My Experience with Dutasteride and Alpha Blockers

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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:

  1. 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).
  2. 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.
  3. 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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  • Posted

    I forgot to mention that I also have an inexpensive device for measuring maximum flowrate while urinating. I purchased it for $10 on Amazon (MDTi Uflow meter). My maximum flowrate is right around 15 ml/sec. This is typically the "rule of thumb" acceptable flowrate for urination. Prior to starting dutasteride, my maximum flowrate was around 12.5 ml/sec (interpolated from the lines on the Uflow meter).

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  • Posted

    Most so called natural supplements are unregulated because they do nothing and are a waste of money.

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    • Posted

      I don't agree with that statement. Natural and herbal remedies have been used for centuries. Pharmaceuticals are no doubt stronger and more effective at achieving a particular goal, but often have more side effects. As I see it, the issue mostly is that there is little incentive for companies to research the effects of natural supplements on a particular illness since they won't have a proprietary claim (financial incentive). I use pharmaceuticals when I have to, but prefer to use natural/herbal supplements if prudent.

      I'll give you an example. If you read the baldness/ body building forums there is a lot of discussion about high estrogen levels (estradiol). I researched potential natural supplements to decrease estradiol and found chrysin. There were actually some research studies done on the estradiol-lowering effect of chrysin. I now drink passionflower tea, which contains chrysin. My last estradiol test showed that it was at the lowest end of the range. Now, I can't be 100% sure that it is due to the chrysin, because I didn't realize I should have insisted on hormone tests prior to starting dutasteride. Still, I suspect the chrysin is working as indicated by the research studies.

      I wouldn't want to live in a world without pharmaceuticals, but I definitely believe that these substances are over prescribed for complaints that could readily be solved by lifestyle changes or natural/herbal supplements .

      With regards to DHT, I might find something that works and I might not. But I definitely intend to have the DHT measured throughout the maintenance phase and see how it goes.

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    • Posted

      Well put rdemyan! Lester has obviously turned sour on natural supplements because he comments every time he sees it mentioned 😃 no offense lester. I am taking Bet Sitosterol and Pygeum and Stinging nettle root. The most I get up is 2 times a night and occasionally only once. That is a HUGE improvement for 3-5 times a night. I have been on the natural supplements for 3 weeks now. Dont know which one made the difference and at this point I dont care. I have not seen any improvement on hesitation or flow as of yet.

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    • Posted

      Yep. European doctors often recommend saw palmetto/stingling nettle as a first treatment program. For mild to moderate LUTS probably worth a try. For more severe LUTS, probably won't work. But, even if a procedure is ultimately required, these supplements or something like dutasteride/alfuzosin can buy a man more time to thoroughly research treatment options rather than having to quickly make a decision. How many times have we seen men on this forum state that they wished they had done more research and not just blindly trust the first recommendations provided by doctors.

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    • Posted

      So what. There are many that work and have been used for hundreds of years. Herbal medicine has been used by billions of Chinese and still is.

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    • Posted

      honestly though lester how many dr's in the US do you know? my uro recommened natural ober prescribed before I commit to a prescription

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  • Posted

    I didn't mention what my motivation was for choosing dutasteride over a BPH procedure. At the time, one reason was just to avoid surgery and the possibility of incontinence/impotence (I'm not that concerned about RE).

    However, the bigger motivation was that I wanted to reduce the size of my prostate so that I could consider other BPH procedures that are generally not suitable for very large prostates. Urolift, for example, is generally not advised for prostates larger than 100 grams (although that may have changed in the last 6 months and may change in the future). At 70 grams or so, I now believe that I can consider virtually all of the BPH procedures available, if that's the direction I need/want to take in the future.

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    • Posted

      Research PAE, a less invasive procedure with a growing track record for relieving BPH symptoms in men with no median lobe problems. You are wasting your time and money with "natural" remedies. The amount of time that homeopathy has been available does not make it a useful treatment. All medicines are derived from nature, where else can you get them from? What matters is whether there is evidence for its effectiveness. There is no such thing as alternative medicine. If it demonstrably works i.e, double blind placebo trials, it's medicine. Everything else is quackery and designed to part the desperate from their money.

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    • Posted

      The only thing I want the natural medicines (saw palmetto and stinging nettle, for example, which are often prescribed by doctors in Germany as a first line treatment), is to keep the prostate at it's current size.

      Just recently I have begun reconsidering PAE; now that it looks like most of the failures are a result of a median lobe (assuming no bladder issues). But first, I will get a 3T MRI to verify that I do not have a median lobe and to get the most accurate estimate of my prostate size.

      My main concern with PAE is that the beads are either placed in arteries that serve other areas besides the prostate or that over time (decades) somehow dislodge and move to other areas. I don't know. I need to do more research.

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  • Posted

    The problem with your plan is that sometimes the side effects the drug you're taking don't reverse after you stop taking them.

    You can definitely get Rezum done now. There are almost no cases of impotence and close to 50% have improved sexual function from it. It works almost all the time when prostate size is the main or sole issue. Enlarged median lobe is not problem. You'll have a messy 1-4 weeks and then you'll be as good as before. By 6 you're likely better.

    Those drugs seem to be taking their toll - in case you end up being a non reverser, you might want to consider getting off of them ASAP.

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    • Posted

      Yes, I've been thinking about reducing the dosage even now. I originally wanted to start after the 6 months, but my uro feels that my PSA is not where it should be (previous PSA measurements have shown that my PSA tends to jump around a lot; probably due to prostatitis). When I took the most recent PSA test, I was not feeling that well and subsequently saw traces of blood in my urine after ejaculating (as measured by urine dipsticks - no visible blood in urine). Using the cancer calculator, my risk is quite low, so he wants me to stay on the pills for another 6 months.

      I suspect the sexual side effects won't be permanent, because i feel the urge multiple times per day - it just doesn't last nearly as long as before. But your point is taken.

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    • Posted

      You obviously are aware of the sexual side effects but seem to have ignored them Common side effects may include:

      decreased libido (sex drive);

      decreased amount of semen released during sex;

      impotence (trouble getting or keeping an erection); or

      breast tenderness or enlargement.

      The sexual side effects of dutasteride may continue after you stop taking dutasteride. Talk to your doctor if you have concerns about these side effects.

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    • Posted

      When I say sexual side effects, I am including the first three points on your list. With regards to breast tenderness, enlargement and even cancer, my research suggests that the culprit is estradiol dominance; hence that is why I am drinking the tea that I mentioned earlier.

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    • Posted

      When I briefly took dutasteride my breasts began to swell and my wife offered to buy me a training bra. A few other meds had a similar effects but went back to normal after stopping it.

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