I've been taking flutamide for a year now, along with Yasmin and 5% minoxidil, since yasmin alone did nothing for my acne and hair loss. My face has been great since then. As for the hair... the first few months were amazing, really the shedding completely stopped, I would have only several hairs on the hair brush after brushing. And then some time this spring it all came back. My hair has been falling out even worse than before. I went to see my gyno again, who prescribed me flutamide in the first place, but he told me that there is no way flutamide is making me shed hair, and there must be some other cause. He told me to consult my dermatologist about it, but she just prescribed me some other brand of minoxidil... all completely useless.
And now the latest development is that I seem to have hyperthiroidism. I've had trouble with shortness of breath for a few weeks, and I've run a lot of tests, and I seem to have too much T4. This was never the case with me before, and I had my last thyroid test about a year and a half ago.
Has this happened to anyone else?
I have yet to see my doctor and ask him if he thinks it could be caused by flutamide, but I have a feeling he'll say no. I've googled high and low and there doesn't seem to be a mention of flutamide having anything to do with thyroid issues... :/
check out the dosages of Flutamide in this study that showed it was an effective anti androgen and helped with hair issues.
The study dosage seems to be quite a bit higher than any of you ladies seem to be on.... just a thought as to why it might not be working that well for you.
Quote:
METHODS: Forty obese women with PCOS were enrolled in the study. After a 1-month diet, according to single-blind design, the patients were allocated to treatment with placebo, metformin (850 mg/orally, twice daily), flutamide (250 mg/orally, twice daily) or metformin (850 mg/orally, twice daily) + flutamide (250 mg/orally, twice daily) for the following 6 months, while continuing hypocaloric dieting. At baseline and at the end of the study, sex hormone, SHBG, lipid, insulin and insulin sensitivity determinations were evaluated. At the same time, clinical parameters such as anthropometry, total (TAT), visceral (VAT) and subcutaneous (SAT) adipose tissue, hirsutism and menses were also measured. RESULTS: We found that, in obese PCOS women, following a hypocaloric diet the addition of metformin, flutamide or the combined metformin + flutamide treatment had some specific additional favourable effects with respect to the low-calorie diet alone. In particular, flutamide treatment seemed to add a significant effect in decreasing visceral fat, androstenedione, DHEA-S, total and low density lipoprotein (LDL) cholesterol and in improving hirsutism. Conversely, metformin had significant benefits on the menstrual status. The two drugs showed an additive effect in reducing testosterone concentrations and a synergistic effect in increasing high density lipoprotein (HDL) cholesterol and SHBG levels. Improvement of insulin sensitivity and hyperinsulinaemia appeared to depend on hypocaloric diet, without any further significant effect of the pharmacological treatments, either alone or in combination. CONCLUSIONS: We conclude that, in obese PCOS women, following a hypocaloric diet the addition of metformin, flutamide or the combined metformin + flutamide treatment appears to have a more favourable outcome on body fat distribution, androgens, lipids, hirsutism and menses. However, our data emphasize the dominant role of hypocaloric dieting in improving insulin resistance and hyperinsulinaemia. Therefore, this study provides a rationale for specifically targeting different therapeutical options for PCOS according to the required outcomes.
Last edited by Deb34; 09-23-2008 at 07:00 PM.
Reason: adding a quote
check out the dosages of Flutamide in this study that showed it was an effective anti androgen and helped with hair issues.
The study dosage seems to be quite a bit higher than any of you ladies seem to be on.... just a thought as to why it might not be working that well for you.
Great study, but don't overlook this line from the end:
Quote:
However, our data emphasize the dominant role of hypocaloric dieting in improving insulin resistance and hyperinsulinaemia.
Also of interest (not hair related, but interesting)
Quote:
In particular, flutamide treatment seemed to add a significant effect in decreasing visceral fat (aka belly fat)
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I don't know about others but I am on 250mg flutamide a day. (But I don't take metformin cos I have no IR and I have no weight issues, just acne and pretty bad hair loss)
I have noticed some weight loss since I've been on flutamide, about 2-3kg, nothing significant. Don't know if it's because of flutamide or not.
the dose of flutamide in the study was 250mg twice per day= 500mg/day....
Also, Kat I didn't emphasize the diet aspect of the study because I was mainly thinking of Flutamide in relation to the hairloss issue, not necessarily focusing on the Metformin which addresses the insulin issues.
