Mild BPH symptoms, unclear treatment path — anyone in a similar situation?

[Globenauta]

Hi everyone,

I’m a 56-year-old male dealing with some mild but persistent lower urinary tract symptoms, and I’d appreciate hearing from others who’ve been through something similar.
 

For the past year or so, I’ve been experiencing:

• Increased daytime urinary frequency (sometimes every 1–2 hours),
• Early morning urgency (often waking between 4-5 am),

• Weak urine flow, especially in the morning,

• Usually 1 wake-up per night, though occasionally I sleep through.

I recently saw a urologist and had some basic tests done:

• Prostate volume on abdominal ultrasound: 26 ml (doctor says "mildly enlarged"),

• PSA: 1.01 ng/mL (previously around 0.4),

• Urine flow test: not dramatic, but mildly impaired, no flat curve, still shows a peak.
   

The doctor did a rectal exam and said my prostate felt “rather enlarged,” though he didn’t repeat that at follow-up. He suggested that a transrectal ultrasound would be more accurate, but also said it wouldn’t change management much unless I pursue intervention.
 

I did a 7-day trial of tamsulosin, and while there might have been some very minor improvement (e.g., one full night of sleep), it wasn’t dramatic. I also experienced retrograde ejaculation, which really affected my sexual experience. My doctor advised discontinuing tamsulosin, saying it likely wouldn’t give more benefit long-term.
 

I asked about Duodart, but he advised against it due to high risk of sexual side effects (I already have ED and take tadalafil 5 mg every other day).

We also briefly discussed options like Urolift, but he said it's usually for more severe symptoms (e.g., people waking up 3–4 times a night, or with serious retention). He didn’t recommend further tests like cystoscopy unless I plan to consider a procedure.
 

So in the end, his advice was basically: try to live with it for now, and come back if symptoms get worse.
 

I’m not sure if I’m doing the right thing by waiting. The symptoms are not disabling, but they are consistently frustrating and affecting my sleep and focus. I’m also uncertain how to assess “how bad is bad enough” when it comes to acting on this.
 

Has anyone else been in a similar “grey zone”?

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

Any shared experiences would be truly appreciated.

Thanks in advance.

[NickyLouie]

Lifestyle changes , are you overweight with no exercise ? 

 

Diet - you can read enough online , but stop eating crap food and sugars, alcohol and caffeine should be really scaled back along with dairy 

 

Drink green tea and take saw palmetto

 

Start doing kegel exercises 

 

 

 

 

[Sheryl]

Before going into the BPH issue, I have to wonder if you  might have an  undiasgnosed prostate infecton or urethitis.

 

Needing to per every1-2 hours seems inconsistent with your degree of BPH.

 

Might  be worth getting a second opinion during which you specifically ask about cultures. 

 

Where are you located? 

[dinsdale]

21 minutes ago, Sheryl said:

might have an  undiasgnosef prostate infecton or urethitis

Agree. 

[Magictoad]

Try the Duodart and see how it goes. I take it every day and haven't noticed anything untoward but I'm 72 with terminal cancer.

[Globenauta]

1 hour ago, Sheryl said:

Before going into the BPH issue, I have to wonder if you  might have an  undiasgnosed prostate infecton or urethitis.

 

Needing to per every1-2 hours seems inconsistent with your degree of BPH.

 

Might  be worth getting a second opinion during which you specifically ask about cultures. 

 

Where are you located? 

 

Thanks, Sheryl,
 

I actually asked the urologist during my recent appointment whether an infection could be part of the problem. He said it was theoretically possible but didn’t seem too inclined to investigate further once I mentioned I had recently done an STD panel.
 

The panel included Chlamydia, Gonorrhea, Mycoplasma, Ureaplasma, Trichomonas, HSV 1 & 2, Candida, and a few others that all came back negative. Would that be enough to rule out a prostate infection or urethritis?
 

I’m based in Samut Prakan, by the way.

Thanks again, very helpful advice.

