@scien123
I started tamulosin (flomax) with finasteride for BPH enlarged prostate in dec-25. Tamulosin relaxes muscle pretty quickly to improve urine flow while finasteride starts to shrink prostate over long term. After 2 weeks I noticed retrograde ejaculation (semen discharges into bladder) because tamulosin as an alpha-1 blocker relaxes the smooth muscle of prostate and bladder neck into urethra. Otherwise semen goes through the penis and out the urethra. That's why some people call it dry orgasm. However, Tamulosin can also relax blood vessels throughout the body, which can make some dizzy.

I did my research and found that after initially using tamulosin to relax the muscle/bladder neck to facilitate urination more quickly, it is better for most to switch to cialis (tadalafil) to "cure" the retrograde ejaculation side effect caused by tamulosin because as a PDE5 inhibitor it also relaxes smooth muscle and bladder neck without paralyzing the bladder neck ability to close during ejaculation -- thus pushing semen through the urethra more normally. Also, cialis is approved for ED, which many men with enlarged prostate need help with, so it solves 2 issues at same time. You wouldn't take all 3 because tamulosin and tadalafil are redundant for relaxing the muscle andvyou would still ha v e retrogradeejaculation.

So now I take cialis (tadalafil) paired with finasteride. I called my insurance to find out which was on formulary at what cost. They are all the same for me, essentially $10 copay. Tadalafil is also easy to get online from places like hims.