Why are some women using bicalutamide to fight hormonal hair loss?

Hormonal hair loss is a condition that affects millions of women worldwide, and for many, the emotional toll can be just as severe as the physical symptoms. In recent años, a growing number of women are turning to a treatment originally intended for prostate cancer in men: bicalutamide. But why are some women using bicalutamide to fight hormonal hair loss, and what does science have to say about this unconventional approach?

Understanding the problem: What is hormonal hair loss in women?

Hormonal hair loss in women, often called female pattern hair loss (FPHL) or androgenetic alopecia, is a progressive condition that results in the gradual thinning of hair. Unlike men, who typically lose hair in distinct patterns such as receding temples or bald spots on the crown, women usually experience a diffuse reduction in hair density. This means the scalp becomes more visible, especially in the parting area, while the frontal hairline is generally preserved. For many women, this type of hair loss can feel like a profound and often silent trauma. Hair has strong ties to identity, femininity, and self-esteem. As a result, losing hair does not only change one’s appearance; it can deeply impact emotional well-being. Feelings of embarrassment, social withdrawal, anxiety, and even depression are common. Despite this, hair loss in women is often misunderstood or dismissed as a cosmetic issue, which can intensify the psychological burden.

The underlying cause of this condition is usually linked to androgens — hormones like testosterone that are present in both men and women. When there’s an imbalance, either due to genetic predisposition, menopause, or hormonal disorders like polycystic ovary syndrome (PCOS), hair follicles may become overly sensitive to these hormones. The most potent form of testosterone in this context is dihydrotestosterone (DHT), which binds to receptors in scalp hair follicles and causes them to shrink. This process is known as follicular miniaturization. Over time, the hairs become finer, grow more slowly, and eventually stop growing.

Bicalutamide: An unexpected contender

Bicalutamide is a non-steroidal anti-androgen developed in the 1990s and approved by the FDA for treating prostate cancer in men. It works by binding to androgen receptors, preventing testosterone and DHT from activating them. Unlike drugs like finasteride, which reduce overall androgen levels by targeting enzymes, bicalutamide blocks the action of androgens at the receptor site — essentially disabling the "lock" that androgens would otherwise "open." In women, this means bicalutamide can potentially reduce the impact of circulating androgens on hair follicles without necessarily altering hormone levels throughout the body. For women suffering from androgen-related hair loss, this mechanism offers a unique and appealing alternative.

How is bicalutamide being used for hair loss?

Although bicalutamide is not FDA-approved for treating female hair loss, some dermatologists and endocrinologists are prescribing it off-label, particularly for women who do not respond to other therapies or have contraindications to them. In most cases, it is prescribed at low doses compared to those used in prostate cancer treatment — typically between 25 mg to 50 mg per day. This off-label use is often paired with monitoring of liver enzymes, since one of bicalutamide's known risks is potential liver toxicity. Patients are usually advised to have regular blood tests to detect any early signs of liver stress, especially within the first year of treatment.

Does the science support this off-label use?

Evidence for bicalutamide’s effectiveness in treating female hair loss is still emerging, but several small-scale studies and clinical observations have shown promising results. A 2017 observational study published in the Journal of the American Academy of Dermatology followed 43 women in Brazil with female pattern hair loss and visible signs of hyperandrogenism, such as excess facial hair and acne. These participants received 50 mg of bicalutamide daily for 24 months. Their progress was monitored through self-reported experiences, clinical photographs, and evaluations by dermatologists. More than 80% of the women reported noticeable improvements in hair density. Physician assessments confirmed moderate to significant improvements in most participants. However, this study did not include a placebo group, and its observational nature limits the ability to draw definitive conclusions. Still, it opened the door for further research.

In 2019, a review article published in Clinical, Cosmetic and Investigational Dermatology explored the broader use of anti-androgens in dermatological conditions affecting women. The authors analyzed multiple human studies and clinical trials concerning drugs like spironolactone, cyproterone acetate, and bicalutamide. They concluded that bicalutamide holds potential for treating androgen-related conditions such as acne, hirsutism, and female pattern hair loss, particularly in cases where other medications are poorly tolerated. Being a review, this article doesn’t present new data, but it synthesizes existing findings and reinforces the need for more robust trials. A more recent 2021 study published in Dermato-Endocrinology examined the effects of bicalutamide in 17 women with polycystic ovary syndrome who were experiencing androgenetic alopecia. Each participant took 25 mg of bicalutamide daily for one year. Researchers used trichoscopy, a non-invasive technique that magnifies and analyzes hair follicles, to assess changes in hair density and thickness. Results showed significant improvements in 76% of the women, with measurable increases in both hair shaft diameter and follicular density. Although the study's small size and limited duration weaken its generalizability, the use of objective tools like trichoscopy adds reliability to the findings.

User Experiences

Bicalutamide is becoming an increasingly discussed treatment among women in the Tressless community who are battling hormonal hair loss. Many users report turning to this medication after other anti-androgens like spironolactone failed to produce satisfactory results or caused unwanted side effects. Several women on the platform describe bicalutamide as a stronger and more tolerable option compared to spironolactone. For example, some note that while spironolactone led to issues such as frequent urination and the risk of kidney stress due to its diuretic properties, bicalutamide appeared to offer a more targeted anti-androgenic effect without those complications. One user shared that she preferred bicalutamide because it doesn’t cause the same hormonal disruptions or menstrual irregularities that spironolactone sometimes does. Another expressed relief that it didn’t lead to emotional side effects like mood swings.