[JensenZ]

I hear nothing about diabetes. Here's some basic information, which is worth exploring:

 

AI overview:

 

"Diabetics may need to urinate more frequently than non-diabetics, potentially multiple times a day, due to the body's attempt to eliminate excess glucose in the urine. While a normal person may urinate 4-7 times a day, a diabetic may urinate more than 10 times. This increased frequency can be a sign of diabetes or other conditions, like high blood pressure or kidney issues"

[Globenauta]

12 hours ago, JensenZ said:

I hear nothing about diabetes. Here's some basic information, which is worth exploring:

 

AI overview:

 

"Diabetics may need to urinate more frequently than non-diabetics, potentially multiple times a day, due to the body's attempt to eliminate excess glucose in the urine. While a normal person may urinate 4-7 times a day, a diabetic may urinate more than 10 times. This increased frequency can be a sign of diabetes or other conditions, like high blood pressure or kidney issues"

Thanks for your feedback.

That was indeed the first question the Dr. asked me (if I am diabetic). I said that I have periodic annual checkups which include blood sugar test (FBS) that have always come back at around the average values of the normal range. The last one was just a couple of mouths ago. Personally, I am not sure if that's enough to rule out diabetes, but he seemed satisfied with it and didn't prescribe further tests.

 

[Sheryl]

16 hours ago, Globenauta said:

 

Thanks, Sheryl,
 

I actually asked the urologist during my recent appointment whether an infection could be part of the problem. He said it was theoretically possible but didn’t seem too inclined to investigate further once I mentioned I had recently done an STD panel.
 

The panel included Chlamydia, Gonorrhea, Mycoplasma, Ureaplasma, Trichomonas, HSV 1 & 2, Candida, and a few others that all came back negative. Would that be enough to rule out a prostate infection or urethritis?
 

I’m based in Samut Prakan, by the way.

Thanks again, very helpful advice.

Most common cause of prostatitis is E. Coli, which an STD panel would nto detect.

Also, depending on the type of test done, there can be false negatives esp for chlamydia.

 

So you still need to rule out prostatitis IMO. It is just not usual for mild BPH to cause the degree of urinary frequency you describe. Add to that the lack of relief from tamsulosin, and suspicion of an infection rises.

 

This doctor is  not too far from Samut Prakan  and has been recommended by other board members

https://www.sukumvithospital.com/doctorprofile.php?id=188&lang=en

 

Ideally you want toi get a prostate massage to express prostatic fluid then a culture and sensitivity

 

As for your BPH: iti s a progressive condition and it worsens with age, but how fast varies greatly. One of the 2 classes of medication used for it can help reduce prostate size/slow growth. These are the 5-alpha reductase inhibitors, such as finasteride and dutasteride. It takes 6-12 months to see the therapeutic effect of these drugs, and they do unfortunately sometimes worsen ED. When they do, sometimes this effect eases up with continued use and sometimes not.

 

The other class of drugs used for BPH are alpha antagonists, such as tamsulosin and doxazosin.  These do nto affect oprostate size but rather give symptomatic relief from blockage by relaxing the smooth muscles in the prostate and bladder neck. Unlike the first class of drugs, action is almost immediate. You already tried this class of drug without  relief.

 

Cialis is also sometimes used to relax the muscles around the bladder neck and prostate, likewise only symptomatic relief. And of course, for ED. 

 

Since the 5-alpha reducatse inhibitors do, over time, reduce the size of the prostate and slow progression of BPH, you  could ask doctor about a daily regimen of Cialis plus finasteride or dutasteride as a way of  potentially off-setting the negative effect of the latter on erectile function. May or may not work, and may or may nto be suitable i nthe context iof your overall medical history.

 

Urolift is nto widely available here, just a few places and doubt any doctor  would  do it for mild case of BPH. Like all treatments, it has potential side effects. 

 

Some people feel that saw palmetto and/or milk thistle supplements help with BPH, others don't, and there is a lack of clear evidence either way. No harm in trying.

 

But above all, I suggest you rule out potential infection as your urinary frequency is unusual from mild BPH. 

