15 Years of Data on Flomax: Why 1 in 5 Men Who Took It Faithfully Still Ended Up in Surgery
A urologist explains what the drug was never designed to do, and the 1 thing he now tells every patient on it to add. Not instead. Alongside.
What the research shows
- In a 15-year follow-up published in 2023, 19% of men treated with an alpha-blocker alone went on to need prostate surgery, and 16.6% had acute urinary retention.
- The Cleveland Clinic states that alpha-blockers do not change the size of the prostate or affect its growth in any way.
- Mayo Clinic's tamsulosin page says the drug will not shrink the prostate, and that surgery may still be needed in the future.
- In the landmark MTOPS trial, an alpha-blocker on its own did not significantly reduce the risk of urinary retention or the need for surgery over the long run.
If you take Flomax, read that list twice. Then keep taking your Flomax. This is not an article telling you to stop.
It's an article about what I never told the men I prescribed it to. Most of my colleagues won't like that I wrote it. I still practice, and I still write Flomax every week. But I've watched too many men do everything right and end up on my operating schedule anyway.
"It's working fine, doc"
For most of my 19 years, the Flomax visit went the same way. A man came in getting up 3 or 4 times a night. I wrote him tamsulosin. He came back in 6 weeks and said, "It's working fine, doc."
I said good. See you next year.
I said that to hundreds of men. I believed it. And I was wrong about what "working fine" meant.
Flomax does exactly 1 thing. It relaxes the smooth muscle around your urethra so urine can get past the squeeze. It does not shrink the gland. It does not slow the growth. It does not touch the hormone that's making it grow.
So the prostate keeps growing behind the drug. Flomax is holding the door open while the room behind it keeps filling up. For a few years, holding the door is enough. Then it isn't.
Gerald did everything right
Gerald was 65. Retired contractor. 15 years on Flomax. He never missed a dose. Every single visit, the same 4 words. "Working fine, doc."
2 years ago he and his wife were pulling their RV through Wyoming when he couldn't pee. Not a drop. He drove another 40 minutes with his bladder locked like a fist, looking for an exit, and clipped the side of the RV on a guardrail trying to pull off.
Ambulance. Catheter in the ER. A blood infection from the urine that had backed up. Then a TURP.
At his follow-up he said, "I wish someone had told me Flomax wasn't actually fixing anything."
I was the someone. I had 15 years of visits to tell him.
My own father took his Flomax faithfully for 11 years. He had his TURP at 74 and never told my mother what he lost. I was already a urologist. I didn't tell him either.
So why should you believe me now? You shouldn't. Not yet. Let me tell you about the patient who changed how I handle every Flomax visit.
Glenn
Glenn was 66. Retired postal supervisor. 6 years on Flomax, the last 2 of them getting worse.
He was up at 1, 3 and 5. He'd lie there doing the math on whether he could make it to 6. He never could. Some nights he stood in the dark bathroom so long his feet went cold on the tile, waiting for anything to start.
Every Thanksgiving for 25 years, Glenn drove 9 hours to his daughter's house in Knoxville. He loved that drive. Coffee in the cup holder, ball game on the radio. Last year he called her in October and told her they'd fly. Then he told her they'd skip it.
He'd done everything he was told. Before Flomax he'd spent a year and a half on saw palmetto and another 6 months on Super Beta Prostate. Nothing moved. Then he took his Flomax every night for 6 years.
That's his ultrasound. 52 cc to 71 cc in 2 years, while he took every dose. The drug was working exactly as designed. The gland grew around it anyway.
I did what I was trained to do. I offered him the higher dose and finasteride, and I started writing a referral to talk about procedures.
He'd read about finasteride. The drive, the fog. He said no to that. "Bump the Flomax if you want," he said. "Hold the referral for a few months."
The bottle he almost didn't open
Glenn's brother-in-law had been taking something called Saika Prostate Intercept, with an ingredient called S-Equol. He'd mentioned it at a family dinner. Glenn rolled his eyes.
"I spent 2 years on saw palmetto before I ever saw you," he told me later. "Nice labels. Nothing. I figured this was more of the same."
What changed his mind was the referral I'd written, sitting on his kitchen counter. "It was that, or a pill that takes your marriage, or a procedure," he said. "This was the only thing on the list I could stop if it didn't work. And I didn't have to give up the Flomax."
He kept his Flomax, same dose. He added Saika. He didn't tell me.