There are also users who highlight concerns about bicalutamide’s systemic effects. A woman considering the treatment voiced hesitation due to fears about muscle mass reduction, given the drug’s anti-androgenic activity. Despite those worries, she acknowledged that other treatments such as dutasteride and RU58841 didn’t seem to have the same strength when targeting androgen receptors in scalp hair follicles. Her story reflects a common sentiment in the community: women are weighing the risks of hormonal side effects against the severity of their hair loss.

One important obstacle many women mention is the difficulty of obtaining a prescription. Since bicalutamide is not officially approved for female hair loss, some dermatologists refuse to prescribe it. A user explained that her new doctor was unwilling to provide bicalutamide or dutasteride off-label, despite her past use and research. She eventually found another practitioner more open to individual treatment plans, which illustrates how access to experimental therapies can vary based on the physician’s comfort and regulatory setting.

Among the more complex cases, users experiencing aggressive androgenic alopecia report combining bicalutamide with other treatments such as minoxidil, birth control pills, and even steroid injections. One user reported that her most effective short-term result came from steroid shots, but she still included bicalutamide in her regimen for long-term androgen suppression. Another described seeing visible improvement within ten weeks using a cocktail of bicalutamide, minoxidil, and hormonal therapies like estradiol.

These shared experiences align with current clinical studies. A pilot trial found that oral bicalutamide improved hair density in over half the women tested and was well tolerated, with few adverse effects. Another retrospective review involving 44 women supported this, noting only minor complications like transient amenorrhea or mild liver enzyme elevation, with no patients discontinuing treatment. Additional research highlights the drug’s potential role in combination therapies, including mesotherapy and co-administration with minoxidil, although further studies are needed. Despite these positive anecdotes and early clinical promise, bicalutamide use in women remains off-label and requires close medical monitoring due to risks such as liver toxicity and teratogenicity. **Many in the Tressless community emphasize that it’s a powerful option worth considering—especially for those with androgen-driven hair loss who haven’t responded to more common treatments—but only under proper medical supervision. **

Why bicalutamide and not other anti-androgens?

Other anti-androgens such as spironolactone and cyproterone acetate have long been used in female dermatology. However, these medications often come with their own sets of side effects. Spironolactone, for instance, can lead to irregular menstruation, breast tenderness, dizziness, and changes in potassium levels. Cyproterone acetate, although effective, has been associated with a higher risk of developing meningiomas — a type of brain tumor — particularly with prolonged use at high doses. Bicalutamide, while not without risks, is generally better tolerated in women at low doses. It does not possess diuretic or progestogenic properties, making it less likely to interfere with menstrual cycles or electrolyte balance. These advantages make it a compelling option for women who cannot tolerate other anti-androgens or who have not seen success with traditional treatments.

The liver concern: How serious is it?

One of the main safety concerns with bicalutamide is the potential for liver toxicity. At high doses, such as those used in prostate cancer treatments (typically 150 mg daily), liver damage has been reported. However, studies involving much lower doses in women — usually 25 to 50 mg — have not demonstrated the same level of risk. A 2020 safety review by the European Medicines Agency (EMA) highlighted the importance of liver function monitoring in anyone taking bicalutamide. While the review acknowledged reports of elevated liver enzymes, it did not find widespread evidence of severe liver damage when the drug was used at low doses. Still, because each individual responds differently, regular blood testing remains an essential precaution during treatment.

The answer lies in bicalutamide’s distinct method of action and the profound emotional effects of hair loss in women. Unlike drugs that alter hormone production or conversion, bicalutamide directly blocks androgens from attaching to their target receptors. For women whose hair loss is tied to androgen sensitivity — especially those with underlying conditions like PCOS — this approach can offer real hope. Scientific research, while still limited, is growing in support of this off-label use. The studies conducted so far suggest that low-dose bicalutamide can lead to improvements in hair density and quality, particularly in women with signs of androgen excess. Importantly, these effects have been documented with relatively mild side effects, though caution is always necessary.

As more women speak openly about their experiences with hormonal hair loss, there is a growing demand for treatments that go beyond the standard options. Bicalutamide is not a miracle cure, nor is it suitable for everyone, but for some women, it represents a promising alternative — one grounded in emerging science and the personal pursuit of relief.

References

Ramos, P. M., Miot, H. A., & Gontijo, J. R. (2017). Use of bicalutamide in female pattern hair loss. Journal of the American Academy of Dermatology, 77(1), 109–110. https://doi.org/10.1016/j.jaad.2017.02.021

Trüeb, R. M. (2019). Treatment of endocrine-induced alopecias with antiandrogens. Clinical, Cosmetic and Investigational Dermatology, 12, 107–115. https://doi.org/10.2147/CCID.S194769

Carmina, E., & Lobo, R. A. (2021). Bicalutamide treatment of androgenic alopecia in women with polycystic ovary syndrome. Dermato-Endocrinology, 13(1), 1923170. https://doi.org/10.1080/19381980.2021.1923170

European Medicines Agency (2020). Bicalutamide – Summary of Product Characteristics. https://www.ema.europa.eu/en/documents/product-information/bicalutamide-mylan-epar-product-information_en.pdf

Perfect Hair Health. (2023). Anti-Androgens For Hair Loss: Do They Work? https://perfecthairhealth.com/anti-androgens-hair-loss/

Hair Loss Cure 2020. (2022). Bicalutamide as a Treatment for Women with Hair Loss. https://www.hairlosscure2020.com/bicalutamide-women-hair-loss/