Finasteride and Fall Risk
Finasteride does not increase the risk of falls in patients using it for BPH or androgenetic alopecia. There is no evidence in current clinical guidelines or research indicating that finasteride is associated with an increased risk of falls in older adults or the general population 1.
Risk Factors for Falls and Medication Considerations
When evaluating fall risk, it's important to understand the established risk factors:
The American Geriatrics Society identifies several key risk factors for falls 1:
- Muscle weakness (RR 4.4)
- History of falls (RR 3.0)
- Gait deficits (RR 2.9)
- Balance deficits (RR 2.9)
- Use of assistive devices (RR 2.6)
- Visual deficits (RR 2.5)
Medication-related fall risks are primarily associated with:
- Psychotropic medications (OR 1.7)
- Class 1a antiarrhythmic medications (OR 1.6)
- Digoxin (OR 1.2)
- Diuretics (OR 1.1)
Notably, finasteride is not included in any of these high-risk medication categories 1.
Finasteride's Known Side Effects
The documented side effects of finasteride include 1, 2:
- Sexual dysfunction (decreased libido, erectile dysfunction)
- Decreased ejaculate volume
- Gynecomastia (in approximately 0.4% of patients)
A comprehensive review of finasteride's adverse effects profile does not mention dizziness, orthostatic hypotension, sedation, or other symptoms that would increase fall risk 1, 3.
Comparison with Other Medications
When comparing finasteride to medications commonly used for BPH:
- Alpha-blockers have been associated with significantly higher rates of dizziness and postural hypotension than 5-alpha-reductase inhibitors like finasteride 1
- The US Preventive Services Task Force notes that medications associated with falls include psychotropic medications, not 5-alpha-reductase inhibitors 1
Special Considerations
While finasteride has been associated with some neurological symptoms in rare cases:
- There is a reported association with sleep disturbances including insomnia 4
- Some patients report cognitive impairment as part of "post-finasteride syndrome" 4
However, these symptoms have not been linked to increased fall risk in the literature, and the primary mechanisms of action of finasteride (inhibition of 5-alpha-reductase) do not directly affect balance, coordination, or blood pressure regulation.
Conclusion
Based on current clinical guidelines and research evidence, finasteride used for BPH or androgenetic alopecia does not increase the risk of falls. When considering fall prevention, clinicians should focus on established risk factors and medications with known associations to falls rather than discontinuing finasteride for this concern.