Prostate meds interfere with love life

DEAR DR. ROACH »

After a few months of taking this capsule I now produce no sperm whatsoever. It’s really affecting my sex life with my wife. Moreover, it’s a very unpleasant feeling. If I stop taking tamsulosin will my problem go away?

— G.R.

ANSWER » Male sexual function is controlled by the autonomic nervous system, which has two divisions: parasympathetic and sympathetic. The parasympathetic controls erection, and the sympathetic controls ejaculation. Tamsulosin works as a sympathetic blocker. It relaxes special muscles in the prostate, which can compress the flow of urine through the prostate. Unfortunately, a side effect is a reduction or even complete prevention of ejaculation. Four percent of men on the low dose (and 18% on the high dose) had this problem in a short study. A longer study found 30% of men had this issue.

Despite prescribing this medication hundreds of times, I have never had a man complain of this problem, which tells me that many men either are not mentioning it or are not taking the medication.

Fortunately, the side effect does go away after stopping the medication. A related medicine, alfuzosin (Uroxatral), does not have this side effect. You might ask your doctor about changing.

DEAR DR. ROACH » I am a 78-year-old woman in good health with no history of breast cancer in my family. When I was going through menopause, I had severe hot flashes and night sweats that kept me up long hours in the night. I was put on hormone therapy with great success. I was happy! Now, at my age, because of the risk of breast cancer, my doctor has taken me off the hormones. I have three or four hot flashes a day and wake up frequently with night sweats. I get irritable and depressed. I have just started to use black cohosh, and I did sleep better last night. Please help!

— R.R.J.

ANSWER » Sleep is important for well-being.

Your doctor is right that combined hormones — an estrogen and a progestin — increase the risk of breast cancer. Even the black cohosh you are taking is thought to work through estrogen effects — that is, if it does work, as the consensus is that it may not be better than placebo. The limited evidence suggests black cohosh is safe. If it works for you it may be an option.

A few women find nothing is as effective as estrogen. In that case, some women accept the risks, including breast cancer, in order to treat the hot flashes and to sleep.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.