How Tadalafil Helps With Benign Prostatic Hyperplasia

Cialis (tadalafil), an erectile dysfunction medication, can also treat urinary symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate.

Prior to this finding, there were only two options for urination difficulties in those with BPH:

  • Alpha blockers like Flomax (tamsulosin) that relax tissue and muscles around prostate
  • 5-alpha reductase inhibitors like Proscar (finasteride) and Avodart (dutasteride) that shrink the size of the prostate over six to 12 months

Although alpha blockers and 5-alpha reductase inhibitors are effective for helping with urination, they can have side effects that affect sexual function. Alpha blockers can cause retrograde ejaculation, or when semen enters the bladder and the person may no longer see ejaculate come out anymore; and 5-alpha reductase inhibitors can decrease libido. Some individuals take both medications, which can really dampen their sexual functioning if they are having both side effects.

Since 2011, Cialis (tadalafil) has been approved by the FDA for daily use in treatment for men with enlarged prostate, or BPH. It's the same medication as for sexual and erectile dysfunction, but it's just taken daily as a lower dose. This has the potential to make Cialis doubly beneficial for both urination and sexual functioning in men with enlarged prostate.

Doctor discussing prostate ultrasound scan with a patient
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What Is BPH?

If you have BPH, you probably need no introduction to its inconvenient, annoying and sometimes very serious symptoms. However, for all of us who are uninitiated, here's some info on this condition.

Benign prostatic hyperplasia is a noncancerous (nonmalignant) enlargement of the prostate gland. In men, the prostate makes part of the male ejaculate, or semen. In men with BPH, the prostate can become significantly larger and cause urinary obstruction. Of note, the prostate is a doughnut-shaped gland that surrounds the urethra or "pee" tube; the prostate sits just below the bladder.

Although prostate cancer can include enlargement and tissue expansion and many of the same initial symptoms as BPH, BPH isn't cancer. It's a benign condition which most men aged 50 or older experience to some degree. Moreover, BPH likely confers no additional risk of developing prostate cancer.

In most men, BPH is asymptomatic and causes no recognizable symptoms. About one-third of American men, however, can experience the following initial symptoms:

  • Weak urine stream which starts and stops
  • Feeling that you still have to pee even after you just finished urinating
  • Trouble initiating a urine stream (hesitancy)
  • An increased urge to urinate at night (nocturia)

Over time, BPH can lead to more serious problems such as urinary tract infections, kidney, and bladder damage. (The obstruction caused by a hyperplastic prostate can cause urine backup which damages the kidney and bladder.)

Initial treatment for BPH is behavior changes, such as decreasing excess caffeine intake. Men with symptomatic BPH typically have the option to start alpha blockers (tamsulosin, terazosin or doxazosin) and 5-alpha reductase inhibitors (finasteride or dutasteride).

Although both types of BPH medications contain alpha in their names the mechanisms of these drugs are completely different. Alpha blockers relax smooth muscle in the bladder neck and prostate in order to improve urine flow and relieve urinary obstruction. While alpha blocker medication acts quickly within seven days typically, 5-alpha-reductase inhibitors target the hormonal underpinnings of BPH and not only help with urinary flow, but, if taken long enough, can actually shrink the prostate and postpone the need for surgery.

Peak effects with 5-alpha reductase inhibitors take longer to be noticed and are achieved after six months of use. The effects of these two types of medications have a greater effect when used together.

Beyond medication, urologists can offer surgical treatments like prostate resection (remove parts of the prostate), implants (lift and hold the prostate tissue so it no longer blocks the urethra), laser ablation (laser used to remove excess tissue), or steam vaporization (steam used to remove excess tissue). Even these surgeries can have sexual side effects.

Adding Cialis to the Mix

For reasons we can all probably appreciate, a big complaint among many men receiving treatment with alpha blockers, 5-alpha-reductase inhibitors or both is that in 5% to 15% of people, such meds mess with erectile function, libido, and ejaculation. To counteract this unwanted adverse effect, urologists and primary care physicians have started adding Cialis to the medication mix. 

Furthermore, in 2011, the FDA had already approved Cialis for treatment of BPH symptoms, too. Thus, in men with BPH, Cialis demonstrates double efficacy—it helps with urination, and it helps with erectile dysfunction.

Fortunately, the science supports the practice of adding drugs chiefly aimed at erectile dysfunction to BPH medication regimens. In a huge randomized-control trial sponsored by Eli Lilly, makers of Cialis (go figure), 695 men were given either Cialis or placebo in addition to the 5-alpha reductase inhibitor finasteride. 

Results were very encouraging with statistically significant improvements in sexual desire, orgasmic function, erectile function, and overall sexual satisfaction observed in those taking Cialis with finasteride. Moreover, adverse effects were few and tolerable. Results were measured at four, 12, and 26 weeks of therapy using a questionnaire titled the International Index of Erectile Function.

Closing Thoughts

If you or someone you love is experiencing sexual difficulties secondary to BPH medications like finasteride and aren't already on Cialis, be sure to discuss it with your primary care physician or urologist. The addition of Cialis to your treatment regimen may help with your sex life and symptoms of BPH itself. 

On a related note, because of its hormonal effects, lower-dose finasteride is also marketed as Propecia, a drug given for hair loss. Although people who typically take Propecia are younger men with fewer erectile dysfunction issues, and Propecia is lower dose than Proscar, Propecia may also interfere with sexual functioning and possibly male fertility. If you're taking finasteride to prevent hair loss and are experiencing erectile dysfunction, libidinal problems, or fertility issues, be sure to inform your prescribing physician.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Fode M, Sønksen J, McPhee SJ, Ohl DA. Disorders of the Male Reproductive Tract. In: Hammer GD, McPhee SJ. eds. Pathophysiology of Disease: An Introduction to Clinical Medicine, Seventh Edition. New York, NY: McGraw-Hill; 2013.

By Naveed Saleh, MD, MS
Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news.