DEAR DR. ROACH: I am a male, 67 years old, and I am afflicted with urinary problems — having to urinate several times a night, burning after urinating and the need to urinate often in small amounts only. My doctor prescribed tamsulosin, 0.4 mg. For more than a year, I have taken one capsule every night 30 minutes after supper.
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 “no sperm” problem go away? — G.R.

ANSWER: Before I answer, let me explain what is happening. 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 that 30% of men had this issue. A study of volunteers showed 90% of men had a measurable loss of volume while taking tamsulosin.

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, which makes my life even harder, as I have to deal with my husband’s senile dementia. I have just started to use black cohosh, and I did sleep better last night. Please tell me you can help! — R.R.J.

ANSWER: Sleep is important for anybody’s well-being, but a caretaker under enormous stress particularly needs her sleep.

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. Fortunately, the limited evidence so far suggests black cohosh is safe, even in women at higher risk for breast cancer. If it works for you it may be a good option.

There are many other options that do not increase risk, including drugs normally used for depression (paroxetine, citalopram) and for epilepsy (gabapentin). However, these drugs are still not as effective as estrogen.

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

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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