The side effect profile of<unk>  is highly dependent on sex; that is, on whether the person is male or female. In men, due to androgen deprivation, a variety of side effects of varying severity may occur during<unk>  treatment, with breast pain/tenderness and gynecomastia (breast development/enlargement) being the most common. Gynecomastia occurs in up to 80% of men treated with<unk>  monotherapy, though is of only mild-to-moderate severity in more than 90% of affected men. In addition to breast changes, physical feminization and demasculinization in general, including reduced body hair growth, decreased muscle mass and strength, feminine changes in fat mass and distribution, reduced penile length, and decreased semen/ejaculate volume, may occur in men. Other side effects that have been observed in men and that are similarly related to androgen deprivation include hot flashes, sexual dysfunction (e.g., loss of libido, erectile dysfunction), depression, fatigue, weakness, and anemia. However, most men have preserved sexual function with<unk>  monotherapy. In females, due to the minimal biological importance of androgens in this sex, the side effects of pure antiandrogens or are few, and<unk>  has been found to be very well tolerated. General side effects of<unk>  that may occur in either sex include diarrhea, constipation, abdominal pain, nausea, dry skin, itching, and rash. The drug is well tolerated at higher dosages than the 50 mg/day dosage, with rare additional side effects.<unk>  monotherapy has been associated with abnormal liver function tests such as elevated liver enzymes in 3.4% of men relative to 1.9% for standard care. Hepatic changes such as marked increases in liver enzymes or hepatitis that necessitated discontinuation of<unk>  have occurred in approximately 0.3 to 1% of men in clinical trials. Monitoring of liver function during treatment is recommended, particularly in the first few months. In men of advanced age with prostate cancer,<unk>  monotherapy has been associated with an increase in non-prostate cancer mortality, in part due to an increase in the rate of heart failure. These mortality-related effects are thought to be a consequence of androgen deprivation, rather than a specific drug-related toxicity of<unk> . There are 10 published case reports of liver toxicity associated with<unk>  as of 2021. Death occurred in 2 of these cases. Symptoms that may indicate liver dysfunction include nausea, vomiting, abdominal pain, fatigue, anorexia, "flu-like" symptoms, dark urine, and jaundice. There are also published case reports of interstitial pneumonitis or eosinophilic lung disease associated with<unk> . Interstitial pneumonitis can potentially progress to pulmonary fibrosis and may be fatal. Symptoms that may indicate lung dysfunction include dyspnea (difficult breathing or shortness of breath), cough, and pharyngitis (inflammation of the pharynx, resulting in sore throat). Both hepatotoxicity and interstitial pneumonitis are said to be extremely rare events with<unk> . A few cases of photosensitivity have been reported with<unk> . Hypersensitivity reactions (drug allergy) like angioedema and hives have also uncommonly been reported in association with<unk> . Because it is an antiandrogen,<unk>  has a theoretical risk of birth defects like ambiguous genitalia and brain feminization in male fetuses. Comparison The side effect profile of<unk>  in men and women differs from that of other antiandrogens and is considered favorable in comparison. Relative to analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA),<unk>  monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction. In addition, unlike analogues and ,<unk>  monotherapy is not associated with decreased bone mineral density or osteoporosis. Conversely,<unk>  monotherapy is associated with much higher rates of breast tenderness, gynecomastia, and feminization in men than analogues and . However, gynecomastia with<unk>  is rarely severe and discontinuation rates due to this side effect are fairly low. These differences in side effects between<unk>  monotherapy, analogues, and are attributed to the fact that whereas analogues and suppress estrogen production,<unk>  monotherapy does not lower estrogen levels and in fact actually increases them.<unk>  does not share the risk of neuropsychiatric side effects like depression and fatigue as well as cardiovascular side effects like coagulation changes, blood clots, fluid retention, ischemic cardiomyopathy, and adverse serum lipid changes that has been associated with. It has a much lower risk of hepatotoxicity than flutamide and and of interstitial pneumonitis than nilutamide. The drug also does not share the unique risks of diarrhea with flutamide and nausea, vomiting, visual disturbances, and alcohol intolerance with nilutamide. Unlike enzalutamide,<unk>  is not associated with seizures or related central side effects like anxiety and insomnia. However, although the risk of adverse liver changes with<unk>  is low, enzalutamide differs from<unk>  in having no known risk of elevated liver enzymes or hepatotoxicity. In contrast to the spironolactone,<unk>  does not have antimineralocorticoid effects, and hence is not associated with hyperkalemia, urinary frequency, dehydration, hypotension, or other related side effects. In women, unlike and spironolactone,<unk>  does not produce menstrual irregularity or amenorrhea and does not interfere with ovulation or fertility.
Bicalutamide
Darolutamide
Topilutamide
Apalutamide
Nilutamide
Acetothiolutamide
Flutamide
Enzalutamide