Benign Prostatic Hyperplasia: Proscar Vs Flomax (Vs Propecia)

By
The Shapiro MD Team

2021-06-07

Being able to urinate effortlessly is a vital part of living a dignified and comfortable life, one that we often take for granted – until we can’t. Aging can wreak havoc on a variety of physiological functions, and for those diagnosed with benign prostatic hyperplasia (BPH), difficulty in this most basic of human functions can be incredibly frustrating.

Benign prostatic hyperplasia, or an enlarged prostate, affects many adult men as they age, with roughly half of men in their fifties suffering from BPH, and the percentage increasing from there. With BPH, the prostate experiences a state of growth and hormonal changes beginning as early as the mid-twenties and typically continuing throughout life. This is when BPH can occur, sometimes causing significant issues as changing hormones cause the prostate to grow and squeeze the urethra.

What’s the relation to hair loss? BPH is often treated with the branded medication Proscar®, for which the active ingredient finasteride is also commonly used to treat male pattern hair loss (or androgenic alopecia) as Propecia®. Both are effective for the very same reason: they block the 5-alpha-reductase enzyme. They're typically prescribed at different doses, however: 5 mg for Proscar vs 1 mg for Propecia.

Age, obesity, family history of BPH and erectile dysfunction can increase the risk of BPH in adult males. The exact cause of BPH is uncertain, though it’s likely due to natural changes in hormones. Preventative measures are difficult to pin down, though exercise and a healthy diet can contribute to the regulation of weight and hormonal balance, which may help to combat the development and symptoms of BPH.

Symptoms of BPH include discomfort while urinating, urgency and frequency in urinating, trouble with emptying the bladder, or feeling as though it isn't emptying, and other urinary difficulties. It can result in kidney and bladder damage, blood in the urine and bladder infection. In some extreme cases, those with BPH can lose the ability to urinate at all and must have emergency intervention.

Surgery is an option when treating BPH, though it’s generally reserved for those in whom medication is not effective at eliminating the symptoms. Surgical options include water vapor therapy, insertion of a UroLift system, transurethral microwave therapy and transurethral needle ablation.

When treating more manageable cases of BPH, prescription drugs are used as a less invasive and effective option. The drugs used typically fall into two categories: 5-alpha reductase inhibitors like finasteride, which shrink the enlarged prostate by blocking the production of the hormone DHT, and alpha-blockers, which work directly to relax the prostate muscles.

Proscar is the brand name for generic finasteride, a 5-alpha reductase inhibitor that is frequently prescribed for the treatment of BPH and for hair loss in a lower dose.

Flomax, also known by the generic name tamsulosin, is a popular alpha-blocker also commonly used for treating BPH.

Though they can have similar outcomes, there are significant differences between the two, including how they work to combat the symptoms of BPH and side effects.

Proscar

Proscar is the brand name for finasteride, first approved for BPH by the FDA in 1992. It’s taken by mouth as prescribed, typically once a day at the same time in coordination with a regular meal, although it isn’t necessary to eat with it. It’s intended to be swallowed whole and is not to be chewed, crushed or otherwise broken up.

When used for an enlarged prostate, the dose is usually 5 mg. Because it also increases the growth of hair on the male scalp, it is also used at a lower dose as part of a hair loss treatment program.

Propecia and generic finasteride for hair loss are approved by the FDA in a 1 mg dose.

How Proscar Works

Proscar works by blocking the 5-alpha reductase, an enzyme that is responsible for changing testosterone into dihydrotestosterone, which can contribute to an enlarged prostate or the loss of hair. By blocking this enzyme, finasteride lowers dihydrotestosterone in the body by as much as 70%.

Less dihydrotestosterone can help to shrink the prostate and contribute to normal hair growth at the same time.

Symptoms of BPH such as difficulty urinating can be improved, and the need for surgery may be reduced or eliminated. That’s the goal with Proscar therapy.

