Flutamide May Help Women With Androgenetic Alopecia Who Don’t Respond to Spironolactone

By age 50, about 30 % of women will develop female pattern hair loss, also known as androgenetic alopecia. Treatments for this condition include topical minoxidil, hormone blocking oral medications such as spironolactone, flutamide and cyproterone actetate as well as hair transplantation. Spironolactone is considered among the first-line oral medications to treat female pattern hair loss.  

But what is the next step when spironolactone doesn’t seem to be helping?

Australian hair loss specialist Dr. Rodney Sinclair and his colleague Dr. Anosha Yazabadi suggested that the oral medication flutamide could be a helpful next step. They report the case of a 35 year old woman with androgenetic alopecia whose hair loss did not improve despite 5 years of spironolactone treatment at a daily dose of 200 mg and a 6 month course of 5 % minoxidil. A decision was made to stop the spironolactone and start flutamide at 250 mg per day and continue minoxidil. After 6 months of use, the patient’s hair loss ceased and her hair density improved.

Yazdabadi A adn Sinclair R. Treatment of female pattern hair loss with the androgen receptor antagonist flutamide. Australasian Journal of Dermatology 2011; 52: 132-34.

Comment: Flutamide may be a helpful medication in women with androgenetic alopecia whose hair loss does not improve with minoxidil and spironolactone and who are not candidates for hair transplantation. This oral medication blocks androgen hormones in several ways, including inhibiting update and the binding of androgens to the androgen receptor. Overall, it is a more potent androgen blocking medication than spironolactone. 

Consultation with a physician is necessarily to fully discuss the side effects of flutamide. This medication can rarely cause inflammation in the liver and so blood tests to monitor the liver are needed while using this drug. Furthermore, premenopausal women must not get pregnant while on flutamide and therefore contraceptive methods need to be carefully discussed with each patient.