 

 

 

 

 

 

[Moonlover]

With your symptoms and age, I would consider trying a course of acupuncture. It's none invasive, pretty cheap compared with standard western treatment and importantly avoids the need for medication with their almost inevitable side affects.

 

It has a very good track record as this website indicates.

 

https://bestofchinesemedicine.com/specialties/bph-treatment/

[xylophone]

I suffered from either prostatitis or BPH for decades and was never quite clear what it was, although large and long doses of one or two antibiotics seemed to do the trick, until it/they didn't!

 

It wasn't until I got in touch with a couple of professors who were working on this very subject that I found relief with a regimen of the antibiotics they prescribed, so it was prostatitis one way or another.

 

However over this time, I was prescribed tamsulosin and others to help alleviate my symptoms and along with that I tried just about every other remedy (herbal and otherwise including Beta Sitosterol) and nothing worked, so I had a TURP done at the Epworth Hospital in Melbourne, and it has certainly not been plain sailing since that time.

 

Latterly I researched other options for BPH and came to the conclusion that if I was to have my time over again I would choose the Urolift procedure or possibly the iTind procedure, both of which are fairly non-invasive and don't actually require surgery.

 

Good luck with whatever you decide and once you go for something like a TURP, there is no turning back, so choose carefully.

 

https://youtu.be/e20Ak49YD6E?feature=shared

https://www.youtube.com/watch?v=e20Ak49YD6E&ab_channel=UroLift

https://www.prostatelasercenter.com/blog/difference-prostatitis-vs-bph/

[Lacessit]

I have an obstructive prostate.

 

Originally I was on finasteride and cardura. My GP in Australia switched me to duodart, which is a combination of dutasteride and tamsulosin.

 

Sheryl's advice of investigating whether the OP has prostatitis should be heeded.

 

The advice of my highly qualified urologist in Australia is live with BPH, take meds, and treat surgery as an absolute last resort.

[msbkk]

1 hour ago, Lacessit said:

I have an obstructive prostate.

 

Originally I was on finasteride and cardura. My GP in Australia switched me to duodart, which is a combination of dutasteride and tamsulosin.

 

Sheryl's advice of investigating whether the OP has prostatitis should be heeded.

 

The advice of my highly qualified urologist in Australia is live with BPH, take meds, and treat surgery as an absolute last resort.

It certainly depends on the case. Medications did not help me at and had the Rezum procedure in Bangkok 2 years ago. I am very satisfied with the result without any side effects.

[Lacessit]

15 hours ago, msbkk said:

It certainly depends on the case. Medications did not help me at and had the Rezum procedure in Bangkok 2 years ago. I am very satisfied with the result without any side effects.

According to my urologist, 90% of BPH patients choosing surgery experience side effects.

You are one of the lucky 10%.

[msbkk]

10 hours ago, Lacessit said:

According to my urologist, 90% of BPH patients choosing surgery experience side effects.

You are one of the lucky 10%.

Rezum is one of the newer minimal invasive surgeries and does mostly not lead to lasting side effects. 

[Lacessit]

1 hour ago, msbkk said:

Rezum is one of the newer minimal invasive surgeries and does mostly not lead to lasting side effects. 

Rezum was one of the options I discussed with my urologist.

 

 I prefer the advice of someone with the qualifications of FRCS, FRACS over your statistical sample of one.

[spidermike007]

Try saw palmetto, and stinging nettle root. Also, pineapple extract is helpful. Miraculous stuff. I was having some of the same issues. All normal with daily intake of this stuff. Best to avoid toxic meds, if you can. Also, always fun to give the finger to Big Pharma. 

[harryviking]

On 5/23/2025 at 1:58 PM, Globenauta said:

Hi everyone,

I’m a 56-year-old male dealing with some mild but persistent lower urinary tract symptoms, and I’d appreciate hearing from others who’ve been through something similar.
 

For the past year or so, I’ve been experiencing:

• Increased daytime urinary frequency (sometimes every 1–2 hours),
• Early morning urgency (often waking between 4-5 am),

• Weak urine flow, especially in the morning,

• Usually 1 wake-up per night, though occasionally I sleep through.