Week 2, he slept through the 1 o'clock trip for the first time in a year.
Week 4, he was up once most nights. The stream started without the waiting.
Week 8, he slept through 3 nights in a row. His wife told me she lay awake the first night waiting for him to get up, and he never did.
| Test | Referral written | 12 weeks later |
|---|---|---|
| Flow rate | 8 ml a second | 13 ml a second |
| Left in bladder after emptying | 160 ml | 70 ml |
| Symptom score | 21 | 11 |
| Times up at night | 3 | 0 to 1 |
I ran the flow test twice because I didn't believe the first one.
"Glenn," I said, "you're on the same dose of Flomax you've been on for 2 years. What changed?"
He put the bottle on my desk. I tore up the referral. I didn't raise his dose.
See what Glenn addedWhat I found when I went looking
I went home that night fully expecting to find nothing. Glenn's 2 years of saw palmetto had already told me what most supplements do. The largest NIH-funded trial ever run on saw palmetto tested it at up to 3 times the normal dose. It did no better than a placebo.
S-Equol was different.
Your prostate grows because of a hormone called DHT. It's 5 times stronger than testosterone, and as men age, the body makes more of it. DHT locks onto your prostate cells and tells them to grow.
Flomax never touches DHT. It was never meant to. Finasteride shuts DHT production off all over the body, which is why it costs so many men their drive.
S-Equol works a different way. It binds to the DHT itself, so the DHT can't lock onto your prostate cells. It doesn't shut anything off. Your testosterone stays where it is, and so does your drive. And it runs alongside your Flomax instead of replacing it. One holds the door. The other goes after what's filling the room.
Saika adds stinging nettle root, whose lignans block a protein called SHBG from docking onto prostate cells and pulling hormone signal into the tissue. 2 ingredients aimed at the same hormone from 2 directions.
Most men can't make S-Equol on their own. It takes the right gut bacteria to turn soy into it. A study across 4 countries found 59% of Korean men make it, and only 14% of American men. Roughly 6 American men in 7 simply don't have the bacteria. Taking it directly skips the gut.
Before I said a word to another patient, I checked the label myself. 12 mg of S-Equol and 50 mg of stinging nettle root per serving, with a small support blend of vitamins, minerals and green tea extract. Every dose printed. No proprietary blend.
Glenn wasn't the only one
Once I started telling my Flomax patients, I started hearing the same thing back.
Ray, 71, a retired machinist, 9 years on Flomax, up 3 times a night. He's up once, same dose.
Dennis, 64, a lineman, had just been bumped to 0.8 mg. 10 weeks later his symptom score had dropped from 18 to 10, and we never talked about a third pill.
Carl, 69, a church organist, couldn't sit through a Sunday service without leaving twice. He made it through Easter without getting up once.
Hank, 66, a plumber, couldn't drive 2 hours without stopping. Last month he drove 6 hours to his daughter's in Tulsa with 1 stop for gas.
What I tell every man on Flomax now
The visit ends differently in my office now. If you're on Flomax, this is the whole plan.
- Keep taking your Flomax. Same dose, same time. Don't stop or change anything on your own.
- Get your starting numbers. Ask for your symptom score, the 7-question form every urology office has in a drawer. Count your nights up for a week. Write it all down.
- Add Saika. 2 capsules a day, 1 in the morning and 1 later in the day, alongside your Flomax.
- Rescore at 8 to 12 weeks on the same form, and count your nights again.
- Decide from the 2 numbers. If they moved, keep going. If they didn't, use the guarantee.
When to call your doctor instead
If you can't pass urine at all, if you see blood in your urine, if you're getting infection after infection, or if your doctor has told you your kidneys are involved, call your urologist now. Saika is not a treatment for any of that, and no supplement is.
What to expect, and when
Weeks 1 and 2. Most men notice little. Some notice 1 fewer trip a night.
Weeks 3 and 4. This is when most men in my practice notice a change. Fewer trips, an easier start.
Weeks 8 to 12. Rescore. This is the number that tells you whether it's working for you.
60 days. The guarantee window. If nothing has changed, you get your money back.
Why your urologist probably hasn't mentioned this
Not because he's hiding it. I didn't mention it either, for most of my 19 years. Flomax works on what we can see in the visit, the stream and the nights. The growth happens between visits, quietly, and nobody walks into a urology office to tell us about S-Equol.
