Creatine and Hair Loss: Unraveling the Facts and the Myths

Creatine is the undisputed heavyweight champion of natural sports supplements, so you’d be forgiven if hair loss wasn’t the first thing that crossed your mind when you thought about it.

No single natural supplement has been studied more frequently, and no single natural supplement provides more bang for your buck in the size and strength department – especially if you find yourself on the favorable end of the response spectrum.

Thankfully, we’re long past the days of the rumors and speculation that creatine is some sort of Anabolic Steroid or illegal performance enhancing drug. It’s simply a molecule produced in the body by the amino acids arginine, glycine & methionine and can be found in a lot of food (namely meat).

However, a newer wave of myths have been popping up attempting to link creatine with hair loss. Have the Gods of Gainz deemed the price of increased performance to be your luscious locks? Is there any real connection between creatine and balding? Or is this another misguided smear campaign against our powdery supplement friend?

Why is Creatine Associated with Hair Loss?

The speculation that creatine causes hair loss was most likely a response to the findings of a 2009 study by van der Merwe et al, which noted an increase in both dihydrotestosterone (DHT) and the DHT:Testosterone ratio in college-aged Rugby players after a three-week intervention of creatine supplementation vs placebo. 

10 subjects received 25 g/day of creatine for the first week (a loading phase), followed by two weeks at a maintenance dose of 5 g/day; the other 10 athletes received a glucose placebo for all three weeks. The intervention took place during their competitive season, meaning training and matches were ongoing during the period of supplementing.

In the creatine group, DHT levels increased 56% above baseline after the seven-day loading phase and stayed 40% above baseline after two weeks of maintenance dosing. The DHT:Testosterone ratio also elevated by 36% after loading and 22% after maintenance. Serum testosterone levels remained unchanged; remember this for later.

DHT is a metabolite of testosterone and is actually more potent than testosterone from an androgenic standpoint, contributing to the masculinization of features and characteristics (i.e. deeper voice, more body hair, etc.). 

This was the first randomized controlled trial that suggested creatine supplementation could even have a hormonal impact in the first place, and concluded that “the mechanisms of action are incompletely understood, particularly in relation to dihydrotestosterone, and therefore the long-term clinical safety cannot be guaranteed.”

This speculative connection between creatine and DHT gave birth to several creatine hair loss myths that are still prevalent today.

DHT and Hair Loss

High DHT levels of the scalp are primarily implicated in Androgenetic Alopecia (AGA), a.k.a. “Male Pattern Baldness.” This condition refers to the loss of hair generated by androgen levels, and nearly 80% of men will experience AGA at some point in their lifetime. Women can also be affected by AGA, it’s just not as prevalent.

While testosterone and DHT are both androgenic, DHT has a much higher affinity for the androgen receptors on the skin. Testosterone can be converted in the body by 5-alpha reductase to create DHT, and, unsurprisingly, the severity of AGA strongly correlates with DHT levels on the scalp. So, theoretically, an increase in DHT alone or an increase in free testosterone (which could then be converted to DHT) would both increase the risk for developing AGA.

Challenging the Study Findings

If you were to take van der Merwe’s 2009 study as gospel, a link between creatine and alopecia doesn’t seem all that far fetched: creatine increases DHT and the DHT:T ratio, and high levels of DHT lead to AGA. 

Case closed, right?

Well, maybe not: those findings have never been replicated and at least a dozen more studies have failed to find any significant effect that creatine has on testosterone or DHT levels. 

Additionally, in van der Merwe’s study, the group receiving the creatine supplementation had a baseline DHT level 23% lower than the placebo group. Following the three weeks of supplementation, a rise of 0.3-0.4 nmol/L compared to a slight decrease (-0.2 nmol/L) in the placebo group created the appearance of the increase in DHT being “statistically significant”. 

However, with the reference range of DHT being between 0.8 – 3.5 nmol/L in healthy adult men, these changes only amount to small swings that are well within normal ranges.

And finally, recall that serum testosterone levels were unchanged in the creatine group in the Rugby study. Testosterone is a necessary precursor to DHT, so the fact that DHT increased at all in that setting still has no mechanistic explanation. 

Creatine and Hair Loss: The Verdict

The current body of evidence suggests that creatine does not cause hair loss or balding. Supplementation does not impact your androgen levels to the degree that would cause you to lose hair because of taking creatine. 

If you are worried about experiencing hair loss or baldness, it’s pretty safe to say it’s not because of the teaspoon of creatine you have every day. Though no true cure for AGA exists, a healthy diet can go a long way as a chronic preventative measure, as can ketoconazole shampoo and even follicle transplant surgery.

However, worth noting, Finasteride is a common treatment option that acts as a 5-alpha reductase inhibitor and decreases systemic (whole-body) DHT levels. While this does a great job combating hair loss, oral Finasteride can also lead to major sexual dysfunction that can last well beyond the period of supplementation. Turns out, blocking DHT levels throughout your entire body can create some pretty considerable side-effects.

Luckily, topical Finasteride offers a best-of-both-worlds solution: low-dose creams can locally decrease DHT on the scalp by roughly 50% while only decreasing blood levels by about 25%. 100 microliters of a 0.1 – 0.25% cream applied one to two times daily to the scalp is just as effective at combating hair loss as oral Finasteride, with a far better safety profile.

Still, even with mitigated risks, any course of treatment (including topical Finasteride) should be monitored closely by a qualified practitioner.

Conclusion

So we can check one more thing off the “vilification of creatine” list: current evidence shows no mechanistic reason why creatine would cause hair thinning, hair loss, or baldness.

If you want to learn more about what certain supplements actually do instead of getting wrapped up in dooms-day scenarios thanks to tenuous extrapolations of single studies, check out Menno Henselmans’ Online PT Course, which is now available in several languages.

The vast majority of the information included here comes directly from the course itself, and it’s only a tiny fraction of the wisdom it has to offer.