Spironolactone Versus Bicalutamide in Female Pattern Hair Loss: A Randomized Clinical Trial

This randomized clinical trial compared the efficacy and safety of bicalutamide (50 mg/day) and spironolactone (100 mg/day) in treating Female Pattern Hair Loss (FPHL) in 204 women. Over 24 weeks, bicalutamide showed greater improvements in hair count and shaft diameter at both frontal and vertex scalp sites compared to spironolactone. Specifically, the mean increase in hair count at the frontal site was 5.05 hairs/cm² for bicalutamide versus 3.13 hairs/cm² for spironolactone, and at the vertex site, it was 6.32 versus 3.06 hairs/cm². Hair shaft diameter also increased more with bicalutamide. Adverse events were less frequent with bicalutamide (11.7%) compared to spironolactone (18.6%). Despite these trichoscopic improvements, no significant differences were observed in clinical endpoints. The study's limitations include a short follow-up period, single-centre design, and per-protocol analysis, which may affect the generalizability of the results.