For every person who extols the virtues of creatine, there'll undoubtedly be 2 or more who'll protest, "B-But creatine makes your hair fall out!"
And I’m sure we can all agree.
As much as you’d like to improve your body composition and/or athletic performance, balding as a side effect can be a serious deal-breaker.
It’s like thinking you’ve finally met “The One” on Tinder — then discovering they’re married. With 2 kids in tow.
So, let’s get to the truth of a question weighing heavily on anyone on the fence. Does creatine cause hair loss?
Creatine and hair loss: the origin
Ever heard of the saying, “There’s no smoke without fire”?
A good reason creatine is widely considered to cause hair loss is this 2009 crossover study published in the Clinical Journal of Sports Medicine. The researchers assigned 20 participants to 2 groups:
2️⃣ Group 2: Placebo (50 g glucose daily for 7 days, followed by 30 g glucose daily for 14 days)
After that, following a 6-week washout period — where participants are taken off their "treatments", regardless of whether it's an "active" or placebo — Group 1 went on the placebo intervention, and Group 2 went on the creatine intervention. I.e., they swapped.
And what did the researchers find?
Creatine supplementation seemed to increase serum DHT levels and DHT:testosterone ratios within the creatine phase and when compared against the placebo phase.
OK, but how does that link creatine to hair loss?
Great question. To understand that, we'll have to dig into what "DHT" stands for and what it does in your body.
What is DHT?
DHT stands for “dihydrotestosterone”.
It’s an androgen (i.e., hormone) derived from testosterone that stimulates the development of male characteristics during puberty. Note: women also produce DHT — only in much lower amounts since women typically have lower testosterone levels than men.
In adulthood, though, DHT’s effects on the body seem a little more … unfavorable.
More specifically, it’s linked to prostate enlargement and androgenic alopecia (previously known as “male pattern baldness”).
Let's not dwell on the prostate enlargement bit.
Just know that a bigger prostate is not usually cause for concern. But it never hurts to see your doctor. Just in case.
Back to the topic at hand: hair loss.
Turns out DHT is the most potent androgen that regulates hair growth. However, research shows that overly high levels of DHT shrink hair follicles, shortening the growth phase and creating thinner hair. It may even eventually halt hair growth altogether.
At this point, you may have already grasped the concerns about creatine and hair loss.
If high DHT levels cause hair loss and creatine supplementation increases DHT levels, then … creatine does cause hair loss, right?
Hmm. Not necessarily.
Why you shouldn’t take the study’s findings at face value
See, there are several issues with the study. Namely:
Findings haven’t been replicated: Worse still, other research (12 studies so far) that measured the impact of creatine on serum DHT and/or testosterone levels has generally failed to find much of an effect.
Suspicious DHT levels: For unknown reasons, baseline DHT levels were ~20% to 25% lower at the start of the creatine phase than the placebo phase. DHT levels also tended to decrease in the placebo phase (why would a placebo, which was simply glucose, affect DHT levels?)
It doesn’t actually measure hair loss: So here's the thing. High levels of DHT are indeed associated with hair loss — but it's not serum DHT (i.e., the amount of DHT in your blood) that’s the issue; instead, it’s the concentration of DHT at the hair follicles themselves. Let’s unpack that below.
Serum DHT levels have nothing to do with hair loss
Wait. What? Yeah, look at what this 2018 review published in Molecular and Cellular Endocrinology had to say about how DHT causes hair loss:
“The unwanted androgen metabolism [note: the conversion of testosterone to DHT] at the hair follicle is the major factor in the pathogenesis of androgenic alopecia … As no correlation between pattern of baldness and serum androgen has been found, the pathogenic action of androgens is likely to be mediated through the intracellular signaling of hair follicle target cells.”
Translated to English, elevated DHT levels in your blood don't contribute to hair loss. Instead, as mentioned earlier, you should only be concerned about the DHT produced in your hair follicles.
So … does creatine cause hair loss?
Does creatine cause hair loss? Looking at the scientific landscape, there’s about as much evidence that creatine causes hair loss as singing causes hair loss. (I.e., none.)
Creatine isn't without side effects
Of course, that’s not to say creatine is without its negative effects or cons.
Creatine is associated with gastrointestinal upset — including bloating, cramping, and diarrhea.
It also doesn't seem to play nice with caffeine.
However, you can circumvent both by appropriately spacing out your daily intake and/or managing your supplementation timing.
Learn the right way to pair creatine with caffeine here:
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Antonio, Jose, et al. “Common Questions and Misconceptions about Creatine Supplementation: What Does the Scientific Evidence Really Show?” Journal of the International Society of Sports Nutrition, vol. 18, Feb. 2021, p. 13. PubMed Central, https://doi.org/10.1186/s12970-021-00412-w.
“Benign Enlarged Prostate: Overview.” InformedHealth.Org [Internet], Institute for Quality and Efficiency in Health Care (IQWiG), 2018. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK279204/.
Ceruti, Julieta María, et al. “Androgens and Androgen Receptor Action in Skin and Hair Follicles.” Molecular and Cellular Endocrinology, vol. 465, Apr. 2018, pp. 122–33. PubMed, https://doi.org/10.1016/j.mce.2017.09.009.
Kinter, Kevin J., et al. “Biochemistry, Dihydrotestosterone.” StatPearls, StatPearls Publishing, 2023. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK557634/.
Ustuner, Emin Tuncay. “Cause of Androgenic Alopecia: Crux of the Matter.” Plastic and Reconstructive Surgery Global Open, vol. 1, no. 7, Nov. 2013, p. e64. PubMed Central, https://doi.org/10.1097/GOX.0000000000000005.
van der Merwe, Johann, et al. “Three Weeks of Creatine Monohydrate Supplementation Affects Dihydrotestosterone to Testosterone Ratio in College-Aged Rugby Players.” Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, vol. 19, no. 5, Sept. 2009, pp. 399–404. PubMed, https://doi.org/10.1097/JSM.0b013e3181b8b52f.