Just my occasional reminder that Bica is about 3x as potent as spironolactone per MG for doing the same job, and that I continue to not have any safety or other problems with the drug. Not even "interstitial lung disease"!

I remember being told how I was going to be sued many years ago, and how terrible it was, and so on.

Many docs simply don't realize all the "complication" case reports are in elderly men with metastatic prostate cancer on doses 200-600mg a day of the drug.

Giving people 50mg a day is like giving someone 1mg of Adderall and expecting them to have a heart attack from it.

I have pulled 3 people off the drug in 10 years for elevated liver transaminases.

Two of them were due to massive weight loss, which I did not know at the time could cause transient ALT/AST bumps. That was a fun fact to learn. These are people who dropped 60 lbs in 120 days. It was insanity, but impressive.

Another had some sort of viral syndrome and after resolution, enzymes normalized.

All were re-introduced to the drug afterwards, and continued to have no issues whatsoever.

I'm working on 2 papers at the moment (and informally a third in regards to the 6p21 thing) and so I've got a bit on my plate for doing more publications, but at some point I will get around to trying to clear Bicalutamide's reputation. At low doses, it is basically a side effect free version of spironolactone with triple the potency per mg. It is also basically curative for females with hormonal acne (though it is critically important they use two forms of contraception as if they get pregnant (which it can increase the likelihood of in a hirsute woman with irregular periods) a male fetus would be born with a vagina. It is that potent at doing its job.

In short, Bicalutamide remains my preferred anti-androgen, and I continue to use it with impunity and have had nobody suffer consequences of that in a decade.

(Addendum: I don't write it for anyone who has a known hepatic problem, so no chronic hep/b/c, alcoholism, etc. You only get it if you have a healthy liver at baseline. You need your liver to live, it's why its called the liver).

(Addendum 2: I will admit I've had patients stop the drug for other reasons. One patient it gave headaches to and we could never figure out why, spironolactone did not, though BP was normal. Other patients I had to stop it because my other methods of MTF HRT basically nuked their androgens so well that blocking their tiny levels of androgens was not beneficial to them from a cognitive and sexual function standpoint, basically, it was no longer needed. Taking Bica at 25-50mg when you have next to no androgens can cause some brain fog/memory issues/sexual dysfunction and I don't recommend it once all androgen labs are low-female range. Other than that, I have had no other unfortunate side effects from the drug that I can remember over 10 years).