst.
With Terazosin, the syncopal episode can be followed by high heart rates of 120-160 beats per minute, meaning that this medication may not be suitable for anyone with cardiovascular health concerns. However, in clinical trials involving 2,000 hypertensive patients treated with Terazosin, syncope was reported in only 1% of patients, (approximately).
Priapism,(painful, penile erection sustained for hours which cannot be relieved by sexual intercourse or masturbation), occurs in probably less than one in every several thousand patients taking Terazosin.
Intraoperative Floppy Iris Syndrome (IFIS) is a condition observed in patients undergoing cataract surgery that requires modification of the surgical technique. It has been associated with patients that have past or present treatment using alpha-1 blockers. Patients that need this kind of surgery must avoid treatment with Terazosin or other alpha-blockers.
In clinical trials, 21% of the patients taking Terazosin experienced one or more of the following symptoms related to low blood pressure: dizziness, hypotension, postural hypotension, syncope, and vertigo. Other reported side effects of Terazosin are:
- Dizziness 9.1% (of patients)
- Weakness 7.4%
- Headache 4.9%
- Somnolence 3.6%
- Tiredness 3.3%
- Flu Syndrome 2.4%
- Nasal Congestion/Rhinitis 1.9%
- Nausea 1.7%
- Dyspnea 1.7%
- Blurred Vision/Amblyopia 1.3%
- Peripheral Edema 0.9%
- Weight Gain 0.5%
A 2002 review of 17 studies involving 5,151 subjects of placebo-controlled studies with patients receiving Terazosin alone or in combination with Finasteride noted an average 37% improvement in reported symptoms. Study duration ranged from 4-52 weeks.
The improvement in the International Prostate Symptom Score (37%) and Peak urine flow rates (22%) by patients taking Terazosin was noticeable but did not differ significantly from the other alpha-blockers.
Notably, adverse side effects were generally mild but more frequent than with other alpha-blockers, which result in two to four-fold increase in treatment discontinuation.
As with other alpha-blockers, Terazosin does not affect the prostate size. Rather the improvement in symptoms is the result of its impact on the smooth muscle of the prostate, bladder neck and prostatic urethra. But the static component of the obstruction (the enlarged prostate) is not affected. It is a symptomatic treatment only.
Terazosin’s efficacy in the treatment of BPH symptoms is similar to other alpha blockers. But despite its targeted nature it still has potentially undesirable effects on blood pressure.
Also, its higher rate of side effects, even mild ones, make it a less popular choice. Besides the numerous side effects, the patient should keep in mind that this treatment doesn’t cure BPH and is only used to relieve symptoms.
Prazosin (Minipress) is a less commonly prescribed alpha blocker than others in this report.
The US Food and Drug Administration (FDA) has disapproved the use of this medication as a primary BPH treatment. It is only really prescribed if the patient presents primarily with hypertension and secondarily with BPH.
It has been available since 1982 under the brand name Minipress, which is manufactured by Pfizer.
The exact mechanisms behind the blood pressure-lowering effects of prazosin are still unknown. However, like other alpha-blockers, Prazosin decreases the tone of the bladder sphincter and allows the opening of the bladder into the urethra.
This relieves the urinary symptoms associated with benign prostatic hyperplasia. Through this effect, the symptoms of an enlarged prostate are masked, and the patient’s urination improves marginally.
Notably, blood levels of prazosin reach their peak within about three hours of an oral dose. The blood pressure lowering effect occurs within two hours of a dose and reaches a peak at two to four hours.
Because Prazosin does not last long in the body, it needs to be taken two to three times daily. This makes it a less attractive option than other alpha blockers as there is always a chance the patient forgets to take a dose or is unable to take a dose at some point in the day, and their symptoms return.
As with all alpha-blockers, Prazosin may cause syncope (sudden loss of consciousness). This is due to an excessive postural hypotensive effect, although occasionally with Prazosin, the syncopal episode has been preceded by a bout of severe tachycardia (abnormally fast heart rate).
These episodes usually occur within 30 to 90 minutes of the initial dose. It has also been reported in association with rapid dosage increments or the introduction of another antihypertensive drug.
Additionally, Prazosin has a well known strong “first dose” effect, wherein the first dose causes a sudden sharp decline of blood pressure, resulting in a loss of consciousness. For this reason, patients are often advised that their first dose should be 0.5mg and they should take it 30 minutes before they want to go to sleep.
