Objective To assess the efficacy of tamsulosin and finasteride monotherapies, and their combination in men with benign prostatic hyperplasia (BPH). Materials and methods This is a prospective randomized study in 90 men with BPH. The international prostate symptoms score (IPSS), peak urinary flow rate and prostate volume were measured as parameters for assessment at baseline, 3 months and 6 months. Results The mean age of patients was 61.65 with a range of 44 to 81 years. There was progressive and sustained improvement in the IPSS score in all patient groups with mean increases at 3 months of 7.24(42.59%), 7.60(41.85%), and 7.24 (40.61%) and at 6 months 8.14 (47.88%), 10.33 (56.88%), and 11.1 (62.25%) in the tamsulosin, finasteride and combination groups respectively. There was an increase in peak urinary flow rate in all groups with a mean increase at 3months of 0.98,0.05 and 3.55(mls/s) and at 6 months of 4.11, 0.87, 3.74(mls/s) in the tamsulosin, finasteride and combination groups respectively. There was reduction in the prostate volume in the finasteride and combination groups at 6months of 6.8 and 6.32cm3 respectively while the tamsulosin group recorded an increase. Conclusion Tamsulosin monotherapy and combination therapy appear to be equally effective in the early treatment of benign prostatic hyperplasia while finasteride monotherapy appears to be the least effective.