Flutamide does not affect the insulin levels as remarked in this study:
In addition to the reproductive consequences, polycystic ovary syndrome (PCOS) is characterized by a metabolic disorder in which hyperinsulinemia and insulin resistance are central features. The effects and possible benefits from insulin-sensitizing drugs are not well known, especially in non-obese women with PCOS. This study was designed to evaluate the effects of metformin and flutamide on metabolic parameters and insulin resistance in non-obese women with PCOS. Thirty non-obese women newly diagnosed with PCOS and 15 age- and weight-matched healthy volunteers as controls were included in the study. Patients were assigned randomly to receive flutamide 250 mg daily or metformin 850 mg three times daily. Glucose, insulin, insulin resistance, androgen levels and glucose and insulin responses to an oral glucose tolerance tests (OGTT) were assessed before and after a 4-week therapy period. A positive correlation was found between body mass index and insulin level in patients with PCOS and controls. Follicle stimulating hormone, luteinizing hormone, free testosterone and dehydroepiandrosterone sulfate levels decreased significantly, but insulin resistance levels were not changed after flutamide therapy. Body weight, free testosterone, insulin and insulin resistance levels decreased significantly after metformin therapy. In conclusion, metformin treatment improved insulin sensitivity and decreased androgen levels, and flutamide decreased androgen levels but failed to improve insulin sensitivity in the non-obese women with PCOS.
PMID: 15697072 [PubMed - indexed for MEDLINE]
These two drug works synergistically but have different actions on different hormone systems.... this is so incredibly interesting isn't it...
Most docs prescribe 250 mg /day. I am on 250 day too. There are studies attesting that this is enough. 125 mg/day is used as a mantainance therapy.
Quote:
OBJECTIVE: To investigate the effects of low dose flutamide (250 mg/d) on hirsutism score and hormone levels in women with hirsutism. DESIGN: Nonrandomized, prospective clinical trial. PATIENTS: Forty-one patients with moderate-severe hirsutism were included in the study. INTERVENTION: Hirsute patients received 250 mg/d flutamide for a period of 6 months. MAIN OUTCOME MEASURES: Hirsutism score, FSH, LH, E2, total T, free T, androstenedione, DHEAS, PRL, 17-hydroxyprogesterone, and sex hormone-binding globulin levels were detected in all the patients before treatment and every 3 months during treatment. RESULTS: Treatment with the antiandrogen flutamide resulted in a particularly rapid and marked decrease in the hirsutism score, which decreased from 17.48 +/- 5.35 to 5.07 +/- 2.89 after 6 months. No significant changes in the levels of hormone and no serious side effects were observed in the study. CONCLUSION: The low-dose flutamide, 250 mg/d, is a cost-effective drug in the treatment of hirsutism. Low-dose flutamide may be used in place of high-dose flutamide, 500 to 750 mg/d.
I don't recall what my dose was for, but more than likely, it was the lowest possible. Back when I took it, VERY, VERY few doctors woud Rx it for women, and it was nearly unheard of for the treatment of hirsutism in pcos. Literally, doctors thought I was crazy for asking them to consider it.
That's why it's important to read research studies. Finding that obscure french study on flutamide being used to treat hirsutism in women changed my life. Once I knew what to look for, I was able to compile a very good list of studies for my doctors to look at (and I finally found one who did his own research on top of that.) But the previous SEVEN doctors wouldn't even consider Rx'ing for me.
Later, I was quoted in articles mentioning that flutamide is what I took, and some of the top pcos experts were also quoted and arguing that flutamide had no place being rx'd for women.
10 years later...it's all turning around...
Eta
It's certainly not the right option for 'everyone', but it is an option, for sure.
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to me a treatment dosage and a maintenance dosage are two different animals for two entirely different purposes.
Treatment doses are almost always higher to bring the symptoms well under control and consistenly for a good period of time.
If a persons symptoms(for which they are taking a medication) are never brought under good control and have been eliminated for a consitent time period, I would have to question whether the original treatment dose was high enough to be effective at all. Resolution of symptoms says to me that the dose is effective. Non-resolution says to me that the dose is too weak to have the intended effect.
I would only consider lowering to a maintenance dose when resolution of symptoms has been achieved.
A sufficient maintenance dose would be enough to prevent the symptoms from returning and requiring re-treatment at higher doses.
JMO, but why bother taking a medication at all if it's not resolving your problems? I would at least consider trying a higher dosage to see a possible change in symtoms before I would keep taking a dose that appears to not do anything....
My personal case in point:
When i first started Spiro 18 years ago, the accepted dosage was 50mg /day for women, and the doctors really thought they were going out on a limb even at that dose.