I recently saw a urologist and had some basic tests done:

• Prostate volume on abdominal ultrasound: 26 ml (doctor says "mildly enlarged"),

• PSA: 1.01 ng/mL (previously around 0.4),

• Urine flow test: not dramatic, but mildly impaired, no flat curve, still shows a peak.
   

The doctor did a rectal exam and said my prostate felt “rather enlarged,” though he didn’t repeat that at follow-up. He suggested that a transrectal ultrasound would be more accurate, but also said it wouldn’t change management much unless I pursue intervention.
 

I did a 7-day trial of tamsulosin, and while there might have been some very minor improvement (e.g., one full night of sleep), it wasn’t dramatic. I also experienced retrograde ejaculation, which really affected my sexual experience. My doctor advised discontinuing tamsulosin, saying it likely wouldn’t give more benefit long-term.
 

I asked about Duodart, but he advised against it due to high risk of sexual side effects (I already have ED and take tadalafil 5 mg every other day).

We also briefly discussed options like Urolift, but he said it's usually for more severe symptoms (e.g., people waking up 3–4 times a night, or with serious retention). He didn’t recommend further tests like cystoscopy unless I plan to consider a procedure.
 

So in the end, his advice was basically: try to live with it for now, and come back if symptoms get worse.
 

I’m not sure if I’m doing the right thing by waiting. The symptoms are not disabling, but they are consistently frustrating and affecting my sleep and focus. I’m also uncertain how to assess “how bad is bad enough” when it comes to acting on this.
 

Has anyone else been in a similar “grey zone”?

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

Any shared experiences would be truly appreciated.

Thanks in advance.

I went to a private hospital back home and got a piece of my prostate "sucked" out through the penis! I was at the hospital in the afternoon and out again the next day! Had to wear a drain for a couple of weeks. This was 7 years ago. All still well! One thing missing though.....no more semen. That goes into the blather and out by urinating. It was a painless experience. 

[newbee2022]

On 5/23/2025 at 11:02 PM, Globenauta said:

 

Thanks, Sheryl,
 

I actually asked the urologist during my recent appointment whether an infection could be part of the problem. He said it was theoretically possible but didn’t seem too inclined to investigate further once I mentioned I had recently done an STD panel.
 

The panel included Chlamydia, Gonorrhea, Mycoplasma, Ureaplasma, Trichomonas, HSV 1 & 2, Candida, and a few others that all came back negative. Would that be enough to rule out a prostate infection or urethritis?
 

I’m based in Samut Prakan, by the way.

Thanks again, very helpful advice.

Blood count done?

[newbee2022]

On 5/23/2025 at 6:58 PM, Globenauta said:

Hi everyone,

I’m a 56-year-old male dealing with some mild but persistent lower urinary tract symptoms, and I’d appreciate hearing from others who’ve been through something similar.
 

For the past year or so, I’ve been experiencing:

• Increased daytime urinary frequency (sometimes every 1–2 hours),
• Early morning urgency (often waking between 4-5 am),

• Weak urine flow, especially in the morning,

• Usually 1 wake-up per night, though occasionally I sleep through.

I recently saw a urologist and had some basic tests done:

• Prostate volume on abdominal ultrasound: 26 ml (doctor says "mildly enlarged"),

• PSA: 1.01 ng/mL (previously around 0.4),

• Urine flow test: not dramatic, but mildly impaired, no flat curve, still shows a peak.
   

The doctor did a rectal exam and said my prostate felt “rather enlarged,” though he didn’t repeat that at follow-up. He suggested that a transrectal ultrasound would be more accurate, but also said it wouldn’t change management much unless I pursue intervention.
 

I did a 7-day trial of tamsulosin, and while there might have been some very minor improvement (e.g., one full night of sleep), it wasn’t dramatic. I also experienced retrograde ejaculation, which really affected my sexual experience. My doctor advised discontinuing tamsulosin, saying it likely wouldn’t give more benefit long-term.
 