Other symptoms often associated with lowering blood pressure – and therefore Prazosin – are dizziness or drowsiness; lightheadedness and fainting. For this reason, it is recommended to avoid driving or performing hazardous tasks 24 hours after taking this medicine or when the dose is increased.
Prazosin has also been linked to Priapism (a painful penile erection sustained for hours, unrelieved by intercourse or masturbation). If priapism is not treated immediately, it could result in penile tissue damage and permanent loss of potency.
In percentage, the most frequent negative side effects associated with Prazosin therapy are:
- Dizziness 10.3%
- Headache 7.8%
- Drowsiness 7.6%
- Lack of energy 6.9%
- Weakness 6.5%
- Palpitations 5.3%
- Nausea 4.9%
Less frequent adverse reactions which are reported to occur in 1–4% of patients are vomiting, diarrhea, constipation, edema, orthostatic hypotension, dyspnea, syncope, vertigo, depression, nervousness, rash, blurred vision, reddened sclera, epistaxis, dry mouth, and nasal congestion.
In an open randomized study, 121 male patients were randomized to receive treatment with Prazosin, Terazosin, or Tamsulosin for 4 weeks.
There was a significant improvement in total symptom score when compared to baselines in the Prazosin, Terazosin, and
Tamsulosin groups, with 38%, 39%, and 26% respectively.
No new studies have been published regarding the use of Prazosin for BPH management since the American Urology Association published its BPH guidelines in 2003. In light of these guidelines, Prazosin is much less commonly prescribed for BPH.
As Prazosin is an alpha-blocker drug; its effect is limited to symptom relief, it doesn’t have any effect on the prostate size.
The use of Prazosin therapy in the management of BPH lowers urinary symptoms but is only normally prescribed if the patient has high blood pressure and BPH.
If you have been prescribed Prazosin or are considering it, you should be aware that there is very limited data from long-term, randomized trials on its long term safety and efficacy. There is also widespread availability of other alpha blockers that have fewer side effects.
This position is widely held and shared by The American Urology Association and regulatory organizations such as the US Food and Drug Administration (FDA) which disapproved the use of this medication as a primary BPH treatment. Its use in BPH is no longer enlisted or labeled in the pharmaceutical industry brochures of the product.
Doxazosin mesylate was introduced to the US market in 1995. It is a quinazoline manufactured by Pfizer pharmaceutical under the brand names Cardura. Cardura is a selective α1 alpha-blocker used as an antihypertensive agent to treat high blood pressure and Benign Prostatic Hyperplasia (BPH).
As with all alpha-blockers, Doxazosin acts on the adrenergic receptors that are present in the prostatic tissue, prostatic capsule, and bladder neck.
By relaxing the smooth muscles, alpha blockers can alleviate the symptoms of BPH such as urinary frequency, nocturia (excessive urination at night), weak stream, hesitancy and incomplete emptying of the bladder.
By blocking these receptors, Doxazosin reduces the tone of the smooth muscle, leading to decreased urethral resistance, and relief of the obstruction symptoms.
Nevertheless, the drug does not have any effect on the size of the enlarged prostate tissue – which is the fundamental cause of the urinary obstruction.
This α1 receptor is also present in many blood vessels. When they are stimulated, the blood vessels are constricted. Hence, the blockage of α1 receptors at this level produces vasodilation (constriction) of blood vessels and can result in a reduction in your blood pressure.
This is beneficial if you have abnormally high blood pressure and dangerous if you do not. Due to this effect, Doxazosin is used as an antihypertensive. In some cases, this effect is greater than desired, producing side effects like hypotension (low blood pressure).
In 2000, a large trial designed to evaluate different antihypertensive medications including Doxazosin and its impact in preventing heart attacks was halted due to the recommendation of the National Heart, Lung, and Blood Institute.
This was because in the group receiving Doxazosin, a significant 25% higher rate of combined cardiovascular disease (CVD), including angina pectoris, congestive heart failure, stroke and peripheral arterial, was observed.
Furthermore, the Doxazosin group had a twofold higher rate of congestive heart failure when compared with the group receiving other medications, and there were trends in the same direction for strokes.
Despite these alarming results, the drug is still being used as an antihypertensive, and in the treatment of patients with Benign Prostatic Hyperplasia (BPH).
