Flutamide is a controversial topic when it comes to hair loss treatments. We are talking about a drug for advanced cases of prostate cancer, but it is prescribed by some doctors in some cases of androgenic alopecia .
The effects of flutamide are quite powerful, and it carries a risk of serious side effects (and there have been some deaths related to the drug!). This is why it was abandoned by most dermatologists.
But should we completely rule out the benefits of this powerful drug?
We put together the information available on flutamide, including the history of the drug and the studies to date, and we will tell you everything we find.
What is flutamide?
Flutamide is a substance discovered in the 1970s and adopted in 1989 by the FDA (Food and Drug Administration, the agency that regulates the sale of drugs in the United States) for the treatment of prostate cancer.
The only authorized use of flutamide is in advanced prostate cancer, however, some of the secondary outcomes of the medicine, such as reduction of acne , hirsutism (excess hair on a woman’s body) and hair loss in cases of androgenic alopecia have led many doctors to prescribe it in these cases.
How does flutamide work?
The androgenic hormones (such as testosterone) have several functions in the human body, such as the formation of male sexual characteristics in the fetus changes boys go through during puberty, regulating the prostate function, mass muscular, among others.
To make these changes, hormones need to connect to androgen receptors on cells. When this connection occurs, the cell begins to do what the hormone determines.
Flutamide is part of the class of drugs that block the androgen receptor , binding to these receptors instead of hormones, preventing them from performing their functions in cells.
In the case of prostate cancer, these hormones can stimulate tumor growth. Treatment with flutamide blocks this effect, helping to control the spread of the disease.
Why does flutamide work for hair loss?
When flutamide treatment is carried out in a systemic way (as in the case of tablets, which act within the body), its action is not limited to the prostate: it also affects various cells in other parts of the body.
Because of this, other problems that are caused or aggravated by the action of androgens, such as acne and hirsutism, can also benefit from the action of the drug.
By acting directly on the androgen receptors in cells, flutamide has the power to reduce the effects of all hormones of that class in the body, especially testosterone and its more potent version, dihydrotestosterone (or DHT ), which is the main culprit for androgenic alopecia (some of the other drugs traditionally used in the treatment of alopecia, such as finasteride , only inhibit the action of DHT).
What are the risks of flutamide?
The problem with systemic treatment with flutamide is exactly that it is not selective. As we have said before, androgen hormones are important for a variety of functions. When the action of these hormones through the body is reduced (rather than just in the area where they are causing problems), this can lead to undesirable side effects.
Some of the possible adverse reactions listed in the flutamide package insert are gynecomastia (abnormal growth of the breasts in men), reduced sperm, decreased libido (sexual desire), depression, lack of energy and anxiety.
But the biggest controversy related to flutamide has to do with the damage it can cause to the liver . In most cases the effects of the medicine on liver functions normalize with reducing the dose or stopping treatment, but very serious problems have occurred.
In 1999, the flutamide labels worldwide were modified to include the occurrence of rare cases of severe liver toxicity. In October 2004, a warning about the risks of flutamide was issued after reports of five cases of fulminant hepatitis in young women who used the drug (four of whom died).
Due to these risks, doctors prescribing flutamide must carefully monitor and regularly check the liver health of patients throughout treatment and, in the event of any complications, be able to take the necessary measures as soon as possible.
Flutamide for women
The fact that androgenic hormones are more important in boys than in girls (although they are also produced in small amounts by women) suggests that the use of flutamide in the treatment of acne, hirsutism and hair loss with a genetic background and hormonal could be well tolerated in women (thesis that is reinforced by some studies 1 – 2 ).
The problem is that these hormones are essential if a pregnancy occurs , which is particularly worrying if the fetus is male, because flutamide could impair its formation. On the other hand, it is possible that the drug affects breast milk during lactation.
The package insert says that no studies have been conducted in pregnant or lactating women, and only recommends the use of flutamide in men. Treatment in women is also considered off-label and is usually only done when there is no longer any chance of getting pregnant (such as after menopause) or in patients who are on strict birth control.
To avoid the effects of flutamide on the liver and other parts of the body, the ideal would be to apply it only in the area where you want it to act (in the case of hair loss, it would be at the level of the hair follicles , the units where the hairs they are produced).
The challenge for the pharmaceutical industry is to produce a formulation to apply flutamide topically (on the surface of the scalp, through creams, lotions, shampoos or other products) and ensure its absorption at the level of the follicles without it entering into the bloodstream to significant levels that eventually produce effects in the rest of the body
A study carried out in human tissues transplanted into mice has shown that flutamide and finasteride gel are capable of stimulating the recovery of hair follicles. But there is still no formula that has been properly tested and that has been shown to be effective and safe in humans (ensuring that the absorption of the drug by the rest of the body is low), approved by regulators, produced on a commercial scale and that it is sold in pharmacies.
Flutamide is a powerful anti-androgenic substance, with proven effect and can be valuable in the treatment of problems caused by an excess of male hormones, including androgenic alopecia , especially since it is possible to use it in a direct localized way in hair follicles and with little systemic absorption .
This is important because, although many people who are on flutamide do not experience side effects, the risks are extremely serious and worrying (and, of course, any effort to combat baldness should not take precedence over our health care).
The most important point that you should be clear about now is that flutamide should never be taken on your own . Do not use it “because my neighbor told me to”, “because my cousin uses it and her hair stopped falling out”, or “because I read on the Internet”. The only person responsible for prescribing and monitoring this type of treatment is a doctor.
While the ideal formula for topical flutamide does not reach our pharmacies, it is best that you evaluate all other treatment options available for the genetic baldness – including options such as the finasteride , minoxidil and ketoconazole – and plan your system to fight the fall of the hair consciously and safely.
Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.