I asked about Duodart, but he advised against it due to high risk of sexual side effects (I already have ED and take tadalafil 5 mg every other day).

We also briefly discussed options like Urolift, but he said it's usually for more severe symptoms (e.g., people waking up 3–4 times a night, or with serious retention). He didn’t recommend further tests like cystoscopy unless I plan to consider a procedure.
 

So in the end, his advice was basically: try to live with it for now, and come back if symptoms get worse.
 

I’m not sure if I’m doing the right thing by waiting. The symptoms are not disabling, but they are consistently frustrating and affecting my sleep and focus. I’m also uncertain how to assess “how bad is bad enough” when it comes to acting on this.
 

Has anyone else been in a similar “grey zone”?

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

Any shared experiences would be truly appreciated.

Thanks in advance.

Take saw palmetto, pumpkin seeds and nettle tea/extract.

To buy at Lazada or pharmacy.

And a blood count would be good.

[RayOday]

I once read some really helpful advice on this forum regarding BPH. I didn't save the link so I regret that I can't credit the author.I did copy the text so here you go...

 

Early 60's and retired, having worked in healthcare my entire career.  I have been living with BPH for about 15 years.

 

When considering prostate treatment options it is important to know your prostate size.  This is generally obtained and calculated from a lower abdominal ultrasound.  Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume).  Smaller prostates are generally more easy to treat than larger prostates.  The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate.  Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe.  A large median lobe can complicate some surgical techniques.

 

Medications are the first line of therapy and are usually quite effective.  Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms.  I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow.   I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin.  In Thailand these are available as Xatral XL 10mg and Urief 4mg.  There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral.  Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy.  Alfuzosin is idealy taken about a half hour after finishing dinner.  Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction.  Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype.  The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation.  The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate.  During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra.  With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder.  For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin).  I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time.  I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective.  I'd also recommend silodosin to any patients trying to pass a kidney stone.

 

The other main class of prostate medications are the 5-alpha reductase inhibitors and these include finasteride and dutasteride.  These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT.  This class of medication is much less effective in patients with smaller prostate sizes.  The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer.   Sometimes these drugs are marketed as combination therapies with alpha-blockers.  The medication Duodart is a good example.  I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart.

 

When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate.  Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital.  The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies.

 

Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that.  This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization.  Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive.

 

Most men, myself included, care quite strongly about preserving normal ejaculatory function.  If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle.  Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys.  During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again.

 

If you don't care about ejaculatory function then don't  early 60's and retired, having worked in healthcare my entire career.  I have been living with BPH for about 15 years.

 

When considering prostate treatment options it is important to know your prostate size.  This is generally obtained and calculated from a lower abdominal ultrasound.  Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume).  Smaller prostates are generally more easy to treat than larger prostates.  The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate.  Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe.  A large median lobe can complicate some surgical techniques.

 

Medications are the first line of therapy and are usually quite effective.  Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms.  I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow.   I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin.  In Thailand these are available as Xatral XL 10mg and Urief 4mg.  There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral.  Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy.  Alfuzosin is idealy taken about a half hour after finishing dinner.  Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction.  Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype.  The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation.  The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate.  During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra.  With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder.  For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin).  I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time.  I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective.  I'd also recommend silodosin to any patients trying to pass a kidney stone.

 

The other main class of prostate medications are the 5-alpha reductase inhibitors and these include finasteride and dutasteride.  These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT.  This class of medication is much less effective in patients with smaller prostate sizes.  The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer.   Sometimes these drugs are marketed as combination therapies with alpha-blockers.  The medication Duodart is a good example.  I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart.

 

When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate.  Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital.  The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies.

 

Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that.  This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization.  Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive.

 

Most men, myself included, care quite strongly about preserving normal ejaculatory function.  If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle.  Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys.  During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again.

 

If you don't care about ejaculatory function then don't waste time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life.

 

I'm not going to discuss techniques for complete removal of the prostate as I really only see that as  time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life.

[blazes]

Been on finasteride for last 4 years (had cystoscopy - "not concerning").  