You have 2 ways to spend the next year on Flomax
The same way
Same pill, same "working fine, doc." The gland keeps growing behind it until the dose goes up, a second pill comes up, or a date does.
Add the other half
Keep your Flomax. Add Saika. Score yourself now and in 12 weeks, and let the 2 numbers decide.
I don't get paid by Saika. I'm telling you this because I sat across from Gerald for 15 years and said "good" every time.
Saika Prostate Intercept has a 60-day money-back guarantee. You email "this didn't work" and your money is back the same day.
Don't take my word for any of this. Look up what alpha-blockers do to prostate growth. Read the MTOPS results. Look up S-Equol and DHT. Read it the way I did, expecting to find nothing.
Last month Glenn drove to Knoxville for his granddaughter's birthday. 9 hours, coffee in the cup holder, 2 stops. His daughter sent me a photo of him asleep on her couch by 8, still in his jacket.
Saika Prostate Intercept
- 12 mg S-Equol and 50 mg stinging nettle root in every serving
- Runs alongside your Flomax, replaces nothing
- 2 capsules a day, 1 in the morning and 1 later in the day
- Every dose on the label, no proprietary blend
- 60-day money-back guarantee, refunded the same day you ask
What customers say
"I'd already wasted hundreds on supplements"
"After spending probably $400 on different prostate pills over the years, I wasn't exactly excited to buy another bottle. My wife actually found Saika and asked me to look into it. What caught my attention was the S-Equol ingredient. I've been using it for about 7 weeks. I can't say it's a miracle, but I appreciate that the company tells you the actual doses instead of hiding everything behind a fancy blend."
"My wife was more worried than I was"
"I'm 71, and after 43 years of marriage, my wife knows when something is bothering me. I'd been waking up several times a night and was getting frustrated. She encouraged me to speak to my doctor and look into my options. That's how we found Saika. I've been taking it for 2 months. It's easy to fit into my morning routine, and we're continuing to keep track of how I'm doing."
"I just wanted to enjoy retirement"
"I retired at 68 thinking I'd spend more time fishing and visiting the grandkids. Instead, I found myself planning drives around bathroom stops. My son helped me research prostate health, and Saika was one of the products we came across. I've been using it for nearly 3 months. I still take my doctor's advice seriously, but I appreciate having a straightforward supplement without a dozen mystery ingredients."
Questions men ask me
Do I have to stop my Flomax?
No. Keep taking it exactly as prescribed. Saika is a dietary supplement meant to run alongside it. Show the label to your urologist or pharmacist.
My doctor just raised my dose. Should I still add this?
Take the dose your doctor prescribed. A dose increase usually means the gland has grown, which is exactly the part Flomax doesn't address. Score yourself now and again in 8 to 12 weeks.
Will it shrink my prostate?
I won't promise that, and you should be wary of anyone who does. S-Equol binds DHT so it can't tell your prostate cells to grow. What that means for your nights and your score is what the 60 days are for.
How is this different from saw palmetto?
Saw palmetto leans weakly on the enzyme that makes DHT, and in the 2 biggest US trials it did no better than a placebo. S-Equol doesn't try to stop DHT being made. It binds the DHT that's already there.
Where should I buy it?
Only at getsaika.com. Listings on Amazon and other marketplaces using the Saika name are not from Saika, and there's no way to know what's in them.
What if it doesn't work?
Email support@getsaika.com and write "this didn't work." Your money is back the same day. You have 60 days.
P.S. Score yourself this week, before your first capsule. Without a starting number, nobody can tell you what changed, not even you.
P.P.S. Your Flomax is buying you time. That's its job, and it does it well. But the clock is still running behind it.
P.P.P.S. Gerald took every dose for 15 years. If you're reading this on Flomax and back to getting up at night, you're where he was before the RV.
- McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. New England Journal of Medicine, 2003;349:2387-2398.
- Cleveland Clinic. Alpha-blockers. Health Library.
- Mayo Clinic. Tamsulosin (oral route), description and brand names.
- Barry MJ, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA, 2011;306(12):1344-1351.
- Akaza H, et al. Cancer Science, 2012 (equol producer rates in men by country).
- Song KB, et al. Prostate, 2008 (equol producer rates in Korean men by age).
- Lund TD, et al. Equol is a novel anti-androgen that inhibits prostate growth and hormone feedback. Biology of Reproduction, 2004;70(4):1188-1195.
- Schöttner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin (SHBG). Planta Medica, 1997;63(6):529-532.