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I have been on dutasteride and alfuzosin for about 7 months. The prevailing opinion on this blog is that these drugs are to be avoided at all costs. I am not here to dispute this but simply to post my experience with taking these drugs.
I had been having noticeable prostate problems for about 5 or 6 years. However, I thought my issue was mostly prostatitis because my uro kept telling me that my prostate was around 40 grams in size, which he was estimating from a DRE. Last year I started having more problems with urinating at night. My GP ordered a transabdominal ultrasound (TAUS) and the result was a prostate size of 140 grams!!? I hit the roof and had it out with my uro. I changed uros and had a transrectal ultrasound (TRUS), which is more accurate than a TAUS. The result was a prostate size of just under 100 grams. I decided to start taking dutasteride and an alpha blocker (originally tamsulosin but switched to alfuzosin). I chose dutasteride because it has an additional pathway for decreasing DHT compared to finasteride. I've sinced learned that the half life of dutasteride is 5 weeks whereas finasteride is around 7 hours or so.
About five years ago, I was urinating a lot, so I kept a detailed urination journal for about a month. I discovered that the problem was I was simply drinking too much fluid (over 3.5 liters per day). Over a year ago, I restarted keeping a detailed urination journal, which is now ongoing. After about 6 to 8 weeks on dutasteride/alfuzosin, I started noticing significant increases in the average amount of urine produced each time I went to the bathroom. As of right now (7 months), I am peeing about 40 to 50 mL more each time I urinate during the daytime, then last year at this time. The amounts that I am currently urinating are about the same if not better than five years ago. I have my own bladder scanner and my PVR is around 70 mL. I get up about 1 to 2 times each night.
About a month ago (the 6 month point), I convinced my uro to order another TAUS. Although the first TAUS appears to have overestimated the prostate size (140 versus 100 from TRUS), I reasoned that a subsequent TAUS should show a difference even if the absolute number wasn't correct. The latest TAUS result was 70 grams. I've also had sex hormone tests done (which I had to forcefully convince my GP to order). DHT is extremely low as is to be expected. Testosterone is above average for a man in his early sixties. So my numbers are all signficantly better and I no longer feel the pretty much constant perineum discomfort; only occassional now (but I still use my prostate cushions). As of now, I am quite happy with these results.
Now with regards to sexual side effects. Originally, I was on dutasteride and tamsulosin and I had a definite loss in libido and performance. The uro prescribed cialis, which helped somewhat. I have tinnitus and convinced my doctor that tamsulosin was making it worse. It was a little bit, but mostly I wanted to get off of tamsulosin. Many American doctors/uros only prescribe flomax; however, having lived in Europe, I always take note of what the Europeans are doing. So, I convinced my uro to switch me to alfuzosin, which is prescribed far more in Europe than in the states (not unsurprisingly, neither my GP nor uro had ever prescribed alfuzosin!). I've since learned that alfuzosin is far less likely to cause floppy iris syndrome when compared with tamsulosin. Sexual side effects were still there while taking dutasteride/alfuzosin, but much less than on dutasteride/tamsulosin. Just recently, however, I am having a further loss of libido and while I can "perform", sex has to occur very quickly after I have desire, otherwise, the interest is gone pretty quickly.
So, I've been formulating a plan to reduce taking the drugs. Here is the thought process:
- Dutasteride/finasteride typcially reduces the size of the prostate by about 25 to 30%. The vast majority of this reduction occurs in the first 6 to 12 months. After that, it seems to me that a man is taking these pills for maintenance (i.e. to keep the prostate from increasing in size again).
- Remember the half lives I mentioned above. It seems to me that, in the maintenance phase, I can start to take dutasteride only every other day or maybe even once a week and still maintain enough of a blood concentration of dutasteride because of the relatively long half life (5 weeks). This won't work with finasteride because of the very short half life.
- I mentioned my tentative plan to my uro, and surprisingly, he agrees with me. He has other patients that are only taking dutasteride every other day. However, he wants me to continue to take dutasteride every day for the full year because after the first 6 months my PSA didn't go down as much as hoped.
So the plan is that after a year on dutasteride, I will start reducing the number of times per week I take dutasteride. Since I am a data-driven person, I told my uro that on the future reduced weekly dosage plan, I would be having my DHT measured whether he agreed or not. He agreed that measuring DHT is a good idea. I'm also going to be asking for TAUS measurements of the prostate size as another way of checking whether the plan is working. Further, I'll continue to keep my urination journal.
Between now and the start of the "maintenance" plan, I am going to be researching if there are natural supplements that can help keep my DHT low so that I can really reduce if not eliminate the need to take dutasteride. I have no desire to stay on these drugs. We'll see how successful I am.
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