Bicalutamide and the new perspectives for female pattern hair loss treatment: What dermatologists should know

Abstract

Female pattern hair loss (FPHL) is the most common form of alopecia in women. FPHL may compromise body image and strongly affect self‐esteem, negatively impacting quality of life. Currently, the only Food and Drug Administration (FDA) approved drug for its treatment is topical minoxidil, with a variable response rate. Recently, a few studies in FPHL have pointed out bicalutamide as an emergent selective androgen receptor antagonist with a favorable safety and tolerability profile. This review aimed to summarize and discuss the key information on this new therapy for FPHL. Bicalutamide has no diuretic effect. It does not cross the blood–brain barrier, and it has little effect on serum luteinizing hormone. Additionally, bicalutamide was found to be effective on women presenting with other features of hyperandrogenism such as seborrhea, acne, and hirsutism with mild and well‐tolerated adverse effects. Despite the high prevalence and psychosocial impairment, FPHL treatment remains challenging. Therefore, although future prospective, comparative, randomized clinical trials are essential to establish the ideal dose and efficacy of the drug, oral bicalutamide appears to be a promising option to expand the arsenal of FPHL treatment.

The Hormonal Background of Hair Loss in Non-Scarring Alopecias

“…Bicalutamide is an emergent selective AR antagonist with favorable safety and reduction in hair loss severity by 24.5% at a 1-year measurement (measurement in Sinclair scale). Studies suggest efficient doses are 10–50 mg daily [ 48 , 49 , 50 ]. There are also natural antiandrogens proposed in AGA therapy.…”

Medical Treatment for Androgenetic Alopecia

“…Bicalutamide is FDA-approved for prostate cancer in doses of 50 to 150 mg/d, and it has recently been used off-label for FPHL in lower doses. [54][55][56][57] Bicalutamide has been used in PCOS and severe hirsutism with mild and well-tolerated adverse effects. In a retrospective study including 17 FPHL, patients were treated with 50 mg bicalutamide daily or every other day for 24 weeks.…”

“…Bicalutamide is recommended for use in FPHL with features of hyperandrogenism (seborrhea, hirsutism, acne, and PCOS). 54,55 Bicalutamide is an option to maximize clinical improvement in treatmentresistant patients and also lessen minoxidil-associated hypertrichosis. 58 Women taking bicalutamide should discontinue 2 months before a planned pregnancy.…”

Female-pattern hair loss: therapeutic update

“…The most frequent side effects were mild alteration of transaminase levels, mastalgia, amenorrhea, and peripheral edema. 42 …”