Flutamide

Flutamide is a nonsteroidal antiandrogen. It has been administered to transgender women in a number of studies/publications. It has been evaluated in the treatment of androgen-dependent conditions like acne, seborrhea, hirsutism, alopecia, and hyperandrogenism (e.g., due to polycystic ovary syndrome) in cisgender women in over 100 clinical studies. It is used for the treatment of hirsutism at dosages ranging from 62.5 mg/day to 500 mg/day and both alone and in combination with oral contraceptives. The overall quality of the evidence for hirsutism is regarded as moderate. Flutamide may be more effective than other antiandrogens like spironolactone, cyproterone acetate, and finasteride for this indication.

Flutamide has a relatively high risk of elevated liver enzymes and hepatotoxicity and has been associated with many cases of severe hepatotoxicity, including deaths. The risk is substantially higher than with other nonsteroidal antiandrogens like bicalutamide and nilutamide. Because of its high risk of hepatotoxicity, flutamide has been recommended against for the treatment of androgen-dependent conditions like acne and hirsutism in cisgender women.

Low or ultra-low doses of flutamide have been reported to lack hepatotoxicity. However, other studies have had very different findings. In addition, many case reports of severe hepatotoxicity at low or ultra-low doses exist, including deaths.