 

Seems to do the trick, but I have had frequent night urination for many decades.  (Tried nettle pills with no effect - for nocturia -- frequent night urination). Maybe I just have a small bladder.

I really should give up all liquid intake by about 4 pm, but I find it v difficult to give up red wine to accompany supper.

Have tried milk thistle with no apparent difference.

If you are bald, an advantage of finasteride is that it encourages hair growth (there's a connection between finasteride and rogaine.)  After 4 years, I am looking more and more like Santa Claus.

[blazes]

24 minutes ago, RayOday said:

The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer. 

After 4 yrs of finasteride, I have had only one of those side-effects: reverse ejaculation. 

[connda]

I'd put off surgery as the last option.  It may work, it may mess you up worse than you were. 
Tamsulosin is expensive and not the most effective.

Try
Stinging Nettle Root 500 mg/day
Doxizosin which is an alpha-blocker like high blood pressure medicine. Start at 2mg.  It takes awhile. Dosage around 2mg to 4mg should work.  Doxizosin is inexpensive.  Generic brand names include Pencor-4 and Cardoxa.  The Pfizer brand is Cardura if you feel like spending a lot of money for a brand name that isn't any more effective that the generics.
Finasteride (5-Alpha Reductase Inhibitor) - once you start, plan to take it for the rest of your life.  Generic brands include Harifin-5 and Firide 5mg.  Both should be around ฿600 per box of 30 count. Or if you want to toss money away buy Proscar. 

Here's a comparison of meds for BPH.  Look at the "Ratings" column.
https://www.drugs.com/condition/benign-prostatic-hyperplasia.html

After a few years you'll find peeing is more important then boom-boom. 
 

On 5/23/2025 at 6:58 PM, Globenauta said:

I asked about Duodart, but he advised against it due to high risk of sexual side effects (I already have ED and take tadalafil 5 mg every other day).

Duodart is just an (expensive) combination of an alpha-block and a 5-alpha reductase inhibitor like those inexpensive ones I listed above.  Can a 5-alpha reductase inhibitor mess with you getting a woody?  Maybe.  But I don't know. I don't have that problem. I'm 73, I've been taking fisasteride for years, and I routinely wake up with "morning wood."  Not that I care.  My libido is quite low which I find to be a blessing at my age.  I can't say I don't care about sex.  Hell, I'm a man and I have a pulse.  I like women.  But it doesn't drive me any longer.  And I'd rather pee freely. 

Best of luck.  🥒 🍆

[connda]

On 5/24/2025 at 5:53 PM, xylophone said:

I suffered from either prostatitis or BPH for decades and was never quite clear what it was, although large and long doses of one or two antibiotics seemed to do the trick, until it/they didn't!

 

It wasn't until I got in touch with a couple of professors who were working on this very subject that I found relief with a regimen of the antibiotics they prescribed, so it was prostatitis one way or another.

 

However over this time, I was prescribed tamsulosin and others to help alleviate my symptoms and along with that I tried just about every other remedy (herbal and otherwise including Beta Sitosterol) and nothing worked, so I had a TURP done at the Epworth Hospital in Melbourne, and it has certainly not been plain sailing since that time.

 

Latterly I researched other options for BPH and came to the conclusion that if I was to have my time over again I would choose the Urolift procedure or possibly the iTind procedure, both of which are fairly non-invasive and don't actually require surgery.

 

Good luck with whatever you decide and once you go for something like a TURP, there is no turning back, so choose carefully.

 

https://youtu.be/e20Ak49YD6E?feature=shared

https://www.youtube.com/watch?v=e20Ak49YD6E&ab_channel=UroLift

https://www.prostatelasercenter.com/blog/difference-prostatitis-vs-bph/

TURP is brutal and I've seen too many bad outcomes.  However, the options for surgery and competent surgeons are few and far between here in Thailand.  If I ever decide to go the surgery route I'd go with laser surgery, but only with a surgeon who has a lot of these surgeries under his belt and can provide patients who would provide testimonials.  Imho, surgery is the last option.  Not the first for mild BPH.