In addition to these concerns, Doxazosin has all of the issues associated with alpha blockers in general, including syncope and other postural symptoms such as dizziness, lightheadedness, or vertigo.
These effects are most common with the first dose but can also occur when the dosage is increased, or if therapy is interrupted for more than a few days.
With Doxazosin, the condition of priapism (sustained erection regardless of sexual activity) is a known side effect. But the frequency of this complication is less than one in every several thousand patients.
Other adverse reactions with an incidence of less than 1% but of clinical interest are tachycardia (0.9 %; dysuria (0.5%), decreased libido (0.8%), leukopenia and thrombocytopenia.
Abnormal liver function tests, cholestasis, jaundice, and hepatitis have also been reported. Fluid retention, resulting in weight gain, may as well occur (0.8%).
There are currently 4 alpha-blockers that are FDA-approved to treat LUTS: Doxazosin, Terazosin, Tamsulosin, and Alfuzosin.
The American Urological Association (AUA) Practice Guidelines committee reports that all of them are equally effective, causing on average a 4 to 6 point improvement in the American Urology Association symptom score.
Many patients perceive this score as a meaningful change. In addition, the improvement in maximal urinary flow rate is similar among all 4 medications.
In the group of men where BPH symptoms resulted from smooth muscle constriction rather than obstruction by excess glandular tissue, they are more likely to respond to an alpha-blocker. This leads to symptom improvement in 30-40% of patients.
Approximately 30% of patients experience at least a 30% increase in peak urinary flow rate. The usual improvement in peak urinary flow rate is 16-25%. Patients with more severe symptoms have a greater response to treatment than those with milder symptoms. But It is not possible to predict who will respond to medication or which drug will work best for a particular patient.
A review article published in 2007 found that all four alpha-blockers were effective at relieving BPH symptoms. Men taking Doxazosin had a 14-39% improvement in relieving BPH symptoms.
A study by Pfizer (the manufacturer of Doxazosin) also reported improvements in indirect measures of obstruction, such as a maximum urine flow rate, which is significantly larger with Doxazosin (34-42%) than with the placebo (13-17 %).
However, this differs from independent studies. Fourteen randomized trials were analyzed and showed that the average magnitude of symptom improvement (International Prostate Symptom Score (IPSS) with Doxazosin typically did not achieve a level detectable by patients when compared with placebo (Timothy J Wilt).
Doxazosin, like other alpha-blockers drugs, has no effect on the prostate size or BPH. It is a symptomatic treatment of this condition.
A placebo-controlled study collected data from 1148 men who were receiving Doxazosin. Overall, they showed an increase in the prostate volume by a median of 24% over an average of 4.5 years in the patients receiving Doxazosin.
This suggests that continued growth of the prostate in patients taking Doxazosin eventually overcomes the relaxation effects of the smooth muscle achieved by its alpha blocker effect.
In other words, Doxazosin is only effective until the condition worsens. This, combined with the potentially higher risk of strokes and cardiovascular disease, should be taken into account when deciding if you wish to take this medication.
Tamsulosin became available to the market in 1996 and was promoted as a breakthrough. Tamsulosin is now the most commonly prescribed drug for men with symptoms of BPH and is often sold under the brand name Flomax.
Commonly reported side effects of Tamsulosin include: dizziness, nasal congestion, rhinitis, rhinorrhea, sinus congestion, seasonal allergic rhinitis, and even drowsiness.
It is highly likely that current research underestimates the number of, and seriousness, of these side effects. The research conducted around this drug is kept from the public, providing very little information about the dangerous effects of Tamsulosin (popularly known as Flomax).
A pharmacologist revealed in 2014 that over 75% of registered trials for tamsulosin were hidden, which is a highly worrying statistic. Therefore, the true effects that this drug could have on your body remain unknown.
A big cause for concern is severe hypotension, which has rarely been reported in clinical trials. Alpha blockers, especially untargeted ones such as Tamsulosin, relax the smooth muscles in the heart which leads to low blood pressure.
A cohort study involving 14,784 men that used an alpha-blocker from 2003 to 2013 were compared to an equal number of men who decided against the use of alpha blockers, in order to examine whether alpha blockers increased the risk of falling.
