Bicalutamide improves minoxidil-induced hypertrichosis in female pattern hair loss: A retrospective review of 35 patients

A practical approach to the management of hair loss in patients with polycystic ovary syndrome

“…For hair loss, the senior authors typically suggest therapy with bicalutamide at 50 mg/day only after a patient has failed therapy with first‐line treatments like COCs, minoxidil and spironolactone due to the drug's side‐effect profile. Bicalutamide can also be used at lower doses of 14–15 mg/day to treat hypertrichosis, which is typically compounded due to lack of commercial availability 43 . In a retrospective review of 316 FPHL patients treated with oral bicalutamide, 9 (2.85%) experienced transaminitis, the most common side‐effect of the drug.…”

“…Though safe, topical minoxidil may be intolerable for PCOS patients because of the dose‐dependent risk of facial hypertrichosis, which is observed in up to 4% of patients and may worsen the appearance of pre‐existing hirsutism 49 . Patients should be advised that this side‐effect can be mitigated through the concomitant use of antiandrogen drugs in combination with physical hair removal methods 43 . The senior authors recommend removing new hair growth with the dermaplaning razor as it is cost effective and efficacious in removing unwanted hair without increasing the risk of papules that may occur with repetitive plucking.…”

“…42 Bicalutamide has also been reported to mitigate hypertrichosis in patients on concurrent minoxidil therapy and may be used as an independent treatment for facial hypertrichosis. 43 In a randomized, doubleblind placebo-controlled study of 70 patients prescribed COCs and bicalutamide 50 mg/day or COCs and placebo for 12 months, patients in the bicalutamide group had a higher reduction in hirsutism than those prescribed COCs alone. 44 For hair loss, the senior authors typically suggest therapy with bicalutamide at 50 mg/day only after a patient has failed therapy with first-line treatments like COCs, minoxidil and spironolactone due to the drug's side-effect profile.…”

“…Bicalutamide can also be used at lower doses of 14-15 mg/ day to treat hypertrichosis, which is typically compounded due to lack of commercial availability. 43 In a retrospective review of 316 FPHL patients treated with oral bicalutamide, 9 (2.85%) experienced transaminitis, the most common side-effect of the drug. The transaminitis resolved in 4 of the FPHL patients without dose change and 2 with dose reduction.…”

“…49 Patients should be advised that this side-effect can be mitigated through the concomitant use of antiandrogen drugs in combination with physical hair removal methods. 43 The senior authors recommend removing new hair growth with the dermaplaning razor as it is cost effective and efficacious in removing unwanted hair without increasing the risk of papules that may occur with repetitive plucking. New hair growth can also be removed with other methods such as laser, waxing, plucking and depilatory creams.…”