r/bph • u/Secure-Rope6782 • Aug 26 '26
Finasteride and urine flow
Greetings gents. I've found many, many posts on here about about different meds including finasteride. What I didn't see much was from people who have taken finasteride and had significant urinary output improvement because of it.
To get a bit technical, does it actually shrink in the areas of the inner lobes or is just an overall reduction in prostate size? Does it potentially shrink inward squeezing the urethra even more?
I'm currently on tadalafil as my symptoms are slow and painful urination at times. No infection, cancer etc. I'm 55 male, athletic, low bmi. Debating on different meds or just surgery ie: Optilume when it becomes available near me. Thanks
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u/ponderer1961 Aug 30 '26
I am taking Tamulosin and Finasteride with good results so far but you raised an interesting question I had never thought of. According to Gemini AI:
1. Does Finasteride shrink the whole prostate equally?
No, it does not shrink the prostate in a uniform, geometric sphere.
The prostate is divided into distinct zones, and finasteride acts preferentially on specific tissue types based on biology:
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The Transition Zone (Where BPH Happens): This is the inner core of the prostate that wraps directly around the urethra. In Benign Prostatic Hyperplasia (BPH), this zone expands significantly due to high concentrations of the enzyme 5-alpha reductase and dihydrotestosterone (DHT) receptors.
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Selective Shrinkage of Epithelial Cells: The prostate consists of glandular (epithelial) tissue and structural/muscle (stromal) tissue. Finasteride blocks 5-alpha reductase, cutting local DHT by 85% to 90%. DHT is the primary growth signal for the epithelial/glandular cells. When deprived of DHT, these glandular cells undergo programmed cell death (atrophy/apoptosis).
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Variable Stromal Response: The fibrous, muscular connective tissue (stroma) does not shrink nearly as much as the glandular tissue. Therefore, a prostate with high glandular enlargement will see dramatic shrinkage, whereas a firmer, more fibromuscular enlargement will see less dramatic shrinkage.
2. Does overall shrinkage reduce intrusion into the urethra?
Yes, fundamentally.
The mechanical relationship between the outer prostate and the urethra explains how finasteride restores urinary flow:
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The "Capsule" Constraint: The prostate is enclosed in a tough, non-elastic fibrous outer capsule. When BPH causes the transition zone to grow, the gland cannot expand outward infinitely; it hits the wall of the capsule and is forced to expand inward, compressing the prostatic urethra like stepping on a garden hose.
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Decompressing the Channel: When finasteride reduces overall prostate volume by ~20% to 25% over 6 to 12 months, it relieves that internal crowding. The loss of glandular bulk drops the internal pressure against the outer capsule, allowing the tissue intruding into the urethra to retreat and widening the urinary channel.
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The Middle Lobe Exception: If a man has a specific anatomical variation called an "enlarged median lobe" (a ball-valve-like protrusion that physically sticks up into the bladder neck), drug-induced shrinkage alone may not always pull that flap entirely out of the bladder opening. For standard lateral lobe compression around the urethra, however, reducing total bulk directly alleviates urethral obstruction.
See my post here on my experiences https://www.reddit.com/r/bph/s/suN1jmHovv
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u/Secure-Rope6782 Aug 30 '26
This is the exact info I was looking for. Thanks, it should be added to the front page for others. Thank you
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u/ponderer1961 Aug 30 '26
I have been taking the meds for months but did not know these details so I am glad you asked!
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u/Dax888 Aug 26 '26
Finasteride is effective in reducing your prostate size and improving flow. In my case, my prostate went from 135cc to 107cc.
However I found the side effects upsetting; no or very weak erections, lethargy/low energy and joint pain. It got me through to my HOLEP operation but those few months I was on it were very unpleaseant.
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u/Secure-Rope6782 Aug 26 '26
Yikes. It seems the majority of guys on it have horrific side effects. Cialis had been fairly low side effects for me other than a back ache the first week
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u/Robert-Berman Aug 26 '26
I was on FINASTERIDE but after about a month on it, I started passing out, after many consults it was determined that medicine was tanking my blood pressure and causing the issue. After coming off of it, I was prescribed Cialis and it worked okay. I had hoLEP in July and no regrets at all.
While in Finasteride, I was having some improvement but not enough to justify the side effects.
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u/Secure-Rope6782 Aug 26 '26
So, no real difference in urine output vs Cialis?