This is because it has been suggested that hypotension can result in serious falls, fractures or head injuries. The use of alpha-blockers increased fall risk by 14% compared to men that did not use alpha-blockers.
If you are going to have cataract surgery, then it is important that you avoid the use of Tamsulosin. Tamsulosin has been shown to cause complications during cataract surgery and result in floppy eye syndrome (Pärssinen, 2006).
A Cochrane systematic review looked at the effects of Tamsulosin for BPH in 2003. The review involved 14 studies that ranged from 1 to 6 months long. The study participants did report improvements in symptoms.
However, they also noted that men taking Tamsulosin were more likely to report dizziness, rhinitis and abnormal ejaculation compared to the placebo group. 75% of men who took a high dose of Tamsulosin (0.8 mg) reported side effects.
The authors of this review also suggested that a need for longer studies looking at the long term effects were required.
Another study published in the Journal of Urology (2008) compared the effects of Tamsulosin on BPH and its associated symptoms. 9% of the group withdrew due to adverse side effects, and 63% reported some form of side effect. Side effects that were reported included erectile dysfunction, retrograde ejaculation, and reduced libido.
In another four year study, 27% of participants dropped out due to inadequate improvement in symptoms, while 17% dropped out due to side effects. The most common side effects were dizziness, abnormal ejaculation, asthenia, hypotension, erectile dysfunction, and headaches.
Evidence suggests that Tamsulosin is moderately effective at best. Patients taking Tamsulosin or considering taking Tamsulosin should be made aware that taking this medication means that symptoms are unlikely to go completely.
The size of the prostate is a determinant on the effectiveness of Tamsulosin. The drug is notably less effective when the prostate is larger.
Finally, it should be noted that a clear majority of the research around this drug remains unpublished. Therefore it is likely that available evidence overestimates its overall effectiveness.
As with all alpha-blockers, Tamsulosin does not improve the long term clinical outcomes of BPH or slow down the growth of the prostate.
A 2008 study found that prostate size did not change, and PSA levels increased by 12.1% over two years of Tamsulosin use. Prostate cancer was reported in 26 men that were receiving tamsulosin. This is not surprising, as research indicating that in the long term, having BPH may increase prostate cancer risk.
Based on the research (or lack of it), and the fact that there are other more effective alpha blockers available with fewer side effects, patients may wish to consider avoiding Tamsulosin altogether.
It has also been identified as a potential carcinogen, as well as linked to macular degeneration in the form of Floppy Iris Syndrome.
Silodosin is the most recent drugs developed for BPH. Development began in Japan, where it was marketed under the brand name Urief®, and launched in May 2006. In the US, the FDA approved it in October 2008; and in 2010, the E.U. gave final approval for the drug to be sold in Europe.
Silodosin is an alpha-blocker. Like other alpha blockers, it works by interfering with the adrenergic receptors. However, unlike older alpha blockers, Silodosin is a much more targeted alpha-blocker. It has a high affinity for the alpha-1A adrenergic receptor and a low affinity for the alpha-1B receptors.
This means it has a greater impact on BPH symptoms and a lower impact on blood pressure.
That’s because there are three distinct subtypes of the alpha-1 adrenoceptors: alpha-1A, alpha-1B, and alpha-1D. Silodosin binds with high affinity to the alpha-1A subtype, which exists in high concentrations in the smooth muscle of the prostate, bladder neck, and urethra, but has less affinity for the alpha-1B subtype, which is present at higher concentrations in the smooth muscle of the circulatory system.
Hence, the vasodilatation and low blood pressure were often seen with other alpha-blockers are not seen in patients who take Silodosin.
Through the inhibition of the alpha 1A-adrenergic receptor, Silodosin can relax the smooth muscles in and around the prostate gland. By relieving the tension, lessening pressure and reducing urethral resistance, the symptoms of BPH are relieved. This improves dysuria (difficult urination) associated with benign prostatic hyperplasia.
While its low affinity for 1B receptors means that Silodosin has less of an impact on blood pressure, its higher affinity for 1A receptors can have an undesirable effect, most notably higher rates of sexual side effects.
As Silodosin is a newer drug, there are no long term studies into its quality of life impacts so we cannot evaluate it on that basis.
However, in clinical trials, Silodosin demonstrated a low level of the reported cardiovascular and blood pressure-related side effects associated with existing alpha blocker-based BPH symptom treatments; including dizziness and first-dose syncope (fainting).
