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Dr Richard Lee, MD answered: "Flutamide: As you are, I am also very interested in the potential benefits of topical flutamide as a treatment for MPB. Since flutamide blocks the androgen receptor sites to DHT and testosterone, the pharmacological properties of flutamide would be ideal in preventing the pathophysiologic pathway of MPB, especially since it has become apparent that it is not DHT alone that initiates atrophy of the susceptible hair follicles on the scalp. Flutamide is a very potent anti-androgen, but it can have very serious, even life-threatening, side effects. For instance, oral flutamide has been associated with deaths due to liver failure. Among the other side effects, which have been reported with oral flutamide, are gynecomastia, loss of libido, impotence, diarrhea, hypertension, drowsiness, confusion, depression, anorexia, anemia, thrombocytopenia (easy bruising) and edema. Consequently, I will not prescribe or dispense topical flutamide until I have sufficient assurances from reliable scientific sources that it can be used safely and effectively as a topical medication in treating MPB. You have probably read the abstract by Dr. Sintov, which is posted at http://www.bgu.ac.il/IAR/Amnon-3.htm.

Dr. Sintov's work is very impressive and very promising. However, the studies were performed on mice with transplanted patches of bald human scalp. There have not been any human studies, so we have no idea of the proper dosage or dosing schedule. Moreover, a lack of change in the serum levels of testosterone and DHT is no indication of its safety. Flutamide blocks the androgen receptor site and is not expected to alter the serum levels of the hormones. Meanwhile, tissues dependent on the male hormones may be deprived of their normal function because the receptor site is blocked. Spironolactone: A spironolactone cream without an offensive smell sounds like an oxymoron. Spironolactone has an intrinsic smell that has been favorably compared to sewer gas. I have not been able to effectively mask or eliminate the odor without significantly altering its beneficial pharmacological effects. If you find a solution (no pun intended), I'd love to hear of it."