 The risk of elevated liver enzymes and liver failure with bicalutamide appears to be much smaller than with , which is the most widely used antiandrogen in transgender women in Europe and elsewhere in the world.In the United States, one of the only countries where has not been approved for medical use, the relatively weak and non-selective antiandrogen spironolactone is commonly used in transgender women instead.Bicalutamide is a favorable alternative option to these antiandrogens in transgender females.