Nevertheless, postural hypotension, with or without symptoms (e.g., dizziness) may develop when beginning Silodosin treatment. As with other alpha-blockers, patients should be cautioned about driving, operating machinery, or performing hazardous tasks when initiating therapy.
In a double-blind, placebo-controlled, 12-week clinical trial, 466 patients were given Silodosin, and 457 patients were administered a placebo. At least one treatment-emergent adverse reaction was reported by 55.2% of Silodosin treated patients and 36.8% for placebo-treated patients.
The majority (72.1%) of the adverse reactions were qualified by the investigator as mild. A total of 6.4% of Silodosin treated patients, and 2.2% for placebo-treated patients discontinued therapy due to an adverse reaction. The most commonly reported adverse effect was abnormal or retrograde ejaculation (28.1%).
Other adverse effects observed were:
- Diarrhea 2.6 %
- Headache 2.4%
- Nasopharyngitis 2.4%,
- Nasal Congestion 2.1 %
The following adverse events were reported between 1%, and 2% of patients receiving Silodosin and these events occurred more frequently than with placebo: insomnia, increased PSA, sinusitis, abdominal pain, asthenia, and rhinorrhea, priapism (painful erection).
This seems to suggest that Silodosin may have lower incidences of non-sexual side effects than other alpha blockers.
It should also be noted that the condition Intraoperative Floppy Iris Syndrome (IFIS), which is associated with alpha-blocker treatment, seems to be less likely in patients taking Silodosin. In a 9-month open-label safety study of Silodosin, only one case of it was reported.
Due to its high affinity for 1A receptors and low affinity for 1B receptors, Silodosin seems to cause higher rates of retrograde and reduced ejaculation than other alpha blockers.
Reduced ejaculation is caused by impaired function of the vas deferens, the duct which conveys sperm from the testicle to the urethra in a normal ejaculation process. When 1A-adrenergic receptors are stimulated, they produce contraction of the vas deferens and sperm delivery from the testes to the urethra, producing a normal ejaculation.
However, if these alpha 1A-adrenergic receptors are blocked by the Silodosin action, the normal contraction is not produced, and sperm delivery is affected.
This is clinically manifested as a reduction in semen volume. It is a dynamic effect, and there are no alterations in sperm formation, number or function and the ability to orgasm is preserved. This effect is reversible (within a few days) upon discontinuation of treatment.
A European trial concluded that Silodosin was effective for alleviating BPH symptoms, but no more so than other alpha blockers. It examined men aged 60+ years with a clinical diagnosis of benign prostatic hyperplasia with an International Prostate Symptom Score of 12 or higher.
Overall, 1036 patients were enrolled. Of these, 766 patients (77.1%) experienced an approximate 25% improvement in their total International Prostate Symptom Score. The number of men reporting a high number of nighttime bathroom trips decreased from 85.7% to 52.4%. Half of the patients reported an improvement in frequency symptoms reported at baseline.
These results indicate that despite the much higher selectivity for Silodosin over other alpha-blockers like Tamsulosin, these drugs have reached the top of the dose-response curve and there is no way to make alpha blockers more effective for alleviating symptoms or to achieve a more significant effect.
Silodosin, as other alpha-blockers drugs, does not affect the prostate size or BPH. It is a symptomatic treatment of the condition.
A long-term evaluation of Silodosin has not yet been carried out. As such, there is no way to know its impact and safety over long term use.
It is essential to keep in mind that this treatment, like many alpha blockers, has limited effects on symptoms, and although it does not have the same blood pressure, vasodilation and hypotension effects as other alpha blockers, it also creates problems like retrograde ejaculation.
You should keep in mind that this treatment does not solve or cure the BPH. That being said, if you are concerned about blood pressure, or adverse side effects but still wish to take an alpha-blocker for your BPH symptoms, Silodosin may be the most suitable medication for you.
The US Food and Drug Administration has approved only four long-acting Alpha1-blockers for the treatment of symptomatic BPH. These drugs include Terazosin, Doxazosin, Tamsulosin, and Alfuzosin SR (sustained release).
Over the past 30 years, the evolution of α-blocker therapy for BPH has focused primarily on improving convenience and tolerability, while at the same time treating symptoms of BPH. This has resulted in the creation of Alfuzosin and has been relatively successful. Only a small number of men have reported severe side effects, with a moderate amount experiencing minor side effects.