It's almost two decades later and I believe it's common practice for Spiro to be prescribed at 200mg/day and possibly more. Why? because it was found that the dose that was thought to be effective was as useless as taking nothing for most women. Actual resolution of symptoms sometimes requires doctors to revise their thinking and face the reality that a study approved dosage may not always be the effective dosage. The dose that gets rid of the symptoms is the right dosage, whatever that dosage may be for each individual woman.
If a persons symptoms(for which they are taking a medication) are never brought under good control and have been eliminated for a consitent time period, I would have to question whether the original treatment dose was high enough to be effective at all.
The other question is, "Was this the appropriate medication for that particular patient.
Another could be, "Was the patient compliant with other measures to resolve the problem?"
Quote:
Originally Posted by Deb34
Treatment doses are almost always higher to bring the symptoms well under control and consistenly for a good period of time.
I can't speak for anyone else, but I'm very cautious when it comes to meds. Especially meds that are off-label usage.
My preference is to take the lowest dosage possible to address the symptoms AND to do whatever I can via lifestyle efforts so I can eventually come 'off' of the meds (if coming off is a possibility)
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The dose that gets rid of the symptoms is the right dosage, whatever that dosage may be for each individual woman.
Yes, that's true. But the problem is that Flutamide kind of puts the liver in danger. And we, cysters, have the tendency to get a fatty liver very easy...so that's why upping the dose is easier said than done.
My shedding improved greatly with adding Yasmin to Flutamide. I did that because I read a study (that I also posted here) that Yasmin lets Flutamide work better.
In other words, althoughdrospirenone itself (as used in fourth-generation OCs) may notbe a clinically relevant anti-androgen (Ibáñezet al., 2004b), it seems to be a progestin that, in contrastto gestodene, allows flutamide to exert its anti-androgen actions.
The other question is, "Was this the appropriate medication for that particular patient.
Another could be, "Was the patient compliant with other measures to resolve the problem?"
Quote:
Originally Posted by Deb34 Treatment doses are almost always higher to bring the symptoms well under control and consistenly for a good period of time.
I can't speak for anyone else, but I'm very cautious when it comes to meds. Especially meds that are off-label usage.
My preference is to take the lowest dosage possible to address the symptoms AND to do whatever I can via lifestyle efforts so I can eventually come 'off' of the meds (if coming off is a possibility)
I completely agree for myself Kat. For a prescribed treatment to work, usually all relevant factors must work together. Diet included.
It's not very realistic to expect that every woman will be completely compliant about all the factors that can contribute to treatment. Usually, in my experience as a woman, it's easier to be compliant with medications than it is to be totally compliant with a diet. How many women can stick to a restrictive diet even for short periods. So, yes, in a semi-perfect world we would all comply with all the factors deemed necessary part of treatment. In the real world, if someone will comply with even part of the treatment, doctors will take what they can get. I know myself have a very hard time with the diet part of my treatment plan....I rarely get it right for long periods of time.. if we we all compliant all the time with everything we are instructed to do, maybe most of us would not need the support of a forum like this (which, BTW i am extremely grateful for.)
Everyone has to put their own reasoning and decision making to the test in regards to the treatment plan they put into place. All the rest of us can do is make suggestions, propose new ideas to follow for investigation etc.
I would only say that we should all do what's right for each of us, we all have a different comfort threshold when it comes to medications, surgeries, foodplans etc.
It's not very realistic to expect that every woman will be completely compliant about all the factors that can contribute to treatment. Usually, in my experience as a woman, it's easier to be compliant with medications than it is to be totally compliant with a diet. .
No one said anything about expecting 'every' woman to be 'completely' compliant with 'all' factors that can contribute to treatment.
That said, going back to the original point:
In evaluating whether or not the 'dose' is the 'right' dose, compliance of the patient in other lifestyle areas should be examined.
As has been pointed out, flutamide raises liver issues, and it might not be in the best interest of the patient to Rx a high dose when they aren't making an effort in the lifestyle areas - especially if they already have liver problems.
I'm not a big fan of 'all or nothing'...my preference is to work with a medical team that looks at the entire picture, rather than just giving me a pill 'at the higest does' - especially if that pill simply 'blocks' symptoms, rather than works to 'eliminate' them.
Just as a side note, the doctor who Rx'd Flutamide for me said that I 'had' to be compliant with some specific lifestyle changes while on the drug or she would take me off of it. Drinking alcohol was an absolute 'no' in her book. While it may have been 'unrealistic' for some people to comply with that rule...that was the rule.
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