Key points
- ◆Non-steroidal antiandrogen used off-label in female pattern hair loss.
- ◆Typical hair-loss doses of 25-50 mg/day in women.
- ◆Requires periodic monitoring of liver function (transaminases).
- ◆Contraindicated in pregnancy and not indicated for hair purposes in men.
- ◆An alternative when other antiandrogens are not tolerated or are ineffective.
Description
Bicalutamide is a non-steroidal antiandrogen classically used in urology. In hair medicine it is used off-label to treat female pattern hair loss, generally when other antiandrogens, such as spironolactone, are not tolerated or are ineffective.
Indications
- Female pattern hair loss in adult women (off-label use).
- Other signs of hyperandrogenism, at the physician's discretion.
- Classic approved indication in urology, at different doses.
Mechanism of action
Bicalutamide selectively blocks androgen receptors, preventing the action of testosterone and DHT on the follicle. Being non-steroidal, it has a hormonal profile different from that of spironolactone.
Mechanism of action
Blocking the androgen receptor stops the follicle from receiving the miniaturising signal.
Usual dosage
In female hair loss, the doses used are usually 25 to 50 mg per day orally. Like other hair treatments, it requires several months of continuous use and its benefit is maintained while treatment lasts.
Side effects
The most relevant adverse effect is possible liver toxicity, so blood monitoring is essential. Other effects include:
- Altered transaminases.
- Breast tenderness.
- Digestive discomfort.
Liver function should be monitored periodically.
Contraindications
- Pregnancy and women of childbearing age without contraception.
- Significant liver disease.
- Hypersensitivity to the active substance.
- Not used for hair purposes in men.
Pregnancy and breastfeeding
Bicalutamide is contraindicated during pregnancy because of the risk of affecting the development of a male foetus. Effective contraception must be ensured in women of childbearing age. It is not advised during breastfeeding.
Important interactions
It is metabolised in the liver and may interact with drugs affecting hepatic enzymes, as well as with oral anticoagulants, whose effect it may enhance. Concomitant use of other hepatotoxic drugs should be avoided.
Level of scientific evidence
Level of evidence: limited. Its use in hair loss is supported by small studies and clinical experience. It is considered a second-line, off-label option in women with female pattern hair loss. In a randomised trial (2025) against spironolactone 100 mg/day, bicalutamide 50 mg/day showed better trichoscopic parameters at 24 weeks, with no significant clinical difference.
Frequently asked questions
Can men take it for hair loss?
It is not used for hair purposes in men because of its antiandrogen effects (such as breast tissue growth). Other options are preferred for them.
Why are liver tests needed?
Bicalutamide can alter liver function, so transaminases should be checked periodically during treatment.
When is it used instead of spironolactone?
It is usually reserved for when spironolactone is not tolerated or is ineffective, always at the physician's discretion.
How long does it take to work?
Like other antiandrogens, it requires several months of continuous treatment to see hair results.
References
- Ismail FF, et al. Bicalutamide in the treatment of female pattern hair loss. Australas J Dermatol.
- Fernández-Nieto D, et al. Oral bicalutamide for female pattern hair loss: a case series. J Am Acad Dermatol.
- Spironolactone versus Bicalutamide in female pattern hair loss: a randomised clinical trial. Clin Exp Dermatol. 2025. PMID: 41742379.
- Kanti V, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia. J Eur Acad Dermatol Venereol (EADV). 2018. doi:10.1111/jdv.14624.
- European Medicines Agency (EMA). Bicalutamide summary of product characteristics.
Clínica Valorian's view
At Clínica Valorian we reserve bicalutamide for selected cases of female pattern hair loss, usually as an alternative to spironolactone, with periodic liver monitoring and always on an individual basis.
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This fact sheet is for information and medical education purposes only. It does not replace a medical consultation or an individual prescription.