Does Creatine Cause Hair Loss?

At this time there’s no strong evidence to suggest that creatine causes hair loss, balding, or hairline recession.  That said, it is important to underscore the fact that zero studies have been conducted with intent to specifically determine whether creatine might cause hair loss.

Some creatine users panicked after one study documented substantial elevations in DHT (dihydrotestosterone) following a short course of creatine supplementation in collegiate rugby players.  Because elevated DHT can induce hair loss (and accelerate preexisting hair loss), this study led some to speculate that creatine supplementation may induce hair loss.

Balding Man

it’s from the creatine bro (P.S. not bald)

Creatine and Hair Loss (Research)

Currently there’s no research that’s examined the relationship between creatine supplementation and hair loss.  Thus far, the only study indirectly supporting the idea that creatine supplementation could potentially provoke hair loss is from van der Merwe et al. (2009).

If stronger evidence is presented indicating that creatine might cause hair loss – I’ll update this article.

In the study by van der Merwe et al. (2009), collegiate rugby players received creatine monohydrate for a 3-week period.  The results indicated that creatine monohydrate supplementation markedly increased DHT concentrations in the athletes.

Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players.

  • Authors: van der Merwe, Brooks, Myburgh (2009)
  • Design: Double-blind, placebo-controlled, crossover
  • Duration: 3 weeks
  • Aim: To determine how creatine supplementation impacts the ratio of dihydrotestosterone (DHT) to testosterone in male 20 college-aged, male rugby players.
  • Methods: Participants received either (1) creatine at a dose of 25 grams/day plus glucose at a dose of 25 grams/day OR (2) a placebo (50 grams/day of glucose) for 7 days.  Thereafter, participants received maintenance doses of either: 5 grams/day of creatine plus 25 grams/day glucose OR 30 grams/day of glucose.
  • Measures: Serum testosterone and dihydrotestosterone (DHT). Both were measured: at baseline (pre-study); after 7 days; and after 21 days.  Body composition of each participant was also measured.
  • Results:
    • Serum testosterone (no change): Neither 7 days of creatine loading (25 g/day) nor creatine maintenance (5 g/day) significantly altered serum testosterone levels.
    • DHT (increased): Dihydrotestosterone (DHT) levels increased by 56% after 7 days of creatine loading and remained elevated by 40% (relative to baseline) following the 14-day maintenance period.
    • DHT to T ratio (increased): The ratio of dihydrotestosterone to testosterone (DHT:T) increased by 36% after 1 week of creatine loading and remained elevated (relative to baseline) by 22% after 2 weeks of creatine maintenance dosing.
  • Conclusion: Researchers concluded that creatine supplementation may bolster the conversion of testosterone to dihydrotestosterone (DHT).  However, because serum testosterone concentrations didn’t change – it may be better to simply conclude that creatine might increase DHT.

(Source: https://www.ncbi.nlm.nih.gov/pubmed/19741313)

What can we conclude from this study?

The only thing we can conclude from the 2009 study by van der Merwe et al. is that creatine monohydrate supplementation may significantly increase DHT (dihydrotestosterone) during a 7-day (25 g/day) loading phase by ~56% (+0.44 ng/mL) and during a 14-day maintenance phase by ~40% (+0.12 ng/mL) in male collegiate athletes.

Was this study an anomaly?

Unknown. There aren’t any other studies that’ve specifically evaluated the effect of creatine supplementation on DHT levels.  There are also many limitations associated with the study including its small sample size, homogenous sample (young adults, males, athletes), and short duration.

Limitations

Homogenous sample: Because only college-aged male athletes were involved in this study – it’s unknown how the results would’ve been with other age groups (pediatrics, middle-aged, elderly), non-athletes, and women.

Short duration: Because the study was conducted over a short-term (3 weeks), it’s unclear as to whether the DHT elevations would’ve been sustained with longer-term creatine supplementation.

Small sample: Because the study had a small sample size (20 athletes), it’s possible that the study was underpowered – such that finding of elevated DHT may not have been attributable to creatine supplementation.

