Flutamide

What it is

Flutamide is a non-steroidal drug that blocks the androgen receptor. The US label (Eulexin capsules) is for prostate cancer used with an LHRH agonist, and it carries a boxed warning for liver injury, including fatal liver failure. Eulexin label It is prescription-only and off-label for hair.

What the studies show

• Oral, women (48 women, 1 year, randomised but unmasked): hyperandrogenic premenopausal women received flutamide 250 mg, cyproterone acetate 50 mg with ethinyl estradiol, finasteride 5 mg, or nothing. Only flutamide moved the Ludwig score (a 21% reduction); the other treatments were not significant, and the authors suggest longer treatment might be needed. Carmina 2003
• Topical (40 patients, 6 months, double-blind): 5% minoxidil plus 2% flutamide beat minoxidil alone for density, thickness and satisfaction (p<0.05). It was a small, single-centre study. Faghihi 2022

Side effects and safety

• Boxed warning (liver): liver failure, sometimes fatal, with about half of cases arising in the first 3 months. The label advises liver tests before starting and monthly for four months, and stopping for jaundice or ALT above twice the upper limit of normal. Eulexin label
• Pregnancy: listed as pregnancy category D (fetal harm). Eulexin label
• A 2025 Canadian Delphi consensus of 11 physicians (some co-authors work for L'Oreal Canada) listed flutamide among 17 interventions it does not recommend for pattern hair loss. Landells 2025

Bottom line

The evidence is thin: one small unmasked trial and one small topical trial. The liver risk makes oral flutamide a poor trade for a condition that is not life-threatening, especially now that spironolactone exists. Topical flutamide is experimental, with no approved product and no long-term data. It is not for men, and not for anyone who could become pregnant without contraception. Discuss with a doctor.