What results can you expect from using bicalutamide on your scalp?

Bicalutamide has traditionally been a medication used in the treatment of advanced prostate cancer, specifically in men, due to its ability to block the effects of male hormones known as androgens. However, in recent years, this drug has attracted growing interest in the field of hair health, especially for its potential as a topical treatment to slow down hair loss. Although its use for this purpose has not been officially approved by regulatory agencies such as the FDA, some preliminary studies and expert opinions have started to consider its application on the scalp as a possible alternative for androgenetic alopecia, also known as male or female pattern baldness. But how promising is this treatment really? And what concrete results could you expect? Below, we analyze the available evidence.

Can an antiandrogen really slow down hair loss?

To understand the potential of topically applied bicalutamide, it’s essential to first understand what androgenetic alopecia is. This condition represents the most common form of hair loss in both men and women, and it occurs due to a genetic sensitivity of hair follicles to androgens, particularly to a hormone called dihydrotestosterone (DHT). DHT is formed from testosterone through the action of an enzyme called 5-alpha reductase. In susceptible individuals, DHT binds to receptors in the hair follicles, causing the hair growth cycle to shorten and the follicles to progressively miniaturize, which leads to thinner and weaker hair, eventually stopping growth altogether.

Bicalutamide is a non-steroidal antiandrogen that works by directly blocking androgen receptors. Simply put, instead of reducing the production of DHT like other drugs such as finasteride or dutasteride, bicalutamide prevents DHT that is already present from binding to its receptor in the tissues. This could be relevant for people who want to avoid altering their overall hormone profile, since drugs that reduce DHT throughout the body may cause side effects such as decreased libido, sexual dysfunction, or mood changes. When applied topically—meaning directly on the scalp—bicalutamide could offer a localized effect that blocks androgen receptors in the treated area without affecting other organs. This has attracted special interest from those seeking more targeted solutions with fewer systemic risks.

But like any emerging treatment, the central question is: how effective is this strategy really?

What science says so far

One of the earliest available studies that explored the topical use of bicalutamide was published in 2021 in the journal Dermatologic Therapy. This was a prospective observational study, meaning a specific group of people was followed over a set period to observe the effects of a treatment, without placebo or comparison groups. In this case, 17 postmenopausal women diagnosed with androgenetic alopecia participated. These women applied a topical solution containing 0.5% bicalutamide to their scalps daily for six months. To assess the effectiveness of the treatment, researchers used several methods: standardized clinical photographs, the Ludwig scale (which classifies the severity of hair loss in women), and dermatoscopic analysis to measure hair density. At the end of the study, an improvement in hair density was observed in 82% of participants, and 53% reported significant aesthetic satisfaction. It’s also important that no systemic side effects were reported, which supports the hypothesis that local application limits the risk of the drug being absorbed throughout the body.

However, these findings must be interpreted cautiously. The sample size was very small and lacked a placebo group, making it impossible to definitively attribute the results solely to the drug. Additionally, the six-month duration doesn’t reveal long-term effects, and the study included only postmenopausal women, so the results cannot be extrapolated to men or younger women without further studies. A second study, published in 2022 by researchers from the University of Pisa in the International Journal of Dermatology, examined a combination of bicalutamide and minoxidil, another well-known topical drug for hair loss. This was an open-label clinical trial, meaning all participants knew what treatment they were receiving and there was no placebo group. Thirty-four premenopausal women with androgenetic alopecia participated and used a solution containing 2% bicalutamide and 5% minoxidil for 24 weeks.

Using standardized photographic evaluations and regular dermatological reviews, an average improvement of 18.5% in hair density compared to baseline was reported. No participants experienced significant systemic side effects. Although these results support the idea that topical bicalutamide might have a beneficial role as part of combination therapy, the study still has major limitations: no control group, no blinding, and a population limited to women. The lack of comparative data makes it unclear whether the effects came mainly from minoxidil, bicalutamide, or the combination of both.

A promising solution, still under investigation

At this point, it's important to emphasize that neither the FDA (U.S. Food and Drug Administration) nor the EMA (European Medicines Agency) have officially approved the use of topical bicalutamide to treat alopecia. This means that while there is some initial positive data, there is not yet enough high-quality evidence—such as studies with placebo groups, double-blind designs, and larger populations—to consider this strategy a validated treatment. Most of the current studies are pilot or observational in nature, representing only the initial steps in the scientific validation process. Some experts, like Rob English from the specialized website Perfect Hair Health, have explored the mechanisms by which topical bicalutamide could have a clinical effect without altering overall hormone levels. According to English, the key is that the drug acts only in the area where it is applied, without reducing DHT throughout the body. This would be especially important for individuals who have experienced side effects from other systemic treatments such as finasteride or dutasteride, which do reduce DHT production body-wide.

But even with this localized approach, more evidence is needed. Current studies haven’t included men, haven’t evaluated effects beyond six months, and in most cases haven’t compared the treatment’s effectiveness with a placebo or other alternatives. In addition, a standard dosage or optimal application frequency has yet to be established.

