Bicalutamide is another medication sometimes used in gender-affirming care, particularly for transgender women (assigned male at birth) or those with androgen-dependent conditions. It is a nonsteroidal anti-androgen that competitively inhibits the action of androgens like testosterone. While it can be effective in suppressing testosterone levels and aiding in feminisation, it’s important to be aware of potential unwanted/adverse/side effects. Here are some of them:
| Side Effect | Description |
| Liver function abnormalities | Bicalutamide may cause liver toxicity, including elevated liver enzymes. Periodic monitoring of liver function through blood tests is recommended during treatment. |
| Breast tenderness and enlargement | Similar to other anti-androgen medications, bicalutamide can cause breast tenderness and enlargement due to its suppression of testosterone and promotion of estrogenic effects. |
| Hot flashes | Some individuals may experience hot flashes or flushing as a side effect of bicalutamide treatment. |
| Gastrointestinal issues | Bicalutamide can cause gastrointestinal symptoms such as nausea, vomiting, diarrhea, or stomach discomfort in some individuals. |
| Decreased libido | A decrease in libido (sex drive) can occur as a side effect of bicalutamide treatment due to its anti-androgenic effects. |
| Erectile dysfunction | Bicalutamide may cause erectile dysfunction or difficulty achieving/maintaining erections in individuals assigned male at birth. |
| Fatigue | Some users may experience increased fatigue or feelings of lethargy while taking bicalutamide. |
| Muscle weakness | Weakness or decreased muscle strength can occur as a side effect of bicalutamide treatment. |
| Thromboembolic events | While less common, there is a risk of thromboembolic events (such as blood clots) associated with bicalutamide use, particularly in individuals with other risk factors for thrombosis. |
| Osteoporosis | Long-term use of bicalutamide can potentially increase the risk of osteoporosis due to decreased bone density. Bone density monitoring and supplementation with calcium and vitamin D may be recommended. |
| Mood changes | Some individuals may experience mood swings, depression, or changes in emotional well-being while taking bicalutamide. |
| Rare allergic reactions | Although rare, some individuals may experience allergic reactions to bicalutamide, including rash, itching, swelling, or difficulty breathing. Immediate medical attention is necessary if any signs of an allergic reaction occur. |