Spironolactone versus Bicalutamide for Female Pattern Hair Loss: A 24-Month Unicenter Retrospective Comparative Study of Effectiveness and Safety

This study compared the effectiveness and safety of spironolactone and bicalutamide in treating female pattern hair loss (FPHL) over 24 months in 187 women. Both medications significantly improved Sinclair grades, but spironolactone, especially at doses over 100 mg/day, was more effective, with 54.4% of users achieving at least a 1-grade improvement compared to 37.3% for bicalutamide. While both drugs had similar adverse event rates, bicalutamide required more frequent monitoring due to laboratory abnormalities. The findings suggest spironolactone as a potentially superior first-line systemic treatment for FPHL.