Spironolactone versus Bicalutamide for Female Pattern Hair Loss

INTRODUCTIONFemale pattern hair loss (FPHL) is a chronic, progressive condition that affects quality of life. Off-label systemic antiandrogens are increasingly used, but comparative data remain limited.

METHODSTo compare the effectiveness, safety, and healthcare resource utilization of spironolactone versus bicalutamide in FPHL over 24 months, we conducted a unicenter retrospective cohort study of women with FPHL treated between 2018 and 2022. The primary outcome was mean change in Sinclair grade from baseline to month 24. Secondary outcomes included ≥ 1 grade improvement, adverse events, and healthcare utilization. Linear and ordinal logistic regression models were adjusted for baseline severity.

RESULTSA total of 187 women (median age 35 years, range 15-69 years) completed 24 months of follow-up. Both drugs produced significant Sinclair grade improvement (mean change -0.5, p < 0.001). Spironolactone (n = 128) was superior, with 54.4% achieving ≥ 1 grade improvement versus 37.3% with bicalutamide (n = 59) (p = 0.030). High-dose spironolactone (> 100 mg/day, median 130 mg/day) showed greater benefit than the maximum bicalutamide dose (50 mg/day). Adverse event rate was similar, but bicalutamide caused more laboratory abnormalities and required closer monitoring.

CONCLUSIONSBoth drugs are effective systemic options. Spironolactone, particularly > 100 mg/day, demonstrated greater efficacy, comparable safety, and less monitoring, supporting its potential role as first-line systemic option.

Abstract from PubMed