The most common side effects of Alfuzosin in clinical studies are dizziness, upper respiratory infection, headache, and fatigue.
Adverse side effects reported during post-marketing experience include angina pectoris in patients with pre-existing coronary artery disease, hepatocellular and cholestatic liver injury, priapism, and angioedema.
Other adverse effects such as diarrhea, rash, pruritus, urticaria, flush and edema and postural hypotension have also been reported.
When taking Alfuzosin, patients should be cautious about driving, operating machinery, or performing hazardous tasks. Especially those with low blood pressure or who are taking antihypertensive medications or nitrates.
This is due to the possible occurrence of symptoms related to postural hypotension such as dizziness. It must be used with caution in patients with a history of QT prolongation (a disorder of the cardiac rhythm) or those who are taking medications which prolong the QT interval.
If the patient is going through cataract surgery or any procedure involving the eyes, it is vital that they inform their ophthalmologist about the use of Alfuzosin, even if they are no longer taking it. The reason for this is Floppy Iris Syndrome (IFIS).
This is a syndrome where the iris becomes flaccid and may require the surgeon to make modifications during surgery. This syndrome is frequently present in patients receiving alpha blockers, especially tamsulosin.
Although Alfuzosin is effective in controlling the symptoms of BPH and has fewer side effects than other drugs of its class, there are drawbacks. Three placebo-controlled clinical trials involving 1,608 men took place. The participants were administered daily doses of 10mg and 15mg of Alfuzosin. Following the trial:
- 5.7% experienced dizziness
- 3.0% upper respiratory tract infection
- 3.0% headaches
- 2.7% complained of fatigue
Other effects reported between 1% and 2% of patients included bodily pain, digestive problems, abdominal pain, dyspepsia, constipation, and nausea. Further side effects included impotence and respiratory issues, such as bronchitis, sinusitis, and pharyngitis.
Approximately 30% of patients experienced at least a 30% increase in peak urinary flow rate. The general improvement in maximum urinary flow rate is 16-25%. Patients with more severe symptoms have a more significant response to treatment than those with milder symptoms.
The effect of Alfuzosin treatment on prostate size has been studied in a randomized control trial in 2006. In this study, 536 participants were randomly allocated to receive Alfuzosin or placebo.
It was discovered that after three months, there were no significant differences in prostate size between the treatment groups and the placebo group. This is to be expected because, like all other alpha blockers, it does not impact prostate size.
Alfuzosin is possibly the most effective alpha-blockers with fewer side effects than its competitors. Symptomatic Improvement is seen in 30-40% of the patients.
However, the degree to which symptoms improve does not seem to vary at all, suggesting that while more men see positive results using Alfuzosin, the improvements are no more significant than if they had a positive reaction to any other alpha-blocker.
Although Alfuzosin may have a better safety profile than drugs, it has numerous side effects that need to be considered. Moreover, it would be best if you kept in mind that this drug only acts to relieve symptoms; it does not cure or treat BPH. A notable downside of Alfuzosin is that it is much more expensive than other prostate medications.
What herbs or natural supplements treat BPH
Many men are cautious about taking a prescription prostate medication, generally due to the risk of sexual or life-threatening side effects, such as cancer or diabetes. However, also sometimes due to the low percentage of other men who have experienced relief using some of these drugs.
These men often look for natural solutions for their prostate problems. While natural options can be more effective for some men and have less or even zero side effects, many men struggle to differentiate between the many different options available.
In our research, we have found that one natural supplement is far superior to all others currently available. For men with an enlarged prostate, we only recommend Total Health For The Prostate, often alongside active surveillance.
Total Health for the Prostate is the first and only, truly complete, and clinically effective prostate supplement. It is scientifically formulated to contain clinically significant dosages of the 23 most effective, most vital, prostate-restoring vitamins, minerals and herbal compounds in the world.
Because it’s a complete formulation, with a multifaceted approach to prostate health, it is more effective and faster working than any other supplement on the market.
Herbal ingredients, such as beta-sitosterol, are natural 5 alpha-reductase inhibitors that have been proven to improve urinary symptoms and flow, and may also work to shrink the prostate via the same mechanisms as pharmaceutical 5 alpha reductase inhibitors – but without the nasty side effects.
