Can bicalutamide stop DHT from shrinking your hair follicles?
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Can bicalutamide stop DHT from shrinking your hair follicles?
Hair loss, particularly androgenetic alopecia, is a common concern affecting both men and women. This condition is closely linked to the action of dihydrotestosterone (DHT), a hormone derived from testosterone that can lead to what is known as "shrinking" or miniaturization of hair follicles. **This term refers to a gradual process where the follicles structures in the skin where each hair grows become smaller over time. **As a result, the hairs they produce become thinner, shorter, and lighter in color, until they eventually stop growing altogether. In the search for effective treatments, bicalutamide, a drug originally used for prostate cancer, has emerged as a potential option for counteracting the effects of DHT on hair follicles.
This article explores the scientific evidence available on the use of bicalutamide for treating androgenetic alopecia.
What is Bicalutamide and How Does It Work?
Bicalutamide is a non-steroidal antiandrogen. This means it blocks the action of male sex hormones (androgens) like DHT, without affecting other hormones such as steroids. It works by directly interfering with androgen receptors in the body’s cells. These receptors act like locks: when a hormone like DHT binds to them, it triggers a series of processes inside the cell. By blocking the lock (the receptor), bicalutamide prevents the hormone from exerting its effects. Unlike other hair loss treatments that reduce DHT production in the body, such as finasteride, bicalutamide does not lower the levels of this hormone. Instead, it prevents DHT from attaching to the hair follicles and triggering their miniaturization. In theory, this could help maintain the follicles at a healthy size, prevent progressive thinning, and in some cases, even allow thicker hairs to grow again.
Scientific Evidence on the Use of Bicalutamide in Androgenetic Alopecia
Although bicalutamide is not FDA-approved for treating hair loss, some research has examined its use in this context. A retrospective study published in 2020 in the Journal of the American Academy of Dermatology analyzed the safety of oral bicalutamide in women with female pattern hair loss. The study included 316 patients and reviewed their medical records. The women received the drug for varying periods, and both clinical outcomes and side effects were monitored. The evaluation method focused on visible improvements in hair volume and subjective symptoms reported by the patients. The study found that the drug was generally well-tolerated, with few side effects reported. However, being a retrospective study, it lacked a control group and randomization, which limits the strength of the conclusions. Still, it provides signs that bicalutamide may be useful in treating hair loss in women.
Another retrospective study, published in 2022 in the same journal, evaluated 35 patients who developed an unwanted side effect from minoxidil known as hypertrichosis (excess hair growth in unwanted areas). The research explored whether bicalutamide could help reduce that unwanted growth. The results showed it could, further supporting its ability to modulate androgen effects in different tissues. However, like the previous study, the small sample size and lack of a control group limit definitive conclusions.
A 2025 systematic review published in JAAD Reviews examined multiple studies on bicalutamide use in women with hair loss. This review did not include new experiments but analyzed existing publications. The authors concluded that bicalutamide appears to be an effective option in women with androgenetic alopecia, especially those showing signs of excess androgens, such as acne or hirsutism (excess facial or body hair). However, they cautioned that more long-term and controlled studies are needed to confirm these results.
Comparison with Other Treatments
The most well-known treatments for androgenetic alopecia include finasteride and minoxidil. Finasteride works by inhibiting an enzyme called 5-alpha reductase, which is responsible for converting testosterone into DHT. By lowering DHT levels in the body, it can slow follicle miniaturization. Minoxidil, on the other hand, doesn’t act on hormones; instead, it improves blood circulation in the scalp, which can stimulate hair growth. Bicalutamide represents a different approach. It doesn’t reduce hormone levels themselves but blocks their action directly at the follicle receptors. This method may be useful for people who cannot use finasteride or who haven’t responded well to minoxidil. It may also be relevant for women, since finasteride is not typically effective in female patients at standard doses and may have significant side effects.
Safety Considerations and Side Effects
Although the studies mentioned indicate that bicalutamide is well tolerated by many patients, there are side effects to consider. Some common ones include breast tenderness, changes in liver enzyme levels, and in rare cases, hormonal changes that could affect the menstrual cycle or metabolism. Bicalutamide can also cause more serious effects if not properly monitored. For this reason, anyone interested in this treatment should do so under medical supervision. Regular testing is recommended to assess liver function and other key health markers while using the medication.