Potential Side Effects of Proscar

There are notable side effects for Proscar when used for the treatment of BPH, which include:

  • Erectile dysfunction
  • Decrease in sex drive
  • Abnormal ejaculation
  • Reduced ejaculate
  • Swelling in breasts, tenderness when touched
  • Skin rash
  • Dizziness, feeling faint
  • Weakness
  • Swelling in feet and hands
  • Hair growth
  • Depression
  • Swelling in mouth and face

If serious side effects like depression or swelling of the lips, mouth or face occur, contact your doctor immediately.

Alternative Uses for Proscar

Male Pattern Baldness

Proscar is FDA-approved for treating male pattern baldness in men, which can be caused by increased levels of the hormone DHT. Studies have shown an increase in scalp hair as well as improved quality of hair over time when finasteride is used. Hair growth may take several months to begin showing, and the medication is intended to be taken long-term. Stopping finasteride will result in the cessation of hair growth.

The same side effects listed above for Proscar when used for BPH apply when it is used to increase hair growth. Side effects of finasteride or Propecia are less significant when it is used to combat hair loss than BPH, typically, likely because it is prescribed at a much lower dose.

Flomax

Flomax is the brand name for the generic tamsulosin. Flomax is typically prescribed at 0.4 mg to be taken at the same time each day, a half-hour after eating a meal. It is not designed to be chewed or crushed and should be swallowed whole. If patients don’t respond to that dose after some time, their doctors may choose to prescribe a higher dose of 0.8 mg, still to be taken once a day after a meal. In addition to treating BPH, it is also sometimes prescribed for kidney stones and bladder outlet obstruction.

How Flomax Works

Flomax is an alpha-blocker, which have been characterized as “the most effective, least costly and best tolerated of the drugs” used for treating urinary tract issues. It works by relaxing the prostate muscles, as well as those of the bladder. By doing so, urination becomes easier, with flow and strength of stream increased and the need to frequently urinate decreased.

Potential Side Effects of Flomax

Side effects of Flomax are less noteworthy than those of Proscar, though they can still be serious. The risk of some of these is higher when the drug is first prescribed or when there is an increase in dosage, so be mindful of any changes in your body during these times.

Side effects include:

  • A sudden drop in blood pressure
  • Dizziness or fainting
  • Headache
  • Back pain
  • Rhinitis
  • Sinusitis
  • Nausea
  • Decreased libido
  • Ejaculation issues
  • Painful or prolonged erection

If serious side effects like an erection lasting longer than four hours occur, seek medical help immediately.

Alternative Uses for Flomax

Flomax and Kidney Stones

Flomax has been shown to help ease the passage of kidney stones, particularly large ones that cannot easily make it on their own. Using Flomax helps decrease the need for surgical or other intervention and could therefore save a person with large kidney stones a significant amount of pain, difficulty and medical intervention if prescribed by a doctor. There are ongoing studies to explore the effectiveness of this treatment.

Flomax and Bladder Issues In Multiple Sclerosis Patients

Flomax is also used to help treat bladder issues in men diagnosed with multiple sclerosis. These problems include difficulty emptying the bladder, urgent need to go frequently, and incontinence. By relaxing the prostate muscles, prostatic urethra and the neck of the bladder, the flow of urine is improved and other symptoms decrease. Because Flomax works on the prostate, it is only prescribed for men; women and children with MS cannot use it for treatment.

Proscar Vs. Flomax

It doesn't have to be finasteride vs Flomax. Combination therapy is commonly employed to better treat patients with BPH. The use of both the alpha-blocker Flomax and the 5-alpha reductase inhibitor Proscar to simultaneously treat BPH has been shown to offer better results for those suffering from symptoms due to a diagnosis of BPH, if appropriate.

Though Proscar and Flomax are both effective medications for treating benign prostatic hyperplasia, they should only be taken as prescribed by a doctor. Be sure to tell your doctor about any medications or supplements you're using before beginning the use of one or more of these prescriptions as there can be serious interactions.

If you're most interested in Propecia (finasteride) for hair loss, Shapiro MD can help. Our telemedicine platform connects men and women with licensed clinicians for prescription hair loss solutions, if appropriate. It's easy and affordable. Get started with your online consultation by clicking here.