Other herbal compounds such as curcumin have been shown to improve urinary symptoms such as urinary retention and urine flow in men with BPH.
Total Health For The Prostate also contains quercetin, derived from the flower buds of Japanese Sophora flowers. Laboratory studies demonstrate its anti-inflammatory properties which are highly beneficial for men with prostate disease.
Quercetin has been shown to reduce prostate-related pain and swelling and helps relieve urinary difficulties associated with prostate disease.
Total Health also contains essential minerals such as zinc, selenium, and boron. In a healthy prostate, zinc is the most abundant mineral in the prostate. Research has revealed that men with BPH (an enlarged prostate) and cancer of the prostate typically have lower levels of zinc in the prostate compared to a healthy prostate.
Additionally, Total Health for the prostate contains selenium. Studies have shown that men who live in areas with selenium-rich soils and eat a selenium-rich diet have lower chances of developing or dying of cancer, (prostate cancer). Other studies have shown that boron works to inhibit human cancer cell growth.
By providing a full suite of minerals in clinically significant doses, Total Health works to restore healthy prostate function and safeguard you against future prostate disease.
Total Health also contains a complete battery of the essential vitamins for your prostate.
Studies done at Georgetown University Medical Center examined the efficacy of natural products for men with BPH. In this study, men were given a combination of beta-sitosterol, vitamin E and various other herbs, minerals, and vitamins.
The men taking the beta-sitosterol and vitamin E complex experienced significantly reduced nocturia (nighttime urination) and saw an improvement in frequency and overall symptoms. Total Health contains all natural Vitamin E in a clinically significant dose.
Other studies have linked vitamin D3 deficiency to an increased risk of developing prostate cancer at a younger age. Lab studies have shown that prostate cancer cells treated with vitamin D3 can be killed and prevented from spreading.
Total Health provides a high dose of vitamin D3 to ensure you have adequate vitamin D3 levels. Studies have also linked vitamin C to a lower risk of prostate cancer.
Is it safe?
Total Health for the Prostate contains clinically significant dosages that have shown to be safe in clinical studies. All ingredients are 100% natural, GMO-free, and tested for contaminants, heavy metals, and radiation.
We rigorously test all raw ingredients in our products to ensure they meet the American pharmacological standards and the American herbal products association standards. Our manufacturing facilities are all US-based and FDA-monitored. We verify the purity of our products and label accuracy using 3rd party independent laboratories.
Total Health for the Prostate is safe to take alongside all common prostate medications or supplements.
*Vitamin D3 can interact with some blood thinners. If you are taking prescription strength blood thinners, you may wish to consult your doctor before taking Total Health for the Prostate.
Does Total Health alleviate symptoms?
Yes. The ingredients in Total Health were chosen because they have been clinically proven to alleviate the symptoms of BPH. Each one of the 23 nutrients has dozens of peer-reviewed, clinical research that demonstrates their efficacy and safety.
On top of that, Total Health for the Prostate has a 20-year track record of alleviating symptoms. It is backed up by hundreds of case studies, customer testimonials and review videos.
Does Total Health shrink and heal the prostate?
Unlike prescription drugs, Total Health for the Prostate was designed to shrink the prostate gland.
Ingredients such as beta-sitosterol are natural 5 alpha-reductase inhibitors, which have been shown to shrink the prostate gland. Additionally, compounds such as curcumin have been shown to outperform placebos and reduce prostate volume as effectively as Finasteride – but without side effects.
Total Health conclusion
Total Health for the Prostate is by far the best quality and most effective natural supplement for prostate disease, BPH and general urinary health available on the market.
It contains higher dosages, more ingredients, and the most bioavailable forms of vital nutrient compounds. It is made in the USA at FDA-audited facilities and tested at 3rd party labs.
We recommend that you take Total Health for at least 90 days to combat BPH and restore prostate health. Total Health will restore prostate health naturally, as well as safeguard you against future prostate disease.
Total Health for the Prostate is a high quality, fast working, and effective all-natural prostate supplement. It works as effectively as pharmaceutical products to alleviate symptoms and reduce prostate volume and size.
However, the critical difference is that Total Health uses all-natural ingredients. As such, no side effects are experienced. It has a 20-year track record of working effectively, backed up by the testimonies of hundreds of men from all over the world. If you would like more information about Total Health For the Prostate, Click Here.