Isotretinoin
Isotretinoin is a teratogen; there is about a 20–35% risk for congenital defects in infants exposed to the drug "in utero", and about 30–60% of children exposed to isotretinoin prenatally have been reported to show neurocognitive impairment. Because of this, there are strict controls on prescribing isotretinoin to women who may become pregnant and women who become pregnant while taking isotretinoin are strongly advised to terminate their pregnancies.
Medical uses of bicalutamide
Bicalutamide has a small risk of elevated liver enzymes and hepatotoxicity at dosages of 50 mg/day and above. As a result, it is recommended that liver function tests periodically be performed. The risk of elevated liver enzymes and liver failure with bicalutamide appears to be much smaller than with cyproterone acetate, 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 cyproterone acetate 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.