Flutamide can be used to treat hirsutism

Information on hirsutism and hair removal treatments
Cosmetic hair removal
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Finasteride
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Spironolactone
Flutamide
Cyproterone acetate
Eflornithine
Ketoconazole
GRH analogs
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Flutamide for Hirsutism

Flutamide is a non-steroidal and pure androgen antagonist that was originally used for the treatment of prostate cancer, as recognized by the Food and Drug Administration. Later it has also been identified as an effective therapy for hirsutism, which is the production of excess and unwanted hair in male-like pattern in women.

Activities of flutamide

The anti-androgenic action of flutamide includes:

  • Blocking of the androgen receptor. Unlike spironolactone, flutamide blocks androgen receptors without any glucocorticoid, progestational, androgenic or estrogenic activity.
  • Intervention of cellular uptake of androgens like testosterone and DHT
  • Improves androgen metabolism to inactive compounds
  • Restrains nuclear binding of androgen in target tissues

Effectiveness and dosage

For best results on hirsute cases, flutamide should be administered in daily doses of 500 mg. However, a single daily dose of 250 mg has also proved effective in some patients. Another report has also suggested that the ideal dosage for hirsutism is generally 125 to 250 mg, twice a day.

While comparing with other androgen blockers, researchers have concluded that whereas cyproterone acetate (CSA) is a partial androgen agonist, flutamide is a pure anti-androgen and is twice as powerful as CSA in suppressing the androgenic activities of DHT on rat ventral prostate gland. One study has also found flutamide to produce better therapeutic results when compared to spironolactone in the treatment of hirsutism, whereas some others have reported equal potency of the two.

Side effects

The disadvantages of this drug include foul urination, extreme dry skin and hair scalp, reduced libido, heightened appetite, liver enzyme disorders, and, rarely, lethal hepatotoxicity. In fact, its unpopularity as an androgen blocker is entirely because of its rare but serious side effect of potentially deadly hepatotoxicity. Moreover, it is an expensive treatment too.

Modern research suggests the administration of lower doses of flutamide in hirsutism treatment in order to reduce costs and chances of hepatotoxicity.

In one such survey conducted on 35 hirsute females, flutamide used in a daily dose of 250 mg for 6 months resulted in a 64 percent reduction in the Ferriman–Gallwey (F–G) scoring system of hirsutism and 71 percent after therapy for a year. The best news was that there were no cases of hepatotoxicity and marked side effects either.

Simultaneously, the same survey was conducted with lower daily doses of the drug on many more hirsute patients. They too came up with similarly effective decrease in unwanted and excess hair production after 3 and 6 months of therapy with 125 mg and 62.5 mg of medication. Again, there were no reports of considerable side effects. Some other clinical investigations however mentioned side effects like dry skin and discolored urine.

In hirsute cases with polycystic ovarian syndrome, continued flutamide doses of 500 mg daily for 2 years did not result in major side effects either. This survey noticed substantial improvement of F–G scores after 6 months of treatment and a progressive decline during another 18 months of treatment.

Combination therapy

Combination of flutamide with other drugs has also worked well on hirsute women with polycystic ovary syndrome (PCOS). For instance, a treatment that combined a daily dose of 250 mg of flutamide a day with a monthly GnRHa (Gonadotrophin Releasing Hormone Agonists) injection, administered on 35 females with PCOS for a period of 6 months, proved highly effective in decreasing F–G scores. The lower hirsutism count continued for 6 months after stopping this combined GnRHa and flutamide medication. Moreover, the only noticeable side effect was hot flashes.

Acne treatment with flutamide

Flutamide has also worked well in acne cure. For treatment of mild to moderate acne, it is sufficient to administer lower daily doses of 62.5 and 125 mg of flutamide for beneficial results.

Even in case of acne cure, it is often suggested that a combined medication involving an oral contraceptive pill (OCP) is more effective than a dose of flutamide alone.

Other comparative studies reported that a higher dose of flutamide (500 mg a day) reaped better results in curing acne than a 100 mg daily dose of spironolactone in patients with PCOS. Moreover, there was no incidence of fatal hepatotoxicity with a usage of less than 500 mg a day of flutamide. However, mild, transient hepatotoxicity occurred in patients using daily doses ranging from 375 to 500 mg.

The expenses involved in flutamide treatment can also be lessened while ensuring the desired results, even when a patient is administered 25 percent of the usual daily dose (i.e. 62.5 mg instead of 250 mg).

But, one must be aware of the adverse effects regarding the normal development of a male fetus (teratogenic potential) caused by flutamide use. This can be managed with the simultaneous use of safe and suitable contraceptives.


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