Could Bicalutamide Help Trans Women Regrow Hair Lost to Testosterone?

Bicalutamide is a prescription-only medication originally developed to treat prostate cancer, not hair loss. This means that its use for hair regrowth is considered "off-label," or outside its officially approved purpose. While its role as an antiandrogen has made it an attractive candidate for treating hair loss in certain populations, no clinical studies have specifically evaluated its effectiveness in trans women. Any assumptions about its benefits for this group remain speculative. Bicalutamide belongs to a class of medications known as non-steroidal antiandrogens. Unlike drugs that reduce testosterone production, bicalutamide does not lower the levels of testosterone or dihydrotestosterone (DHT) in the blood. Instead, it blocks these hormones from binding to androgen receptors throughout the body, including in the scalp. This mechanism is important because excess androgen activity is one of the major factors that contributes to hair thinning and loss in people assigned male at birth.

The U.S. Food and Drug Administration (FDA) approved bicalutamide in 1995 for the treatment of advanced prostate cancer. It was never intended or tested as a treatment for alopecia, and it is not approved for that use. For this reason, its application in hair-related concerns is classified as experimental and should be approached with clinical caution.

What the Research Shows

While no studies have focused on bicalutamide’s effect on hair in trans women, some investigations have explored its effects in cisgender women with female pattern hair loss (FPHL) or related androgen-sensitive conditions. These studies offer limited insight, and their findings cannot be assumed to apply to other groups without additional research.

One randomized clinical trial published in 2025 in JAAD International examined the use of 25 mg/day of bicalutamide combined with 1 mg/day of topical minoxidil in 74 cisgender women with FPHL. Participants were split into two groups—one using only minoxidil, and the other combining minoxidil with bicalutamide. After 24 weeks, both groups showed slight improvement, but there was no statistically significant difference between them (hair density increased by 18.1 vs. 21.5 hairs/cm²; P = .86). Hair density was assessed using a technique called trichoscopy, which magnifies the scalp to count individual hair follicles. While this was a well-controlled study, its short duration and limited scope reduce its relevance for long-term treatment strategies. Importantly, the participants were cisgender women, not trans women. Another study from 2024, published in the Australasian Journal of Dermatology, retrospectively compared 50 mg/day of bicalutamide to 100 mg/day of spironolactone in 120 cisgender women with FPHL. Both groups used minoxidil. After 24 weeks, the bicalutamide group showed a greater improvement in hair density based on the Sinclair scale—a clinical tool for grading female hair loss. However, as a retrospective study, this research lacks the rigorous controls of randomized trials and is subject to potential selection bias.

A small 2025 pilot study in India tested mesotherapy—injecting small amounts of medication directly into the scalp—using bicalutamide in four cisgender women. Only one participant experienced notable regrowth after 24 weeks. Two showed no change, and one saw worsening hair. With such a small sample and no control group, these results are inconclusive.

A separate 2020 safety review examined liver health in 316 cisgender women taking bicalutamide for FPHL. Mild increases in liver enzyme levels occurred in about 3% of users, but the elevations resolved without discontinuing treatment. These results suggest a relatively safe profile in the short term, although ongoing liver monitoring is recommended.

User Experiences: Can Bicalutamide Help Trans Women Regrow Hair Lost to Testosterone?

Bicalutamide, a non-steroidal antiandrogen, is being increasingly discussed in the trans community as a potential tool to reverse androgenic hair loss caused by testosterone exposure prior to transition. On Tressless, several transgender women have shared personal experiences with bicalutamide, often comparing it with other antiandrogens like spironolactone. Here’s a synthesis of those community discussions and how they intersect with available research.

