Does Creatine Cause Hair Loss?

Amidst a sea of ridiculous fitness myths and clickbait headlines misinformation can often overshadow scientific truth. The question of whether creatine causes hair loss stands out as a prime example.

The vast majority of speculation regarding the relationship between creatine supplementation and hair loss/baldness originates from a single study.

This was a study published in 2009⁽¹⁾ where college-aged male rugby players who supplemented with 25 g/day of creatine for 7 days followed by 5 g/day thereafter for an additional 14 days experienced an increase in serum dihydrotestosterone (DHT) concentrations over time. 

Specifically, DHT increased by 56% after the seven-day creatine loading period, and remained 40% above baseline values after the 14-day maintenance period. These results were statistically significant compared to when the subjects consumed a placebo (50 g of glucose per day for 7 days, followed by 30 g/day for 14 days thereafter).

Given that changes in these hormones, particularly DHT, have been linked to some (but not all) occurrences of hair loss/baldness⁽²⁾, the theory that creatine supplementation leads to hair loss gained some traction and this potential link continues to be a common question/myth today.  

Specifically, the paper mentioned above by Merwe et al.⁽¹⁾ states in their discussion that “Clinically, an increased ratio of DHT:T has been linked to higher male pattern baldness”. This is most like that catalyst which started the proposed theory that creatine supplementation leads to hair loss.

It is important to note that the results of this 2009 study⁽¹⁾ have not been replicated, and that intense resistance exercise itself can cause increases in these androgenic hormones. 

If results have not been replicated for this long, it raises some suspicion on this study, how they examined their data and made their conclusions.

First, a little about dihydrotestosterone.

DHT (dihydrotestosterone) is a hormone that plays a key role in the sexual development of males.  More specifically, DHT is an androgen — a hormone that stimulates the development of male characteristics. DHT affects the sexual development of males throughout their lives, beginning as early as in fetal development.

The role of DHT changes as males progress through different life stages. Scientists aren’t sure if and how DHT affects females, but they think it may play a role in body hair and pubic hair growth.

As an adult, your body converts about 10% of your testosterone (the main androgen) into DHT each day. This takes place in the genital skin and prostate in males and in the skin in females. It also happens in other parts of your body, such as your liver.
 
Levels of DHT are naturally much higher in males than females because they naturally have more testosterone. DHT is a metabolite of testosterone, formed when the enzyme 5-alpha-reductase converts free testosterone to DHT⁽³⁾.

In males, DHT can bind to androgen receptors in susceptible hair follicles and cause them to shrink, ultimately leading to hair loss and balding⁽⁴⁾.

Here is the important part about the 2009 study mentioned above:

• - No increase in total testosterone was found in the 16 males who completed the study.
• - 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). 

This is a big mistake in research because these groups were not evenly distributed and matched, hence causing bias right from the start. 

Once of the most important things in sound research is to properly match/distribute groups at baseline before independent variable are brought into the research.
 
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) explains the “statistically significant” increase in DHT noted by the 2009 study⁽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.

I will highlight a couple studies below.

• - Twenty amateur male swimmers ingested creatine monohydrate or a matched placebo for 6 days.
• - All subjects performed 6 days, swimming exercise.
• - The subjects were tested for performance and hormonal responses the day before and after this creatine loading.

They concluded that short-term creatine supplementation has improved 50 m sprint performance in amateur swimmers, and it seems unlikely creatine loading is hormonally mediated.

Another study published in 2015 investigated the influence of resistance exercise with creatine loading on resting blood pressure and heart rate are unclear and no study directly compared resting testosterone and cortisol concentrations following 3, 5 and 7 days of creatine loading⁽⁶⁾.

• - Twenty active males were randomly assigned to either a creatine group or placebo group.
• - Participants performed resistance exercises at day 3, 5, and 7; and tested at day 4, 6, and 8.
• - Subjects of the creatine group showed increases in testosterone concentrations and decreases in cortisol concentrations, in comparison with placebo and baseline, after 5 and 7 days of creatine loading (P < 0.05).
• - There were no significant changes in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product for both groups at all times. 

Results of the present study suggest that more than 5 days of creatine supplementation, associated with resistance exercises is sufficient for increasing testosterone concentrations and decrement in cortisol concentrations.

To date, 12 other studies have investigated the effects of creatine supplementation (i.e. doses ranging from 3-25 g/day for 6 days to 12 weeks) on testosterone.

Two studies, as detailed above, reported small, physiologically insignificant increases in total testosterone after six and seven days of supplementation, while the remaining ten studies reported no change in testosterone concentrations. In five of these studies, free testosterone, which the body uses to produce DHT, was also measured and no increases were found.

Summary

In summary, there is lack of evidence indicating that creatine supplementation increases total testosterone, free testosterone, DHT or causes hair loss/baldness. 

The fact is that creatine is the most studied supplement on the market.

It has incredible research-backed health benefits ranging from muscle growth to brain health and everything in between.

Because creatine is osmotically active and relies on a sodium-dependent transportation system in order to be absorbed, supplementing additional sodium and potassium may help to increase cellular hydration and muscular performance.

ATP-FUSION is 100% pure creatine monohydrate powder infused with a performance-focused dose of sodium and potassium in order to better aid with creatine absorption and utilization within the body.

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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 19:399-404, 2009
    2.    Ustuner ET: Cause of androgenic alopecia: crux of the matter. Plast Reconstr Surg Glob Open 1:e64, 2013
    3.    Bartsch G, Rittmaster RS, Klocker H: Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia. World J Urol 19:413-25, 2002
    4.    Trüeb RM: Molecular mechanisms of androgenetic alopecia. Exp Gerontol 37:981-90, 2002
    5.    D. Sheikholeslami Vatani HF, R. Soori, M. Mogharnasi: The effects of creatine supplementation on performance and hormonal response in amateur swimmers. Science & Sports 26:272-277, 2011
    6.    H. Arazi FR, K. Hosseini, A. Asadi,: Effects of short term creatine supplementation and resistance exercises on resting hormonal and cardiovascular responses. Science & Sports, 30:105-109, 2015