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Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes. [45]

Five cases of hepatotoxicity or liver failure , two of which resulted in death, have been reported with bicalutamide. [96] [97] Symptoms that may indicate liver dysfunction include nausea, vomiting, abdominal pain, fatigue, anorexia , "flu-like" symptoms , dark urine , and jaundice . [20] Bicalutamide has also been associated with several case reports of interstitial pneumonitis , which can potentially progress to pulmonary fibrosis . [98] [99] [100] 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 ). [101] Both hepatotoxicity and interstitial pneumonitis are said to be extremely rare events with bicalutamide. [96] [102] [103] A few cases of photosensitivity have been reported with bicalutamide. [22] Hypersensitivity reactions ( drug allergy ) like angioedema and hives have also uncommonly been reported in association with bicalutamide. [20] Because it is an antiandrogen, bicalutamide has a theoretical risk of birth defects like ambiguous genitalia and brain feminization in male fetuses . [79] [80] [104] [105]

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