A Reddit thread titled “Insane MTF recovery 18 months blocking androgens” features a transgender woman reporting significant regrowth after 18 months of estrogen therapy and antiandrogen use, including bicalutamide. While the results were visually compelling, it’s unclear whether the regrowth came solely from bicalutamide, or from a combination of treatments including estrogen, RU58841, and dutasteride. Nonetheless, the case illustrates the potential for follicular recovery when DHT is aggressively suppressed. In another discussion, a user compared bicalutamide with spironolactone for women with androgenic alopecia, noting differing side effect profiles. Some users preferred bicalutamide due to fewer anti-mineralocorticoid side effects like dehydration or potassium imbalance, commonly seen with spironolactone. However, liver enzyme monitoring was frequently brought up due to the hepatic risks associated with oral bicalutamide.

What We Still Don’t Know About Trans Women

Bicalutamide is sometimes prescribed as part of hormone therapy for trans women due to its antiandrogen effects. It can help reduce testosterone-related characteristics like facial hair or acne. However, there are no published clinical trials specifically evaluating whether bicalutamide helps trans women regrow scalp hair previously lost to testosterone. Anecdotal experiences are not a substitute for peer-reviewed evidence. A 2021 systematic review in Dermatology and Therapy assessed dermatologic treatments used among transgender patients. The review concluded that rigorous studies are severely lacking, particularly when it comes to scalp hair treatments. Without clinical data, it is impossible to determine if bicalutamide would provide a meaningful benefit for trans women experiencing androgenic hair loss.

Evaluating the Evidence—Strengths and Gaps

The studies that exist suggest bicalutamide may help prevent further hair loss or modestly improve density in cisgender women. But none of these studies report significant regrowth, and all of them exclude trans women. The existing research is limited in scope, often short in duration, and lacks consistency in outcome measurement. Even the most optimistic findings do not point to dramatic transformation, and the use of this drug for hair loss remains unapproved and off-label. Moreover, bicalutamide carries risks. Although short-term safety data are promising, any use must involve medical supervision, particularly for monitoring liver function. It’s important to remember that medications affect each individual differently and that assumptions based on other populations may not be reliable.

Final Thoughts: Proceed With Caution

Bicalutamide is a prescription medication approved for prostate cancer. Its ability to block testosterone has led some to explore its use in addressing hair loss. While small studies in cisgender women suggest it may help stabilize hair thinning, no evidence confirms it helps trans women regrow hair lost to testosterone. For now, the answer to whether bicalutamide can regrow hair in trans women remains uncertain. No high-quality studies support its use for this purpose, and the existing evidence does not include the trans population. Anyone considering bicalutamide for hair-related reasons should do so under medical supervision and with realistic expectations.

References

Libório, R. D. S., et al. (2025). Bicalutamide 25 mg combined with minoxidil 1 mg versus minoxidil 1 mg for female pattern hair loss: A randomized double-blind clinical trial. JAAD International. https://pubmed.ncbi.nlm.nih.gov/40034971/

Australasian Journal of Dermatology (2024). Comparative review: bicalutamide vs spironolactone in FPHL. https://pubmed.ncbi.nlm.nih.gov/38762801/

Indian Journal of Dermatology, Venereology and Leprology (2025). Mesotherapy with bicalutamide. https://ijdvl.com/mesotherapy-with-bicalutamide-for-female-pattern-hair-loss/

Journal of the American Academy of Dermatology (2020). Safety profile of bicalutamide in cisgender women. Summary of liver enzyme monitoring. [Source in full text journal]

DeWane, M. E., et al. (2021). Dermatologic care of transgender patients: A systematic review. Dermatology and Therapy*, 11(4), 1303–1322. https://link.springer.com/article/10.1007/s13555-021-00574-0

Reddit user. (2023, April 27). Insane MTF recovery 18 months blocking androgens. r/tressless. https://reddit.com/r/tressless/comments/1313o71/insane_mtf_recovery_18_months_blocking_androgens/

Reddit user. (2022, April 25). Spironolactone vs bicalutamide: What is the difference between them for androgenic alopecia for women? r/tressless. https://reddit.com/r/tressless/comments/ub8wre/spironolactone_vs_bicalutamide_what_is_the/

Reddit user. (2022, October 12). How effective is spironolactone? r/tressless. https://reddit.com/r/tressless/comments/y2inbi/how_effective_is_spironolactone/