What causes hair loss? (How it occurs)

In men, the most common cause of hair loss (on the head) is elevated concentrations of the androgen DHT (dihydrotestosterone).

DHT is a byproduct of testosterone that is produced via the 5α-Reductase enzyme.

The 5α-Reductase enzyme converts a percentage of testosterone to DHT in bodily tissues such as the skin, liver, prostate – and hair follicles.

Persons who are prone to hair loss exhibit elevations in DHT wherein the elevated DHT binds to hair follicle receptors.

The binding of DHT to hair follicle receptors causes the follicles to shrink in size (via a process called “miniaturization”), weaken, and ultimately – die.

In other words, interactions between DHT and DHT-sensitive hair follicles provokes hair loss.  For this reason, hair loss is commonly treated with agents that reduce concentrations of DHT and/or inhibit the 5α-Reductase enzyme.

Men with DHT-sensitivities (determined by genetics) tend to experience hair loss, hair thinning, and/or baldness at a younger age than men without DHT-sensitivities.

If creatine causes hair loss – what are the hypothesized mechanisms?

If creatine supplementation is eventually discovered to directly cause hair loss – below are potential mechanisms by which creatine-mediated hair loss might occur. (Keep in mind that these mechanisms are hypothetical – as it is unclear whether creatine induces hair loss).

  1. Free testosterone increase: Creatine supplementation might increase concentrations of free testosterone. Since free testosterone gets converted to DHT within the body, this could be a mechanism by which creatine supplementation increases DHT, and over time, causes hair loss.
  2. 5α-Reductase enzyme modulation: Creatine supplementation might modulate the activity or concentrations of the enzyme 5α-Reductase. By upregulating or augmenting the activation of 5α-Reductase – the body will accelerate the conversion of free testosterone to DHT.  This increase in DHT could lead to faster hair loss.
  3. Dual modulation: It’s possible that creatine could influence concentrations of free testosterone and 5α-Reductase simultaneously to provoke and/or accelerate hair loss.

Note #1: Even if creatine increases free testosterone and/or modulates 5α-Reductase – this does not mean all creatine users are guaranteed hair loss.  Some individuals may be more sensitive to creatine-induced DHT/5α-Reductase changes compared to others. The dose might also influence the magnitude of its effect.

Note #2:  Creatine might also have zero effect on DHT, testosterone and 5α-Reductase to cause hair loss – further studies are warranted.

Recommendations for future research of creatine and hair loss

  • Creatine vs. DHT: Future research should specifically evaluate the effect of creatine on DHT concentrations.
  • Creatine vs. 5α-Reductase: Future research should evaluate whether creatine modulates 5α-Reductase activation.
  • Epidemiological studies: The relationship between long-term creatine supplementation and hair loss hasn’t been assessed epidemiologically.  A long-term epidemiological study should compare rates of unintentional hair loss, receding hairline, and hair thinning among creatine users – relative to non-creatine users while controlling for as many potential confounds as possible.
  • RCT, large sample, longer-term: A long-term randomized, double-blind, placebo-controlled study over a long-term with a large sample would give a better idea as to whether creatine monohydrate supplementation increases DHT levels.
  • Dose: In long-term research, creatine monohydrate should be administered at doses of 5 g/day – as there’s no significant performance benefit to be attained beyond that dose following muscular saturation.
  • Different populations: Researchers may want to evaluate the effect of creatine in populations beyond male collegiate athletes (e.g. middle-aged men, non-athletes, women, etc.).

Variables that might influence creatine-induced hair loss

1. Genetics: A fairly recent GWAS (genome wide association study) published in 2017 identified over 200 independent genetic correlates of hair loss. A subset of genes may increase one’s hair follicle sensitivity to DHT and/or activation of 5-alpha reductase.

(If creatine increases DHT – then this might induce balding in persons with a follicular sensitivity relative to those with higher magnitudes of follicular insensitivity). (R1, R2)

2. Creatine dose: If creatine somehow contributes to hair loss then it’s possible that the dose warrants consideration. In the study by van der Merwe et al. (2009), DHT concentrations significantly increased during a creatine loading phase (25 g/d) and dropped slightly during a maintenance phase (5 g/day).