[Zenwind]

   I’m 75 and have had problems with BPH for quite a while.  I’ve tried a range of the standard prescribed medications, as well as folk meds such as saw palmetto, etc., but it just got progressively worse.  (Aging is a bit of a drag, ain’t it?) 

   After a urinary infection late last year, I was fitted with a urinary catheter at Yanhee International Hospital in Bangkok.  When the catheter was removed, I could not pee.  Imaging showed a huge intrusive prostate.  I had the Rezum treatment at New Years, but I still could not pee. 

   I then had a cystoscopy, which clearly showed that my prostate had indeed shrunk from the Rezum treatment, but that scar tissue was continuing to block my urethra. 

   I’m looking at another surgery to remedy that.  I’m definitely not looking forward to it, but I’m tired of being chained to a urinary catheter.  (I call my catheter collection bag “Sancho Panza”, since it is my constant sidekick wherever I wander.) 

[Thailand J]

For those considering surgery, Prostate Artery Embolization is now available at Siriraj Radiology Center, 72 yr Building 2nd floor. 02-419-8731.

 

 

[mdlak]

There's a natural herb you should consider grown right here in Thailand: Butea superba

Something to consider, certainly before anything toxic like finasteride. 🤮

"Research indicates that butea superba increases DHT in the bloodstream, which enhances libido and sexual function. However, it simultaneously reduces DHT in the prostate, potentially protecting against prostate enlargement (9). This balanced action makes it particularly valuable for older men concerned about prostate health while seeking to maintain sexual vitality."

Search online for "jacked thoughts butea superba" for the source of the above quote. 

https://www.jackedthoughts.com/butea-superba/

Good luck.

[Globenauta]

On 5/24/2025 at 3:48 PM, Sheryl said:

Most common cause of prostatitis is E. Coli, which an STD panel would nto detect.

Also, depending on the type of test done, there can be false negatives esp for chlamydia.

 

So you still need to rule out prostatitis IMO. It is just not usual for mild BPH to cause the degree of urinary frequency you describe. Add to that the lack of relief from tamsulosin, and suspicion of an infection rises.

 

This doctor is  not too far from Samut Prakan  and has been recommended by other board members

https://www.sukumvithospital.com/doctorprofile.php?id=188&lang=en

 

Ideally you want toi get a prostate massage to express prostatic fluid then a culture and sensitivity

 

As for your BPH: iti s a progressive condition and it worsens with age, but how fast varies greatly. One of the 2 classes of medication used for it can help reduce prostate size/slow growth. These are the 5-alpha reductase inhibitors, such as finasteride and dutasteride. It takes 6-12 months to see the therapeutic effect of these drugs, and they do unfortunately sometimes worsen ED. When they do, sometimes this effect eases up with continued use and sometimes not.

 

The other class of drugs used for BPH are alpha antagonists, such as tamsulosin and doxazosin.  These do nto affect oprostate size but rather give symptomatic relief from blockage by relaxing the smooth muscles in the prostate and bladder neck. Unlike the first class of drugs, action is almost immediate. You already tried this class of drug without  relief.

 

Cialis is also sometimes used to relax the muscles around the bladder neck and prostate, likewise only symptomatic relief. And of course, for ED. 

 

Since the 5-alpha reducatse inhibitors do, over time, reduce the size of the prostate and slow progression of BPH, you  could ask doctor about a daily regimen of Cialis plus finasteride or dutasteride as a way of  potentially off-setting the negative effect of the latter on erectile function. May or may not work, and may or may nto be suitable i nthe context iof your overall medical history.

 

Urolift is nto widely available here, just a few places and doubt any doctor  would  do it for mild case of BPH. Like all treatments, it has potential side effects. 

 

Some people feel that saw palmetto and/or milk thistle supplements help with BPH, others don't, and there is a lack of clear evidence either way. No harm in trying.

 

But above all, I suggest you rule out potential infection as your urinary frequency is unusual from mild BPH. 

 

 

 

 

 

 

Thanks again, Sheryl, this is very helpful.
 

