Bicalutamide 50 mg Superior to Spironolactone 100 mg in FPHL

Bicalutamide 50 mg more effective than Spironolactone 100 mg

I was very interested to read a study from India which set out to compare the effectiveness of spironolactone and bicalutamide in the treatment of female-pattern hair loss (FPHL). The study was a retrospective study of 120 female patients 18-50 years of age who used these drugs. Group A comprised patients who were taking 100 mg of spironolactone once daily, along with 2% minoxidil and Group B comprised patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2%. Patients were analysed at approximately 24 weeks from the start of the treatment.

24 week results showed a mean reduction in hair loss severity score on the Sinclair scale of 19.51% in spironolactone group compared to 28.20% in bicalutamide group. This was felt to be statistically significant. On global photographic assessment, researchers found a greater improvement in the bicalutamide group compared to the spironolactone group, although this was not significant (p = 0.139).

Conclusions and Comments

With a study design like this, it’s really hard to say if bicalutamide truly beats our spironolactone. One things this is not - is a randomized controlled trial. The study uses Sinclair scales as opposed to quantitative measurements which makes it challenging to really offer definitive conclusions. However, it sure does seem that spironolactone and bicalutamide area in a similar league of effectiveness - and both appear to be good options for FPHL.

More studies are needed.

REFERENCES

Abhijeet Kumar Jha et al. Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study. Australas J Dermatol. 2024 May 19.doi: 10.1111/ajd.14306. Online ahead of print.