Does creatine cause hair loss/ baldness?

You may have heard that creatine causes hair loss. These claims stem mainly from a single study published in 2009 (1). The study looked at college-aged male rugby players who supplemented with creatine (25 g/day for 7 days, followed by 5 g/day thereafter for an additional 14 days). These athletes experienced an increase in serum dihydrotestosterone (DHT) concentrations by 56% after the seven-day loading period and remained 40% above baseline values after the 14-day maintenance period. It’s important to note that the authors made no reference to hair. Nonetheless, it has led readers to draw conclusions between creatine consumption and the possibility that it may contribute to male-pattern baldness as DHT is the hormone most associated with male-pattern baldness.

DHT is a metabolite of testosterone, formed when the enzyme, 5-alpha-reductase, converts free testosterone to DHT (2). In males, DHT can bind to androgen receptors on hair follicles and cause them to shrink, ultimately leading to hair loss in males who are genetically susceptible (3). However, in the van der Merwe et al. study, no increase in total testosterone was found in the 16 males who completed the study (1) and free testosterone was not measured. Moreover, the increase in DHT and the DHT: testosterone ratio remained well within normal clinical limits. Furthermore, baseline (prior to supplementation), DHT was 23% lower in the creatine group (0.98 nmol/L) compared to the placebo group (1.26 nmol/L). Thus the small increase in DHT in the creatine group (+0.55 nmol/L after 7 days of supplementation and +0.40 nmol/L after 21 days of supplementation), in combination with a small decrease in the placebo DHT response (-0.17 nmol/L after 7 days of supplementation and -0.20 nmol/L after 21 days of supplementation) contributes to the statistically significant increase in DHT noted by van der Merwe et al. (1). While it is possible that creatine supplementation upregulated 5-alpha-reductase activity in these males (potentially leading to increased formation of DHT), no study has reported hair loss/baldness in humans.

To date, 12 other studies have investigated the effects of creatine supplementation on testosterone. Two studies reported small, physiologically insignificant increases in total testosterone after six and seven days of supplementation (4, 5), while the remaining ten studies reported no change in testosterone concentrations. In five of these studies (6-10), free testosterone, which the body uses to produce DHT, was also measured and no increases were found.

In summary, the current body of evidence does not indicate that creatine supplementation increases total testosterone, free testosterone, DHT or causes hair loss/baldness (11).

References

1. van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clin J Sport Med. 2009;19(5):399-404.

2. Bartsch G, Rittmaster RS, Klocker H. Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia. World J Urol. 2002;19(6):413-25.

3. Trüeb RM. Molecular mechanisms of androgenetic alopecia. Exp Gerontol. 2002;37(8-9):981-90.

4. Sheikholeslami Vatani D, Faraji H, Soori R, Mogharnasi M. The effects of creatine supplementation on performance and hormonal response in amateur swimmers. Science & Sports. 2011;26(5):272-7.

5. Arazi H, Rahmaninia F, Hosseini K, Asadi A. Effects of short term creatine supplementation and resistance exercises on resting hormonal and cardiovascular responses. Science & Sports. 2015;30(2):105-9.

6. Cook CJ, Crewther BT, Kilduff LP, Drawer S, Gaviglio CM. Skill execution and sleep deprivation: effects of acute caffeine or creatine supplementation - a randomized placebo-controlled trial. J Int Soc Sports Nutr. 2011;8:2.

7. Cooke MB, Brabham B, Buford TW, Shelmadine BD, McPheeters M, Hudson GM, et al. Creatine supplementation post-exercise does not enhance training-induced adaptations in middle to older aged males. Eur J Appl Physiol. 2014;114(6):1321-32.

8. Hoffman J, Ratamess N, Kang J, Mangine G, Faigenbaum A, Stout J. Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes. Int J Sport Nutr Exerc Metab. 2006;16(4):430-46.

9. Volek JS, Ratamess NA, Rubin MR, Gómez AL, French DN, McGuigan MM, et al. The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching. Eur J Appl Physiol. 2004;91(5-6):628-37.

10. Rahimi R, Faraji H, Vatani DS, Qaderi M. CREATINE SUPPLEMENTATION ALTERS THE HORMONAL RESPONSE TO RESISTANCE EXERCISE. Kinesiology: international journal of fundamental and applied kinesiology. 2010;42:136-43.

11. Antonio J, Candow DG, Forbes SC, Gualano B, Jagim AR, Kreider RB, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? Journal of the International Society of Sports Nutrition. 2021;18(1):13.