User experience
Bicalutamide, a non-steroidal oral anti-androgen, is emerging as a treatment option for female pattern hair loss (FPHL), particularly in women who do not respond well to other therapies like spironolactone or experience unwanted side effects. On Tressless, several users have shared personal experiences that help shed light on how and why bicalutamide is being used, alongside published scientific research supporting its effectiveness. In one discussion, women compared spironolactone and bicalutamide for androgenic alopecia. Some users reported that while spironolactone helped reduce hair loss, it often caused side effects like decreased libido and frequent urination. Bicalutamide, on the other hand, was perceived as more tolerable in some cases, offering similar benefits with fewer hormonal side effects.
Another post featured a 30-year-old woman who considered using bicalutamide for androgenetic alopecia but expressed concern over potential impacts on muscle growth. The community suggested alternative treatments such as dutasteride, RU58841, and minoxidil, emphasizing the importance of weighing anti-androgenic effects against personal goals like athletic performance. In more severe cases, such as one user experiencing both AGA and chronic telogen effluvium (CTE), the use of bicalutamide was part of a broader regimen that also included finasteride, spironolactone, oral minoxidil, and birth control. Despite trying these treatments, only steroid injections temporarily stopped hair shedding. This highlights that bicalutamide might not be effective in all cases and may work best as part of a comprehensive, individualized protocol.
Another female user noted difficulty obtaining a prescription for bicalutamide, as her dermatologist refused to prescribe it due to its off-label status, even after she had unsuccessfully tried more traditional therapies. This reflects the reality that, despite its potential, access to bicalutamide can be limited by regional medical guidelines or physician hesitation.
Clinical research supports the community's observations. A pilot study published in Dermatologic Therapy found that bicalutamide improved hair density in 53% of women with FPHL and was well tolerated, suggesting a favorable safety profile compared to flutamide. A review in the Journal of Cosmetic Dermatology also described bicalutamide as a promising treatment for women, particularly those with other signs of hyperandrogenism such as seborrhea or acne. It emphasized that bicalutamide does not cross the blood-brain barrier and has minimal effects on luteinizing hormone, suggesting fewer hormonal disruptions (Romiti, 2022).
There is also early evidence on the use of bicalutamide via mesotherapy. In a small study involving six premenopausal women, monthly injections of bicalutamide 0.5% led to subtle improvements in hair density and reduced seborrhea, with no reported adverse effects. However, the improvements did not persist at six months, indicating that more research is needed to evaluate the long-term benefits of this delivery method. In conclusion, bicalutamide appears to be a viable off-label option for some women experiencing androgen-related hair loss, especially those who do not tolerate other anti-androgens like spironolactone. While anecdotal reports and early studies show promise, the need for larger, randomized clinical trials remains clear. Access to treatment may depend on physician openness and local regulations.
Conclusion
Bicalutamide’s mechanism of action could be helpful in countering the follicle miniaturization process caused by DHT. Although it does not directly lower the amount of this hormone, it prevents its action in sensitive tissues like hair follicles. This may help preserve their size and function, and in some cases, reverse hair loss. However, the scientific evidence available so far is mainly based on retrospective studies and literature reviews. While promising, these studies don’t carry the same weight as randomized clinical trials. Therefore, more research is still needed to definitively confirm the efficacy and safety of bicalutamide for treating androgenetic alopecia.
References
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Ismail, F. F., Meah, N., de Carvalho, L. T., Bhoyrul, B., Wall, D., & Sinclair, R. (2020). Safety of oral bicalutamide in female pattern hair loss: A retrospective review of 316 patients. Journal of the American Academy of Dermatology, 83(5), 1478–1479. https://doi.org/10.1016/j.jaad.2020.03.034
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Moussa, A., Kazmi, A., Bokhari, L., & Sinclair, R. D. (2022). Bicalutamide improves minoxidil-induced hypertrichosis in female pattern hair loss: A retrospective review of 35 patients. Journal of the American Academy of Dermatology, 87(2), 488–490. https://doi.org/10.1016/j.jaad.2021.10.048
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Pérez, S. M., Nguyen, B., & Senna, M. M. (2025). Efficacy and safety of bicalutamide in female hair loss: A review of the literature. JAAD Reviews, 3(2), 123–130. https://doi.org/10.1016/j.jaad.2025.03.032