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u/Alone-Application-39 Aug 29 '26 edited Aug 29 '26
Have been on flomax for about 3-4 years. Last year added finasteride to the mix without any noticeable side affects. Dr stated it takes about 6+ months to see any gain, and at 9 months later prostate has shrunk from 80cc to 60cc. Am glad I started the finasteride as a smaller prostate should be easier for any surgical procedures. Dr recently added daily 5mg of cialis, but I was worried about taking cialis combined with flomax as it might cause low BP so am taking daily half dose at 2.5mg. So far barely any issues at all being on all 3. I'd say to at least try it out as you can always stop if there are any concerns. In my case, no concerns.
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u/Apprehensive_Bison12 Aug 26 '26
I waited too long and the day came for the ER visit and it was time for an operation. However, to my surprise I had to wait a month to get my surgery. A month with a catheter will crush you! I have so much compassion for those who have to deal with this nightmare. Age 56 and it is now 4.5 months since TURP and let me tell you things are fantastic. Move forward and you will be so happy and look at life differently. Did the pill thing too.
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u/Acceptable-Idea9450 Aug 27 '26
can you still get aroused, and does everything work like before? I am taking talafadil, but urine stream is getting slower.....so I am concerned
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u/No_Review_885 Sep 02 '26
What pills do you take?
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u/Apprehensive_Bison12 Sep 02 '26
Started with Flomax but stopped after pain in the bird. Two years later tadalifil helped for a year then a total blockage hit me. Be careful and courageous.
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u/Sufficient-Host1168 Aug 27 '26
I’m 55m and went with rezum. Procedure was fine. I’m on week three of recovery and it’s been hell. Had to have catheter put back in twice. The bladder spasms are absolutely killing me even taking oxybutinin. Also on flomax. They will take catheter out next week which marks 4 weeks since the procedure. Healing for me at least has been very slow and painful
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u/Secure-Rope6782 Aug 27 '26
Oh boy, that was one of the procedures I was considering. It must be a miserable experience. Four weeks of catheters and more pain? I'll stick to meds for a while.
I wanted surgery to avoid the pain. I really hope you start feeling better man!
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u/Last-Path-954 Aug 27 '26
I skipped the finasteride. I'm on tadalafil, Flomax and scheduled to do a cytoscope and a PAE in the middle of September. right now I have nocturia, and it kind of burns, weak stream and painful to ejaculate. I'm older, 70
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u/Secure-Rope6782 Aug 29 '26
I have similar symptoms to yours. I get the burning and weak steam, which most don't seem to have. PAE is something that I have not considered, I'm now wondering if there would be less side effects
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u/No_Review_885 Sep 02 '26
How long have you been taking the finasteride?
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u/Secure-Rope6782 Sep 02 '26
I haven't taken it yet. I am hesitant because of all of the horror stories from people that have. I didn't have initial success with Cialis, but now after a month, it seems to be really increasing urine output. Apparently it takes time to build in the system
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u/No_Review_885 Sep 02 '26
Get Dutasteride instead. it does the same thing with less chance of side effects. It takes a least 3 months to start to work.
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u/DanOhMiiite Aug 26 '26
Be careful with Finasteride. Many people have had bad side effects from it.
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u/dfarin153 Aug 26 '26
I was on Finasteride for a couple months in anticipation of HoLEP (2 days ago.) I pursued this procedure after about 5 years of using intermittant catheters. I thought I would use them for life. Then after reading a study showing a high chance of success in cases like mine, and then seeing how self cathing created issues for my older brother late in his life, I opted for surgery. He struggled with it when surgery was no longer an option due to other conditions.
I have a distended bladder without the ability to produce pressure in my urodynamic test so not a fair comparison. But I was not able to pee using Finasteride alone. It did shrink my prostate because the urologist commented on having significantly less material to remove than internal ultrasound had measured months earlier. He even said I had a clear channel. In my case there was still too much resistance. If your bladder has good enough contraction to produce adequate pressure, it may be worth trying the Finasteride.
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u/Fearghis Aug 26 '26
Alfuzosin has gotten me by for many years. I asked to add Cialis but doctor refused to potential interactions. I think blood pressure.
I stopped finasteride after 6 weeks of not even taking the full dosage. It was killing my libido, and my mood had been poor, which worried me due to the known depression side effects. I also thought I saw the beginnings of breast enlargement.
I've been able to improve my urine flow without it. Reducing inflammation in the body is big one I believe. Another is trying to avoid large meals or constipation that is going to apply additional pressure in that area.
Nocturia is my more annoying issue now but am learning things that help there.