Creatine is one of the most widely used sports supplements in the world, and concern about its relationship to hair loss surfaces regularly in gyms, online forums, and clinical consultations. The question has a specific origin: a single 2009 clinical trial that found elevated DHT levels in rugby players taking creatine, and it has generated far more anxiety than the evidence warrants. This article examines what the study actually found, how it has been mischaracterized, and what the genuine state of the evidence is.
The Origin of the Concern
The study most frequently cited in discussions of creatine and hair loss was published in 2009 in the Clinical Journal of Sport Medicine by van der Merwe and colleagues. The trial enrolled 20 male rugby players and randomized them to receive either creatine monohydrate (25 g/day for seven days, then 5 g/day for 14 days) or placebo.
The results: serum DHT levels increased by 56% during the loading phase and remained 40% above baseline during the maintenance phase in the creatine group. Total testosterone levels did not change.
This is the finding that generated the hair loss concern. DHT is the hormone that drives follicle miniaturization in androgenetic alopecia. If creatine raises DHT, the hypothesis is that it could accelerate hair loss in susceptible men.
The concern about creatine and hair loss comes from one study showing elevated DHT with creatine use. It is important to understand what the study did and did not show.
What the Study Did Not Show
The 2009 van der Merwe study has several important limitations:
It measured DHT, not hair loss. The study did not follow participants for hair outcomes. It measured a surrogate biomarker (DHT) that is associated with hair loss but is not the same thing as hair loss. No participant's hair was assessed before or after.
DHT remained within the normal range. The 40–56% elevation in DHT, while statistically significant, kept DHT within the normal physiological range for healthy young men. Higher DHT within the normal range does not inevitably cause hair loss. Genetic sensitivity is required.
The sample size was very small. Twenty participants is a small sample for drawing broad conclusions.
The study has not been replicated. No subsequent adequately powered study has confirmed the finding of significant DHT elevation with creatine supplementation.
The 2009 study found a DHT elevation within normal range, did not measure hair outcomes, and has not been replicated. The jump from "creatine raises DHT in one small study" to "creatine causes hair loss" is not supported by the evidence. Subsequent Research
Several studies have examined creatine's effects on testosterone and DHT without finding the same result.
A 2021 systematic review published in the Journal of the International Society of Sports Nutrition analyzed all available research on creatine and androgen levels. It concluded that the majority of studies do not show a significant increase in total testosterone or DHT with creatine supplementation. The evidence overall does not support creatine as a meaningful driver of androgen elevation.
A 2011 study by Arazi and colleagues measured testosterone and DHT in 27 resistance-trained men before and after creatine supplementation and found no significant change in either hormone.
Similarly, a 2015 study of 20 male strength athletes found no significant change in total testosterone, free testosterone, or DHT after six weeks of creatine supplementation.
The majority of studies on creatine and androgen levels do not replicate the 2009 finding. The evidence base, taken as a whole, does not support creatine causing significant DHT elevation.
Who Might Be at Risk
Even if creatine did consistently raise DHT, the implication for hair loss would be conditional on genetic sensitivity to DHT. Men without a genetic predisposition to androgenetic alopecia (those whose follicles are not DHT-sensitive) would not experience hair loss from elevated DHT regardless of the degree of elevation.
Men with a strong genetic predisposition to androgenetic alopecia who are concerned about any potential DHT-raising effect may choose to avoid creatine or to ensure they are on a DHT-suppressing treatment before using it. This is a precautionary position rather than an evidence-based recommendation.
Even if creatine raised DHT meaningfully, only men with genetic DHT sensitivity would be at theoretical risk. Men without androgenetic alopecia risk factors have no evidence-based reason for concern.
The Broader Context
Creatine has been studied in hundreds of clinical trials over more than two decades. It is one of the most researched dietary supplements in existence. Its safety profile is well-documented. There is no clinical signal of creatine-associated hair loss across this literature.
If creatine were causing meaningful hair loss, it would have been seen among the large population of creatine users who have been studied in clinical trials. It has not been.
The absence of a hair loss signal across decades of creatine research, in hundreds of trials and millions of users, is relevant evidence. It does not establish that creatine cannot affect hair loss, but it strongly suggests the effect, if any, is very small. Practical Guidance
For men with no personal or family history of androgenetic alopecia, the evidence does not support avoiding creatine out of hair loss concern.
For men with androgenetic alopecia or a strong family history who are not on DHT-suppressing treatment and are anxious about any potential contributory factor, creatine avoidance is a reasonable personal choice — though it is a precautionary one not firmly backed by evidence.
For men already on finasteride or dutasteride, systemic DHT is suppressed by 70–95%. Any creatine-related DHT effect, even if real, would be blunted substantially by the medication.
Men on DHT-suppressing treatment have minimal reason to be concerned about creatine. Men without treatment who have significant genetic risk may choose precautionary avoidance, understanding that the evidence for harm is weak. Summary
The concern about creatine and hair loss originates from a single small study finding elevated DHT (but within the normal range) with creatine use. The study did not measure hair outcomes. Later studies have largely not replicated the DHT elevation finding. The wider creatine literature, spanning decades and hundreds of trials, contains no meaningful signal of hair loss as an adverse effect. Men without androgenetic alopecia have no evidence-based reason for concern. Men with significant genetic risk who are not on DHT-suppressing treatment may choose precautionary avoidance.