Key facts
- An enlarged prostate is not prostate cancer, and treating one is not screening for the other.
- The two drug families work on completely different timescales. Alpha blockers relax and act within weeks; 5-alpha reductase inhibitors shrink and take months.
- Knowing which one you are on prevents most of the giving-up, because people abandon the slow one before it has had a chance.
- Alpha blockers lower blood pressure, and so do ED medicines. Taken together, in heat, that is a real stack, and this audience is unusually likely to be taking both.
- Finasteride appears twice on this site, at a different strength for hair loss, so it is possible to take it without realising you already are.
- Dizziness on standing is the effect to report, particularly at the start.
- Being unable to pass urine at all is an emergency, not something to sleep on.
For about two years you have been getting up twice a night, and for about two years there has been a reason. The beer. The heat. The fact that you drink more water here than you ever did at home. The air conditioning. The late dinner.
Every single one of those is plausible, which is precisely the problem. In a temperate country a man notices the change against a stable background. Here, the background changed too, and the symptom hides in it.
Why it hides so well
The pattern is gradual: a weaker stream, a wait before it starts, a feeling that it is not finished, and the night waking that finally makes it a topic. None of it arrives on a particular day. It arrives over a couple of years, and every stage of it has an available explanation that is not the prostate.
The prostate sits around the tube that carries urine out of the bladder. As it enlarges, which it commonly does with age, it squeezes that tube. The bladder compensates by working harder, and eventually stops compensating as well. SingHealth sets out the condition and its treatment.
The thing to say first, because it is what everyone is quietly wondering: benign prostatic hyperplasia is not cancer, does not become cancer, and having it does not mean you have the other. It also does not rule it out, which is why symptoms get assessed rather than assumed. Whether to test for prostate cancer is a separate discussion with its own arguments, and it differs by country and by man. It is worth having with a doctor rather than settled by an article.
Two families, two completely different clocks
This is the most useful thing to understand, and the reason people stop treatment that was working.
| Family | On this site | What it does | How long it takes |
|---|---|---|---|
| Alpha blockers | tamsulosin, terazosin, alfuzosin | Relax the muscle in the prostate and bladder neck, widening the channel | Days to weeks |
| 5-alpha reductase inhibitors | dutasteride, finasteride | Reduce the hormonal signal driving growth, so the gland gradually shrinks | Months, often six or more |
Nothing about the gland has changed when an alpha blocker works. The plumbing is the same size; the muscle around it has let go. That is why the effect arrives quickly and disappears quickly if you stop.
The second family actually changes the gland, which is why it is slow. And that slowness is where treatment goes wrong: a man is given a tablet, takes it diligently for six weeks, concludes it does nothing, and stops. It was working. It had not finished. HealthHub describes the alpha blocker side; the timescale difference is the thing to ask about directly when you are handed either.
Sometimes both are used together, which is a deliberate combination rather than a doubling up: quick relief while the slow one gets to work.
Browse what we list under prostate health and benign prostatic hyperplasia.
The interaction this site is obliged to mention
Here is the part that matters most for the people reading this particular website.
Alpha blockers lower blood pressure. So do the ED medicines. Sildenafil, tadalafil and the rest work by relaxing blood vessels, which is the mechanism, and lowering pressure elsewhere is an unavoidable consequence of it. Put the two together and the effects add up. Add a hot climate, which lowers pressure again for the reasons set out in blood pressure medicine in a hot climate, and you can arrive at genuine light-headedness or a faint.
This is not hypothetical for our readers. Men in the age range where the prostate starts to matter overlap almost exactly with the men reading our ED treatment articles, and the two conditions frequently coexist. A great many people are taking both.
What to do about it is not for this article to say. These medicines are prescribed together routinely and safely, with attention to which ones, what order and how they are started. What is genuinely dangerous is one doctor prescribing one of them without knowing about the other, or a man buying the second from somewhere that never asked.
So the practical point is a sentence: make sure whoever prescribes either one knows about the other. Including if the other came from somewhere you would rather not mention. This is exactly the situation where an incomplete account produces a bad afternoon.
Finasteride, twice
Worth its own short section because the overlap is easy to miss.
Finasteride is used for the prostate, and the same molecule at a different strength is used for hair loss, which we cover in hair loss treatment in Hong Kong. It is entirely possible to be taking it for hair, be prescribed it for the prostate by someone who was not told, and end up taking it twice.
That is a straightforward thing to prevent by mentioning it. It is also worth knowing that this family affects PSA readings, the blood test used in prostate cancer discussions, which is another reason your doctor needs to know you take it.
The sexual side effects of this family are real, discussed at length in the hair loss article, and they belong in the decision. They are also less common than internet forums suggest, and worth discussing rather than either dismissing or panicking about.
What to report, and what is urgent
Dizziness on standing, particularly in the first days of an alpha blocker, is the common one. It is often manageable by changing when the dose is taken, which is a prescriber’s adjustment. In a hot climate it deserves more attention than it would elsewhere, and falls do more harm than the symptom that caused them.
If you are due any eye surgery, including cataract surgery, tell the surgeon you take or have taken an alpha blocker. There is a well-recognised effect on the iris during surgery, and surgeons plan around it easily when they know in advance.
And the emergency: being unable to pass urine at all, with a painful full bladder, needs urgent care the same day. That is acute retention, not a bad night.
Blood in the urine, pain, fever, or unexplained weight loss are also not this condition and need assessment.
Also worth reading
For the bladder rather than the prostate, and the heat effect of that family, see overactive bladder in an air-conditioned life. For the ED side, see ED treatment in Thailand. For finasteride in its other role, see hair loss treatment in Hong Kong.
FAQ
Will I have to take this for the rest of my life?
Often yes for as long as it helps, since both families treat rather than cure, and the symptoms return when they stop. Treatment is reviewed, and surgery is an option for some men, so it is not a single permanent decision.
Does an enlarged prostate turn into cancer?
No. They are different conditions that happen in the same organ and in the same age group, which is why they get confused. Having one does not cause the other.
Should I take saw palmetto instead?
It is widely sold and the evidence for it is weak compared with the prescription options. If you take it, say so, because it is still worth your doctor knowing what you are on.
Why do I need to get up at night when the daytime is fine?
Night waking has several causes beyond the prostate, including how fluid redistributes when you lie down, sleep problems and other conditions. That is one reason the assessment is worth more than a self-diagnosis.
Can I take an ED medicine if I am on tamsulosin?
Very often yes, and it is prescribed that way routinely. What matters is that it is prescribed with both in view rather than assembled by you from two sources.
Sources
This article is general information, checked on 10 August 2026. It contains no doses and no schedules, and it is not a substitute for advice from a clinician who knows your history.