Since your last reply, I’ve started tracking my urination frequency more precisely. It turns out I’m averaging about every 2.0 to 2.5 hours while awake, which is more reasonable than the 1–2 hours I initially estimated. That said, I still get that uncomfortable “need to hold” sensation and urgency, even shortly after going.
 

Also, thank you for the doctor recommendation. I’ll definitely keep that in mind if I decide to get a second opinion.

I really appreciate your support, to be honest, this has been more helpful than my recent urology visit.

[rumak]

On 5/27/2025 at 1:41 PM, RayOday said:

I once read some really helpful advice on this forum regarding BPH. I didn't save the link so I regret that I can't credit the author.I did copy the text so here you go...

 

Early 60's and retired, having worked in healthcare my entire career.  I have been living with BPH for about 15 years.

 

When considering prostate treatment options it is important to know your prostate size.  This is generally obtained and calculated from a lower abdominal ultrasound.  Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume).  Smaller prostates are generally more easy to treat than larger prostates.  The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate.  Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe.  A large median lobe can complicate some surgical techniques.

 

Medications are the first line of therapy and are usually quite effective.  Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms.  I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow.   I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin.  In Thailand these are available as Xatral XL 10mg and Urief 4mg.  There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral.  Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy.  Alfuzosin is idealy taken about a half hour after finishing dinner.  Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction.  Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype.  The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation.  The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate.  During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra.  With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder.  For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin).  I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time.  I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective.  I'd also recommend silodosin to any patients trying to pass a kidney stone.

 

The other main class of prostate medications are the 5-alpha reductase inhibitors and these include finasteride and dutasteride.  These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT.  This class of medication is much less effective in patients with smaller prostate sizes.  The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer.   Sometimes these drugs are marketed as combination therapies with alpha-blockers.  The medication Duodart is a good example.  I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart.

 

When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate.  Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital.  The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies.

 

Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that.  This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization.  Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive.

 

Most men, myself included, care quite strongly about preserving normal ejaculatory function.  If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle.  Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys.  During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again.

 

If you don't care about ejaculatory function then don't  early 60's and retired, having worked in healthcare my entire career.  I have been living with BPH for about 15 years.

 

When considering prostate treatment options it is important to know your prostate size.  This is generally obtained and calculated from a lower abdominal ultrasound.  Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume).  Smaller prostates are generally more easy to treat than larger prostates.  The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate.  Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe.  A large median lobe can complicate some surgical techniques.

 

Medications are the first line of therapy and are usually quite effective.  Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms.  I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow.   I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin.  In Thailand these are available as Xatral XL 10mg and Urief 4mg.  There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral.  Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy.  Alfuzosin is idealy taken about a half hour after finishing dinner.  Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction.  Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype.  The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation.  The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate.  During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra.  With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder.  For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin).  I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time.  I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective.  I'd also recommend silodosin to any patients trying to pass a kidney stone.

 

The other main class of prostate medications are the 5-alpha reductase inhibitors and these include finasteride and dutasteride.  These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT.  This class of medication is much less effective in patients with smaller prostate sizes.  The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer.   Sometimes these drugs are marketed as combination therapies with alpha-blockers.  The medication Duodart is a good example.  I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart.

 

When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate.  Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital.  The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies.

 

Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that.  This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization.  Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive.

 

Most men, myself included, care quite strongly about preserving normal ejaculatory function.  If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle.  Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys.  During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again.

 

If you don't care about ejaculatory function then don't waste time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life.

 

I'm not going to discuss techniques for complete removal of the prostate as I really only see that as  time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life.

 

Thanks for posting that.... a really good piece of info that i have now saved as well .

If anyone reading this has used Alfuzosin please make a comment on how it has worked for you .   Silodosin seems to be the NEW favorite of the docs, but sounds a bit stronger than i would like due to side effects.

Right now i do not take any meds,  but at night when waking my bladder is Very tight and uncomfortable.... which alleviates as i stay up for a while , walk around, and urinate twice.  Anyone have the "tightness" issue like i do ?