The side effects of<unk> s vary depending on the type of<unk>  – namely whether it is a selective AR antagonist or lowers androgen levels – as well as the presence of off-target activity in the<unk>  in question. For instance, whereas antigonadotropic<unk> s like GnRH modulators and cyproterone acetate are associated with pronounced sexual dysfunction and osteoporosis in men, selective AR antagonists like bicalutamide are not associated with osteoporosis and have been associated with only minimal sexual dysfunction. These differences are thought related to the fact that antigonadotropins suppress androgen levels and by extension levels of bioactive metabolites of androgens like estrogens and neurosteroids whereas selective AR antagonists similarly neutralize the effects of androgens but leave levels of androgens and hence their metabolites intact (and in fact can even increase them as a result of their progonadotropic effects). As another example, the steroidal<unk> s cyproterone acetate and spironolactone possess off-target actions including progestogenic, antimineralocorticoid, and/or glucocorticoid activity in addition to their<unk>  activity, and these off-target activities can result in additional side effects. In males, the major side effects of<unk> s are demasculinization and feminization. These side effects include breast pain/tenderness and gynecomastia (breast development/enlargement), reduced body hair growth/density, decreased muscle mass and strength, feminine changes in fat mass and distribution, and reduced penile length and testicular size. The rates of gynecomastia in men with selective AR antagonist monotherapy have been found to range from 30 to 85%. In addition,<unk> s can cause infertility, osteoporosis, hot flashes, sexual dysfunction (including loss of libido and erectile dysfunction), depression, fatigue, anemia, and decreased semen/ejaculate volume in males. Conversely, the side effects of selective AR antagonists in women are minimal. However, antigonadotropic<unk> s like cyproterone acetate can produce hypoestrogenism, amenorrhea, and osteoporosis in premenopausal women, among other side effects. A number of<unk> s have been associated with hepatotoxicity. These include, to varying extents, cyproterone acetate, flutamide, nilutamide, bicalutamide, aminoglutethimide, and ketoconazole. In contrast, spironolactone, enzalutamide, and other<unk> s are not associated with significant rates of hepatotoxicity. However, although they do not pose a risk of hepatotoxicity, spironolactone has a risk of hyperkalemia and enzalutamide has a risk of seizures. In women who are pregnant,<unk> s can interfere with the androgen-mediated sexual differentiation of the genitalia and brain of male fetuses. This manifests primarily as ambiguous genitalia – that is, undervirilized or feminized genitalia, which, anatomically, are a cross between a penis and a vagina – and theoretically also as femininity. As such,<unk> s are teratogens, and women who are pregnant should not be treated with an<unk> . Moreover, women who can or may become pregnant are strongly recommended to take an<unk>  only in combination with proper contraception.
Antiandrogen
Antiestrogen
Antiglucocorticoid
Thyroid blocker
Aromatase inhibitor
Nonsteroidal antiandrogen
Antiprogestogen
Phytoestrogen