Rare instances of liver toxicity/damage have been reported with this medication and it is therefore recommended to monitor your liver enzymes (ALT/AST) once a year.

Bicalutamide

Seller Product Price Single $/50mg Bulk $/50mg Stock Notes
Pharmacy-House Bicalutamide 150mg x 30 $85.48 $0.95 $0.93 Yes
TeaHRT Bicalutamide 50mg x 100 $85.00 $0.85 $0.90 115 days ago
Bulgarian Online Pharmacy Bicalutamide Accord 50mg x 30 £25.00 $0.83 $0.83 Unknown
Pilloid Bicalutamide Cannon 50mg x 30 $38.75 $1.29 $1.29 Unknown
Pilloid Bicalutamide Teva 50mg x 28 $43.94 $1.57 $1.57 Unknown
Medicina Mexico Bicotexida 50mg x 28 $106.00 $3.79 $3.79 Unknown
Medicina Mexico Bilumiv 50mg x 28 $150.00 $5.36 $5.36 Unknown
Inhouse Pharmacy Binarex 50mg x 28 $66.00 $2.36 $2.36 Unknown
United Pharmacies (NL) Calutide 50mg x 10 €20.85 $2.08 $1.94 No
United Pharmacies (US) Calutide 50mg x 10 $23.02 $2.30 $2.14 Yes
United Pharmacies (UK) Calutide 50mg x 10 £18.93 $1.89 $1.76 Yes
4NRX Pharmacy Calutide 50mg x 10 £18.56 £1.86 £1.86 No
Inhouse Pharmacy Calutide 50mg x 30 $82.50 $2.75 $2.75 Unknown
ReliableRx Pharmacy Calutide 50mg x 30 $59.63 $1.99 $1.99 Yes
AllDayChemist Calutide 50mg x 30 $59.63 $1.99 $1.99 Yes
United Pharmacies (UK) Casodex 150mg x 28 £81.05 $0.96 $0.96 No
RxAisle Casodex 150mg x 28 $59.00 $0.70 $0.59 Unknown
4NRX Pharmacy Casodex 150mg x 28 £79.43 £0.95 £0.95 No
United Pharmacies (US) Casodex 150mg x 28 $99.90 $1.19 $1.19 No
Dragon Ordnance Casodex 150mg x 28 $85.00 $1.01 $1.01 Yes
Favskinhouse Casodex 50mg x 28 $58.00 $2.07 $2.07 Unknown
Dragon Ordnance Casodex 50mg x 28 $25.00 $0.89 $0.89 Yes
Silhouette Beauty Casodex 50mg x 28 €38.50 $1.38 $1.38 Unknown
RxAisle Casodex 50mg x 28 $59.00 $2.11 $1.77 Unknown
DashPCT Castramid 50mg x 10 $11.00 $1.10 $1.10 Yes
United Pharmacies (UK) Procalut 50mg x 28 £24.98 $0.89 $0.83 No
United Pharmacies (US) Procalut 50mg x 28 $30.38 $1.08 $1.01 No
4NRX Pharmacy Procalut 50mg x 28 £24.48 £0.87 £0.87 No
Otokonoko Pharmaceuticals Bicalutamide 50mg x 50 $50.00 $1.00 $1.00 115 days ago This seller is currently suffering delays

Info

Bicalutamide functions as an anti-androgen by competing with testosterone and blocking its activity at the androgen receptor. While it is commonly prescribed as an anti-androgen, its usage is less common within the United States.

Dosing

Dose Amount Per Day Amount Every Other Day
Minimum 25mg daily 50mg bi-daily
Typical Starting 50mg daily 100mg bi-daily
Maximum Dose 50mg daily 100mg bi-daily
Maximum Safe 100mg daily 200mg bi-daily
  • There is no reason to go above the maximum dose when taken in conjunction with estrogen.
  • Some people use bicalutamide mono-therapy, information on the topic can be found here.

Monitoring

Adjusting bicalutamide dose from the starting dose is typically not needed, however there are some blood tests you should monitor.

Liver AST/ALT

Liver tests should be done at least six months after starting and once a year after, and it can be afforded three months in, six months in, and every six months after.

AST Normal Ranges: 8-33 U/L (Cleavland Clinic).
ALT Normal Range: 7-56 U/L (Cleavland Clnic).

Ranges on liver tests can vary significantly depending on demographics, however if out of range discontinue the medication and consult with a doctor (in these situations switching to injection monotherapy might be best).

Testosterone

Bicalutamide does not decrease blood levels of testosterone and may actually cause them to increase as the body tries to compensate for the reduction of androgen receptor activity. This is not a cause for concern. (Randolph John, 2018).

Safety and Effects

Bicalutamide and Liver Toxicity

These symptoms can be a major sign that you are experiencing a acute problem with your liver, if you are experiencing these please see a doctor:

  • Yellowing of the skin and eye whites (jaundice)
  • Abdominal pain in the upper right portion of the abdomen
  • Dark or tea-colored urine.

This list is not conclusive however these signs are serious indicators of liver issues (others are detailed in the source) Mayo Clinic.

The risk for liver toxicity in prostate cancer patients is small (one in four thousand); this risk of liver toxicity in transgender patients taking a much smaller dose as an anti-androgen is undoubtedly significantly lower, but this risk has not been studied. If possible, doing a liver panel after long-term use of bicalutamide is a good idea. (Aly 2020).