FPHL(female pattern hair loss) is associated with an increased androgen activity in the scalp. Classic Antiandrogens such as spironolactone, cyproterone acetate, and flutamide are used in FPHL. Oral bicalutamide is a selective androgen receptor antagonist with a greater affinity and a good safety profile which makes it a promising treatment for FPHL and hirsutism.
Bicalutamide is a nonsteroidal, pure antiandrogen. It has no estrogenic, progestational, glucocor- ticoid, mineralocorticoid, or androgenic activity and does not inhibit steroid 5 – reductase. Bicalutamide does not cross the blood-brain barrier and has little effect on serum LH and testosterone and is peripherally selective.
BICALUTAMIDE is being used off-label for treatment of female pattern hair loss (FPHL) and androgenetic alopecia. Few studies show that it reduces hair loss and improves hair density in some women with signs of hyperandrogenism such as seborrhea, acne, or hirsutism/PCOS.
Oral bicalutamide seems to have a favorable safety profile when used to treat FPHL, even in combination with treatments, such asoral minoxidil and spironolactone. OB may decrease the risk of hypertrichosis, which is the most frequent adverse effect of oralminoxidil.
Key points:
- Oral bicalutamide (typically 10–25 mg) has shown efficacy for FPHL in few studies, both as monotherapy and combined with other agents such as oral contraceptives.
- A significant reduction in hair shedding is reported in studies in women taking bicalutamide.
- Mesotherapy (local scalp injections of bicalutamide) is being tried; evidence is limited but shows modest improvement in hair density and good tolerability in premenopausal women. Results are preliminary and based on very small sample size..
- Oral use may cause liver enzyme changes uncommonly- so requires monitoring at baseline/3 months and 6 months.
- Bicalutamide is not approved for male pattern hair loss.
Important limitations:
- Bicalutamide is still an off-label option for hair loss.
- Current evidence is limited by small sample size, few number of studies, short follow-up, and a lack of large, randomized trials.
- It should be used only under specialist medical supervision due to potential adverse effects and the need for liver monitoring.
- Bicalutamide can be tried as an option for certain women with pattern hair loss, especially those unresponsive to standard treatments.