“I am 69 and have been taking doxazosin for many years and finasteride 5 mg. I still get up three or four times during the night. It may take four to eight minutes to urinate, the stream is very slow and comes in stages, and afterward I feel that only half to two-thirds of the urine has come out. Could pumpkin seed oil, stinging nettle or hydrangea help?”
Quick Answer
I would not add herbs as the main next step in this situation.
Severe difficulty emptying the bladder despite treatment with both an alpha-blocker and finasteride deserves medical reassessment. Your doctor may need to measure your urinary flow and the amount of urine remaining in the bladder after you urinate.
Pumpkin seed and stinging nettle have some studies suggesting possible improvement in BPH symptoms, but the evidence is limited and they should not be expected to correct significant bladder outlet obstruction.
I am not aware of good human clinical evidence establishing hydrangea as an effective BPH treatment.
Your Urinary Symptoms Are More Important Than the Supplement Question
Herctor, the most concerning part of your question is not whether pumpkin seed oil works.
You describe several significant lower urinary tract symptoms:
- getting up three or four times every night to urinate
- waiting a long time for urine to pass
- very slow flow
- urination occurring in several stages
- straining or making an effort
- a persistent feeling that the bladder has not emptied
These symptoms can occur when an enlarged prostate obstructs urine flow, but they can also occur when the bladder muscle has become weak or when another obstruction is present.
A simple bladder scan can measure the post-void residual, or PVR—the amount of urine remaining in the bladder after you urinate.
What Is Post-Void Residual Urine?
Post-void residual urine is the amount of urine left inside the bladder after attempting to empty it.
It can be measured with ultrasound, a bladder scanner or, in selected circumstances, catheterization.
A high residual may occur because:
- the prostate or bladder outlet is obstructed
- the bladder muscle is not contracting strongly enough
- both problems are present
A single number does not by itself diagnose the cause, but persistent or increasing residual urine can be an important sign that treatment needs reassessment.
Has Your Body Become Resistant to Doxazosin?
Not necessarily.
The old answer suggested that after taking doxazosin for many years, the body simply becomes accustomed to it and the medicine stops working.
That is too simplistic.
Doxazosin is an alpha-blocker. It relaxes smooth muscle around the prostate and bladder neck so urine can pass more easily.
However, alpha-blockers do not substantially shrink the prostate and do not prevent every case of disease progression, urinary retention or eventual surgery.
Symptoms can worsen over time because the prostate has enlarged further, obstruction has progressed, bladder function has changed or another urinary problem has developed.
What Is Finasteride Doing?
Finasteride is different from doxazosin.
It is a 5-alpha-reductase inhibitor and can gradually reduce prostate volume in appropriately selected men with an enlarged prostate.
It may also reduce the long-term risk of acute urinary retention and BPH-related surgery.
However, no medication works adequately for every man.
If severe symptoms continue despite combination therapy, the correct response is not automatically to keep adding products. The cause and severity of the obstruction should be reassessed.
See my BPH medication guide for more detail.
Does Finasteride Affect PSA?
Yes.
Finasteride generally lowers PSA substantially after several months of treatment.
For this reason, doctors interpreting PSA need to know that you are taking finasteride.
A new PSA baseline is usually established after treatment, and a confirmed subsequent rise deserves evaluation.
You can read more in my PSA guide.
Could Pumpkin Seed Help BPH?
Pumpkin seed and pumpkin seed oil have attracted genuine scientific interest, so I would not dismiss them completely.
Some clinical studies have reported improvement in symptom scores.
However, the results are not strong enough to conclude that pumpkin seed oil reliably treats significant prostate obstruction.
A large one-year trial involving men with BPH-related urinary symptoms found some improvement with whole pumpkin seed, but pumpkin seed extract did not clearly outperform placebo on the main response measure.
A smaller study comparing pumpkin seed oil with tamsulosin also reported improvement in symptoms, but tamsulosin produced greater symptom reduction and the researchers stated that further studies were needed.
Does Pumpkin Seed Oil Shrink the Prostate?
There is not good evidence showing that pumpkin seed oil reliably produces clinically important prostate shrinkage.
This distinction matters.
A supplement might produce a small change in symptom scores without actually correcting obstruction or substantially reducing prostate volume.
For a man who already takes finasteride and still needs several minutes to empty his bladder, symptom relief alone is not the only concern.
What About Stinging Nettle?
Stinging nettle root, or Urtica dioica, has also been studied for BPH.
Some trials have reported improvements in urinary symptom scores and urine flow, but the overall evidence remains limited.
Therefore, I would not describe stinging nettle as one of “the most effective treatments for BPH,” as the old article did.
It may be considered a phytotherapy with some preliminary clinical evidence, but it should not replace evaluation of significant urinary obstruction.
What About Hydrangea?
Hydrangea is sometimes included in herbal prostate formulas.
However, traditional use or inclusion in a supplement blend is not the same as evidence of effectiveness.
I would not recommend hydrangea as an established BPH treatment because good-quality human clinical evidence demonstrating meaningful improvement in BPH symptoms, urine flow, prostate size or progression is lacking.
Can These Three Herbs Be Combined?
I would not advise experimenting with several herbal products at once.
Combining products creates several problems:
- you cannot determine which product caused an effect
- side effects become harder to identify
- supplement ingredients and doses can vary between manufacturers
- herbs may interact with prescription medicines
- temporary symptom changes may delay evaluation of significant obstruction
Tell your doctor or pharmacist about any supplement you intend to use, particularly when you are already taking prescription BPH medication.
