Category Archives: Anti-Androgen

Bicalutamide for Female Pattern Hair Loss

Bicalutamide Female Pattern Hair Loss
Bicalutamide to treat female pattern hair loss. Before and after 6 months of treatment with 50 mg per day. © 2020 by the American Academy of Dermatology, Inc.

Over the past several years, I have increasingly been hearing about an oral anti-androgen called bicalutamide (brand name Casodex). While originally approved to treat prostate cancer in 1995, it is becoming a popular option in treating female pattern hair loss (FPHL).

Bicalutamide is a nonsteroidal antiandrogen (NSAA). It is also called a selective androgen receptor (AR) antagonist. Among the skin and hair conditions that it is being used to treat include acne, hirsutism and female pattern hair loss. Bicalutamide was originally derived from a structural modification of flutamide.

Update: August 2023 — A new paper from Brazil on treating female pattern hair loss covers bicalutamide in detail.

Update: April 2023 — From yesterday’s ISHRS Webinar:

April 19, 2023

Bicalutamide for Female Pattern Hair Loss

A number of recent reviews, studies and presentations conclude favorably in regards to the use of oral bicalutamide to treat female pattern hair loss (FPHL).

  • In 2022, researchers from Brazil reviewed various studies and concluded that oral bicalutamide seems to be a promising option to expand the arsenal of FPHL treatment. They do point out the need for clinical trials to establish the ideal dose and efficacy of the drug.
  • At the 2022 ISHRS conference, Dr. Sergio Vañó Galván discussed two “new medications” to treat hair loss: bicalutamide and clascoterone (aka Breezula).
  • Moreover, at the same conference, Dr. Alba Gómez-Zubiaur had a presentation titled: “Mesotherapy with Bicalutamide: A New Treatment for Androgenetic Alopecia.” In April 2023, he published a study on this interesting mesotherapy delivery method for bicalutamide. Make sure to also read my post on mesotherapy and dutasteride.
  • In 2020, a group of Spanish researchers retrospectively reviewed all patients who were receiving oral bicalutamide (OB) for FPHL at their hair clinic between February 2018 and February 2020. A total of 44 women receiving OB 25-50 mg daily were included. They concluded that OB had favorable hair growth results and a very good safety profile, even when used in combination with oral minoxidil or spironolactone. One of their patient’s before and after photo is shown at the top of this post.
  • In 2020, a team from Australia led by Dr. Rodney Sinclair reviewed the safety results in 316 women treated with bicalutamide. Doses ranged from 5 mg per day to 50 mg per day. The vast majority of them were also using oral minoxidil or spironolactone. In general, the safety profile was excellent and the drug benefitted female androgenetic alopecia (AGA) patients. The few patients who got a mild elevation in liver enzymes saw no adverse symptoms.

Side Effects

Bicalutamide has no diuretic effect and it does not cross the blood brain barrier. In comparison to another popular anti-androgen called flutamide, bicalutamide has a much lower rate of liver toxicity. Moreover, unlike the former, the latter does not affect serum luteinizing hormone and testosterone levels.

Bicalutamide can cause a mild elevation of liver transaminases (enzymes), peripheral edema and gastrointestinal complaints in a very small percentage of users. These side effects are usually reversible. Overall, this medication seems to cause fewer side effects than Spironolactone, the most popular anti-androgen that is used for reducing hair loss.

Note that bicalutamide is often used as an antiandrogen in feminizing hormone therapy for transgender women. And also as a puberty blocker in adolescent transgender girls.

In 2017, the combination of bicalutamide and a birth control pill was evaluated in a phase III clinical trial for the treatment of severe hirsutism in women with PCOS. The combination was found to be significantly more effective than a birth control pill alone.

Fluridil and Flutamide

To date, I have covered two anti-androgens in detail on this blog: Spironolactone and RU58841. Two other anti-androgens, fluridil and flutamide, are also fairly popular in the hair loss world. Due to their similar names, many people confuse the two, so I am writing one post to cover both products.

I do not want to write too many separate posts on anti-androgens. Moreover, if Breezula (Clascoterone) is ever released, it might end up being the most effective androgen receptor (AR) antagonist in history.


Flutamide (brand name Eulexin) is a synthetic anti-androgen that was first approved by the US FDA in 1989 to treat prostate cancer in men. The drug is sold under numerous brand names. According to the wikipedia entry on Flutamide, the drug has now largely been replaced with newer anti-androgens with fewer side effects.

I am not so sure if this is true when it comes to scalp hair regrowth applications since numerous hair loss forum members continue to use flutamide. Moreover, topical application of flutamide via nanoparticles could results in fewer or no side effects.

An interesting study from 2011 where a women with hair loss saw no results when on Spironolactone plus topical Minoxidil, but did see hair regrowth when on Flutamide.


An interesting 2000 study from Italy compared Finasteride, Flutamide and Spironolactone for treating hirsutism. It found that all three were almost equally effective in reducing body hair modestly after a 6-month course of therapy.


The chemical name for Fluridil is Topilutamide. It was developed by Biophysica, Inc. of San Diego, California. Fluridil is currently sold via the brand name Eucapil, a topical product that is manufactured by Czech Republic based company Interpharma that holds patent rights to Fluridil.

Sometimes you can find it for sale on Amazon.

Fluridil Eucapil
Fluridil (brand name Eucapil).

The company claims that Eucapil is not absorbed systematically and it has thus far not resulted in any side effects. Interpharma was founded in 1932, and became a subsidiary of Japan’s Otsuka Pharmaceutical in 2008. Eucapil is only approved for sale in several European countries, but many people around the world seem to be getting their hands on the product easily.

The one and only study on Pubmed regarding Fluridil is from 2002, and suggests a modest benefit (anagen hair quantity increased from 76 percent to 87 percent) for hair loss sufferers with no major side effects. Also see this one other important paper on Fluridil. Eucapil’s before and after photos of scalp hair when using Fluridil seem decent, but perhaps they are exhibiting a best case scenario.

Fluridil versus Flutamide

Over the years, on all major hair loss forums people have created a number of threads asking whether fluridil or flutamide is better for treating hair loss.

If you do a google search for each product, flutamide has 423,000 results and fluridil has only 15,900 results. Clearly, this is a no contest when it comes to importance (by comparison, Spironolactone has 728,000 results and RU58841 has 78,600 results).

Moreover, if you do a search on Pubmed, flutamide has 3,238 results (although the majority are not related to scalp hair loss issues). Meanwhile, fluridil has only two results (!), with only one of those two being of significance. So based on popularity, it seems like flutamide is the way to go.

It is also likely that because flutamide is so heavily studied, its side effects are unlikely to result in any major surprises. However, based on effectiveness, the superiority of flutamide over fluridil is is not clear when reading hair loss forum testimonials.


There are numerous anti-androgens available in the market today. If I were to take one just for scalp hair loss, I would only use a topical one in order to limit side effects. When it comes to effectiveness on scalp hair, do not expect miracles. While all anti-androgens seem to result in at least modest benefits for scalp hair, regrowing hair on totally bald scalps is not likely.

As far as flutamide versus fluridil, I am not sure which one is more effective, but fluridil seems to be somewhat safer. However, flutamide is by no means dangerous from what I have read on the various hair loss forums and studies.

It is imperative to consult a doctor prior to trying such drugs, as my opinions and conclusions are just based on internet research. I am neither a doctor, nor educated or experienced in any kind of medical field.