Bicalutamide: A potential new oral anti-androgenic drug for female pattern hair loss - A case series

Female pattern hair loss (FPHL) is a common cause of progressive hair thinning in women and can be difficult to manage in those with inadequate response to standard therapies. This case series evaluates the efficacy and safety of oral bicalutamide as an adjunct to low-dose oral minoxidil (LDOM) in women with FPHL refractory to minoxidil monotherapy. Thirty women with clinically and trichoscopically confirmed FPHL (Sinclair grade ≥2) who showed no significant improvement after more than six months of LDOM were included. Oral bicalutamide was added at 50 mg twice weekly for one month, then increased to 50 mg on alternate days with regular biochemical monitoring. Response was assessed at six months using standardized photographs and a 7-point rating scale. At six months, 63.3% showed slight improvement and 33.3% moderate improvement; one patient had no change. No adverse effects were observed. Larger prospective studies are needed to confirm long-term safety and efficacy.