Comparison of the Three Supplements
| Product | Evidence for BPH | What I would conclude |
|---|---|---|
| Pumpkin seed / pumpkin seed oil | Some clinical studies suggest possible improvement in urinary symptom scores, but results are inconsistent and confirmatory evidence is limited. | May have modest symptom effects in some men, but should not replace established treatment for significant obstruction. |
| Stinging nettle root | Some limited clinical evidence suggests improvement in lower urinary tract symptoms. | Evidence is insufficient to call it a reliably effective BPH treatment. |
| Hydrangea | No convincing high-quality human clinical evidence establishing effectiveness for BPH. | I would not rely on it to treat prostate enlargement or urinary obstruction. |
Would Kegel Exercises Fix This?
Not necessarily.
The old article recommended Kegel exercises as if strengthening the pelvic floor would improve prostate obstruction.
Kegel exercises can be useful for certain forms of urinary leakage, including continence rehabilitation after prostate surgery.
But they do not shrink an enlarged prostate and do not mechanically open an obstructed bladder outlet.
In some men with an overly tight or poorly coordinated pelvic floor, repeatedly tightening those muscles may not be helpful.
Someone taking four to eight minutes to urinate should first be assessed for obstruction and bladder function rather than assuming pelvic-floor strengthening is the solution.
Can Reducing Evening Fluids Help Nocturia?
Yes, this part of the original advice remains reasonable.
If waking during the night is a major problem, avoiding large amounts of fluid during the few hours before bedtime may reduce nighttime urine production.
Caffeine and alcohol can also worsen frequency or nocturia in some men.
However, lifestyle changes cannot correct significant mechanical obstruction.
Why Might BPH Medication Stop Being Enough?
There are several possibilities:
- the prostate may have enlarged further
- bladder outlet obstruction may have progressed
- the bladder muscle may have weakened after years of working against resistance
- another urinary condition may be contributing
- medication may simply provide insufficient symptom relief
Therefore, the next question should be why is bladder emptying poor?, not simply which herb should I add?
What Tests Would Be Useful Now?
A urologist may consider:
- International Prostate Symptom Score or similar symptom assessment
- urinalysis
- physical examination
- PSA interpretation in the context of finasteride use
- urinary flow-rate testing
- post-void residual measurement
- prostate size assessment when clinically useful
- kidney-function testing when indicated
- ultrasound in selected cases
- cystoscopy or urodynamic testing when the diagnosis remains unclear or a procedure is being considered
Current European guidance specifically includes uroflowmetry and post-void residual measurement when following men receiving medical treatment for lower urinary tract symptoms.
Could Surgery or a Procedure Be the Next Step?
Possibly—but that decision requires proper assessment.
Current guidelines generally consider procedural treatment when urinary symptoms or residual urine remain inadequately controlled despite conservative or medical treatment.
Surgery is particularly important to consider when complications develop, such as:
- recurrent or refractory urinary retention
- recurrent urinary infections
- bladder stones
- persistent BPH-related bleeding
- upper urinary tract dilation or kidney impairment caused by obstruction
There are now many options beyond traditional TURP, and the appropriate procedure depends on prostate size, anatomy, medical conditions and patient priorities.
See my BPH procedures and surgery guide.
Does BPH Turn Into Prostate Cancer?
No.
The old article implied that men over 65 with BPH may develop prostate cancer because of their BPH.
BPH and prostate cancer can occur in the same man because both become more common with age, but BPH itself does not turn into prostate cancer.
Your age and other risk factors may make appropriate prostate-cancer assessment relevant, but persistent urinary symptoms do not prove that cancer is present.
When Should You Seek Urgent Medical Attention?
- become unable to urinate at all
- develop severe lower abdominal pain with a full bladder
- develop fever or shaking chills with urinary symptoms
- have heavy or persistent blood in your urine
- develop vomiting, marked weakness or become acutely unwell
Acute urinary retention can require catheter drainage and should not be managed with supplements at home.
What I Would Do in Herctor’s Situation
I would arrange a urology review and bring a complete list of medications and supplements.
I would specifically ask:
- What is my post-void residual?
- How strong is my urine flow?
- How large is my prostate?
- Is the obstruction still primarily caused by BPH?
- Is my bladder muscle emptying normally?
- How should my PSA be interpreted while taking finasteride?
- Would changing medical management help?
- Am I now a candidate for a BPH procedure?
Herctor, I would not respond to these symptoms by simply adding pumpkin seed oil, stinging nettle and then hydrangea one after another. Pumpkin seed and stinging nettle have some limited research suggesting possible symptom improvement, but that evidence is not strong enough to manage the degree of urinary difficulty you describe. Taking four to eight minutes to urinate and still feeling that a substantial amount remains in your bladder despite doxazosin and finasteride deserves reassessment of your urine flow, residual urine and prostate obstruction. Once that is understood, you and your urologist can decide whether medication remains appropriate or whether a procedure should be considered.
European Association of Urology. Management of Non-neurogenic Male LUTS: Disease Management.
European Association of Urology. Management of Non-neurogenic Male LUTS: Diagnostic Evaluation.
National Institute of Diabetes and Digestive and Kidney Diseases. Treatment of Urinary Retention.