Have you been prescribed tamsulosin (also known as Flomax) or finasteride (also known as Propecia or Proscar) for your prostate or even for hair loss? If so, you need to know about the shocking side effects that can come with these medications. In this article, we will share with you the potential side effects of these medications and whether they go away when you stop taking them.

What are Tamsulosin and Finasteride?

Tamsulosin is an alpha blocker that is prescribed by urologists for an enlarged prostate. Tamsulosin is an alpha-blocker. It works by relaxing the muscle around the bladder exit and prostate gland to allow easy passage of urine. Finasteride, on the other hand, is used for hair loss in a lower dosage or for an enlarged prostate at a higher dosage.  It works by shrinking the size of the prostate.

How do they work?

Tamsulosin and Finasteride work by blocking the enzyme 5-alpha reductase. This enzyme is found in many parts of the body, particularly the prostate, but it is also found in the brain. When these medications cross the blood-brain barrier, they can inhibit three neuro-active steroids: DHT, 5-alpha dihydroprogesterone, and 5-alpha dihydrodeoxycorticosterone. It is thought that reducing the amount of these molecules in the brain can affect the parts of the brain that are responsible for sexual desire, leading to low libido.

What are the side effects?

The labeling of these medications states that there is a lower than 10% risk of impotence, decreased libido, ejaculatory disorder, and general sexual dysfunction.

However, a survey of 71 men who suffered from post-finasteride sexual dysfunction after taking it for hair loss found that over 90% of people complained of decreased libido, decreased arousal, and erectile dysfunction. Almost 70% also had difficulty with orgasm. The scariest part was that when researchers looked at how long these sexual side effects persisted after stopping finasteride, the average time was about 40 months (almost four years). 20 of these men had symptoms for over six years.

The other side of the coin is something called the nocebo effect. This is the negative side of the placebo effect, where people are psychologically inclined to think they have developed certain symptoms after being counseled on the potential side effects.

When it comes to tamsulosin, the side effect that people will see is having decreased ejaculation volume. This side effect can occur in 8-18% of men who take the medication, depending on the dose they are using. Tamsulosin works by blocking alpha receptors, which are located in the bladder neck and the seminal vesicle. The seminal vesicles contain about 80% of semen volume and they also have a lot of alpha receptors. When tamsulosin binds to receptors either serotonin or dopamine receptors in the brain, it prevents the brain and the spinal ejaculatory center from allowing ejaculation to happen.

What are the alternatives?

If you are suffering from these issues and you are on these medications, please talk to your urologist or your primary care doctor. There are other alternatives to tamsulosin, including terazosin, alfozosin, and doxazosin. All of these have much lower rates of ejaculatory dysfunction. Alpha zosin seems to have the lowest rate at 0.6%, while tamsulosin and cilidosen seem to have the highest rate of ejaculatory dysfunction.

Conclusion

It is important to be aware of the potential side effects of tamsulosin and finasteride before taking them. If you are already on them and you have been taking them for over a year and you are not having sexual side effects, you are probably not going to get them moving forward. However, if you are suffering from sexual side effects, there are alternatives that you can discuss with your doctor.