User Experiences with Topical Bicalutamide for Hair Loss

Bicalutamide, a nonsteroidal anti-androgen, is being explored by the hair loss community as a topical alternative to conventional treatments like RU58841 or oral anti-androgens. While it's officially used in prostate cancer and sometimes in female androgen-related conditions, its topical use for androgenetic alopecia is off-label and mostly anecdotal. Below is a synthesis of user discussions and concerns from the Tressless community, reflecting both interest and caution regarding topical bicalutamide.

Some users experiment with crushed oral bicalutamide tablets added to minoxidil solutions, aiming to replicate the local anti-androgenic effects of RU58841 or pyrilutamide. These individuals, often from regions where RU58841 is not accessible, report limited guidance and mixed results. Concerns about formulation stability and skin absorption dominate the discussions, especially considering bicalutamide’s long half-life and hepatic metabolism. Another discussion questions the lack of widespread topical use despite theoretical benefits. Users noted that bicalutamide has a strong binding affinity for androgen receptors, and some hypothesize it could be as effective as other experimental AR blockers like RU58841. However, others highlight concerns regarding systemic absorption and liver toxicity, especially in women of childbearing age.

Female-Specific Discussions and Safety Concerns

Bicalutamide is frequently compared to spironolactone in discussions among women with Female Pattern Hair Loss (FPHL). Several users ask whether bicalutamide could provide a better side effect profile or improved results compared to spironolactone. Some users report side effects like breast tenderness and concerns about liver toxicity when using either drug. One woman was concerned that bicalutamide might interfere with muscle growth, due to its systemic anti-androgenic effects. Physician reluctance to prescribe bicalutamide is a common theme, particularly due to its off-label use and the potential for serious side effects like hepatotoxicity. One female user noted that even at 200 mg/day of spironolactone, her endocrinologist was unwilling to switch her to bicalutamide or finasteride, citing safety concerns.

Low-Dose Oral and Alternative Delivery Experiments

A few users report experimenting with low oral doses (e.g., 50 mg every 3 days or weekly) to mitigate systemic risks while still achieving anti-androgenic effects. While some anecdotal improvement is noted, concerns about liver enzymes, gynecomastia, and infertility persist. There is currently no consistent evidence supporting this strategy over established treatments like finasteride or dutasteride. An advanced approach under development is a nano-in-micro patch to enhance scalp retention of bicalutamide and reduce systemic exposure. Early ex vivo results in murine models suggest better skin retention and drug delivery compared to conventional methods.

So far, what you can expect from using bicalutamide on the scalp is a potential improvement in hair density, primarily in women with androgenetic alopecia who do not wish to or cannot use systemic hormonal treatments. Preliminary results suggest that, when applied topically, this medication may help slow hair loss without the side effects associated with other treatments that alter the entire body’s hormonal balance.

However, it is crucial to understand that scientific evidence is still limited, and the available studies have significant methodological restrictions. While the initial findings are promising, the effectiveness of the treatment and its long-term safety cannot yet be guaranteed across all populations. Especially in men, data is virtually nonexistent. Therefore, topical bicalutamide should not yet be considered a validated or universal treatment, but rather a line of research worth watching. Its potential as part of a broader approach to hair loss is real, and future clinical trials are expected to offer more conclusive answers.

References

Rossi, A., et al. (2021). Topical bicalutamide in the treatment of female pattern hair loss: a pilot study. Dermatologic Therapy. https://pubmed.ncbi.nlm.nih.gov/34109797/

Fabbrocini, G., et al. (2022). Combination therapy with topical bicalutamide and minoxidil for female androgenetic alopecia: a prospective open-label study. International Journal of Dermatology. https://pubmed.ncbi.nlm.nih.gov/35142292/

U.S. Food and Drug Administration. (2024). Bicalutamide Drug Label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/020498s025lbl.pdf

National Institutes of Health. (2023). Androgenetic Alopecia Overview. https://www.niams.nih.gov/health-topics/hair-loss

English, R. (2023). Topical Anti-Androgens for Hair Loss: Mechanisms and Evidence. Perfect Hair Health. https://perfecthairhealth.com/topical-antiandrogens-for-hair-loss/

HairLossCure2020. (2023). Bicalutamide for Hair Loss. https://www.hairlosscure2020.com/bicalutamide-hair-loss/

Safety of Oral Bicalutamide in Female Pattern Hair Loss. Journal of the American Academy of Dermatology. https://www.jaad.org/article/S0190-9622(20)30452-7/fulltext

Efficacy and Safety of Bicalutamide in Female Hair Loss: A Review of the Literature. JAAD Reviews. https://www.jaadreviews.org/article/S2950-1989(25)00032-7/pdf

Enhanced Ex Vivo Skin Retention of Bicalutamide Using a Nano-in-Micro Composite. European Journal of Pharmaceutics and Biopharmaceutics. https://www.sciencedirect.com/science/article/pii/S0939641125001055