Assuming creatine dose-dependently influences DHT levels – hair loss may might be more likely to result only from higher doses.  Since most people use 5 g/day – this would be the optimal dose to evaluate in future research.

3. Regularity & duration: Regular (i.e. daily) administration of creatine at a sufficient dose (5 g/day) for a long-term may influence hair growth differently than infrequent administration and/or short-term use.

Note: Factors like age, sex, and concurrently-used substances may also influence one’s likelihood of losing hair as a result of taking creatine.

Did I lose my hair from creatine?

In the past, for 2 to 3 years, I supplemented with creatine monohydrate at a dose of 5 grams per day.

My initial reason for supplementing with creatine monohydrate was to assess whether it enhanced my cognitive performance. (Read more: Creatine & Cognitive Enhancement).

During the 2-to-3-year period of daily creatine monohydrate supplementation, it seemed to me (subjectively) that creatine improved aspects of my cognition.

Because also I lifted weights 4 to 5 times per week and knew that creatine monohydrate enhanced lifting performance – I saw no reason to discontinue.

After 2-to-3 years of daily creatine supplementation (5 grams), I noticed some very modest hairline recession near the crown of my head.

Because there are many potential confounding variables that could’ve influenced this hairline recession such as: genes (most impactful); aging; stress; hair washing regimen; etc. – I cannot be sure whether the creatine was to blame.

Moreover, since I never measured my DHT levels checked at baseline (prior to creatine supplementation) and at various checkpoints throughout the 2 to 3 years of supplementation, I cannot be sure that creatine was causally implicated in my noted hair changes.

Although creatine may have contributed to a slight recession of my hairline – there’s no way for me to test this possibility.

It’s also important to counter my anecdote of mild hairline recession (while using creatine) with anecdotes from other creatine users who’ve never noticed any hair loss with long-term (years) of daily supplementation.

What if you’re concerned about hair loss from creatine monohydrate?

1. Avoid it: Creatine is a nonessential nutrient that you don’t need to survive. If you eat meat, you’re getting some creatine from your diet already. Unless you’re engaged in physically-demanding training, you probably don’t need creatine.

2. Self-experimentation: If you want to use creatine, but are concerned about hair loss, you could conduct a little self-experiment.

Test your DHT levels: Assuming creatine can cause hair loss via increasing DHT, you may want to test your DHT levels before using creatine – then compare them to your DHT levels at various checkpoints during supplementation.

If your DHT levels significantly increase with creatine supplementation – and you’re concerned about DHT-induced hair loss – you may want to discontinue creatine.

Hair measurements: Evaluate your hairline, bald spots, and hair thickness prior to using creatine.  Then re-evaluate your hairline, bald spots, and thickness at various checkpoints (e.g. every 6 months) while supplementing.

(Since aging may cause hair loss, understand that measurement changes may not be from creatine.  Keep the hair measurement changes in context to first-degree relatives’ hair statuses at your age).

Note: If you do a self-experiment with measuring DHT and/or hair measurements – I’d be very interested in hearing the results.

Final thoughts on creatine and hair loss

If you suspect that creatine supplementation might cause hair loss over the long-term (e.g. hair loss runs in the family) – and you’re afraid of this – don’t use creatine.

Most people can get through life just fine without creatine supplementation.

If you stand to benefit significantly from creatine supplementation (such as in athletics; strength and power; gym workouts; or cognitive performance – particularly if you’re vegan eating a diet devoid of creatine) – know that there’s zero high-level evidence suggesting that creatine causes hair loss.

Even if creatine does somehow cause hair loss – it may not be severe and/or may only occur after a long-term of regular use and/or in genetically-susceptible individuals.

Moreover, the benefit of substantial performance enhancement associated with creatine may outweigh any hair loss that it induces.

In conclusion, creatine monohydrate has a favorable safety profile and no current evidence suggests that it causes hair loss.

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