BPH Medications Explained: A Urologist’s Simple Guide

The Problem in a Nutshell: A Room Getting Too Crowded

Most men, as they get older, will deal with an enlarged prostate. It’s almost a rite of passage. I tell my patients to think of their prostate as a room, and the urethra—the tube you urinate through—is the hallway that runs right through the middle of it. For your whole life, that room is a normal size. But as you age, the walls of the room start to slowly close in, squeezing the hallway. That’s BPH. Suddenly, it’s harder to get through the hallway. Your stream is weaker, you have to go more often, you feel like you can’t empty your bladder. It’s a plumbing problem, pure and simple.

So, when we treat it with medication, we have two basic strategies: we can either relax the people crowding the hallway to make more space, or we can actually start knocking down walls to make the room bigger again.

The Quick Fix: The Relaxers (Alpha-Blockers)

This is almost always the first thing we try. Medications like tamsulosin (Flomax) or alfuzosin (Uroxatral) are called alpha-blockers. They don’t shrink the prostate at all. Instead, they work by relaxing the muscle fibers within the prostate and at the opening of the bladder.

• How They Work: They are the crowd control. They tell the muscle fibers crowding the hallway to just take a step back and relax. This opens up the passage, and urine flows more freely.
• The Big Plus: They work fast. You’ll often notice a real improvement in your symptoms within days to a week.
• The Trade-Off: Because they relax muscles, they can sometimes cause dizziness. The most common side effect is a change in ejaculation, often a dry orgasm, where little to no fluid comes out. This is harmless but can be surprising. You can read more in my guide on the link between an enlarged prostate and sex.

The Long Game: The Shrinkers (5-ARIs)

If the prostate is particularly large, or if alpha-blockers aren’t enough, we bring in the demolition crew. Medications like finasteride (Proscar) or dutasteride (Avodart) are called 5-alpha reductase inhibitors (5-ARIs). Their job is to actually make the prostate smaller.

• How They Work: They block a hormone that fuels prostate growth. Over time, this causes the prostate gland to physically shrink, sometimes by as much as 25%. They are literally making the room bigger.
• The Big Plus: They treat the root of the problem—the size. For men with very large prostates, this can provide significant, lasting relief and can reduce the risk of needing surgery down the road.
• The Trade-Off: This is a slow process. You won’t feel much for the first few months. It can take six months or even a year to get the full effect. Because they work on a hormonal level, they can also have sexual side effects for a minority of men, like a lower sex drive or erectile dysfunction.

The Wild Card: Using an ED Pill for BPH

This is a fantastic option that has become very popular. A low, daily dose of tadalafil (Cialis) is also FDA-approved to treat BPH symptoms. We believe it works by increasing blood flow and relaxing muscle tissue in the prostate and bladder. For a man who has both BPH and ED, this is an incredible two-for-one solution. You can learn more about this in my article comparing daily vs. as-needed Cialis.

The Takeaway: You Don’t Have to Live With It

The days of just accepting a weak stream and sleepless nights are over. We have excellent, safe medications that can make a huge difference in your quality of life. Sometimes we use the relaxer. Sometimes we use the shrinker. And often, for the toughest cases, we use them together.

The most important step is starting the conversation. BPH is not something you have to just live with. We can fix this plumbing problem.