Creatine and Hair Loss: The DHT Study That Started the Myth

Few supplement myths have spread as rapidly as the claim that creatine causes hair loss. Type "creatine" into any search engine and hair loss appears among the top autocomplete suggestions. The concern is visceral and personal in a way that abstract kidney function markers are not. Yet the entire fear rests on a single study that did not measure hair loss, has never been replicated, and contained methodological features that limit its interpretability.

The Study: van der Merwe et al. (2009)

The origin of this myth is a study published in the Clinical Journal of Sport Medicine by van der Merwe, Brooks, and Myburgh in 2009. The study examined 20 college-aged rugby players in South Africa. Participants underwent a 7-day creatine loading phase (25 g/day) followed by a 14-day maintenance phase (5 g/day).

The study was not designed to investigate hair loss. It measured hormonal responses to creatine supplementation, including testosterone, dihydrotestosterone (DHT), and the DHT:testosterone ratio. The key finding was that the DHT:testosterone ratio increased by 56% after the loading phase, remaining 40% above baseline after the maintenance phase. Total testosterone levels did not change significantly.

The researchers did not measure hair loss. No participant reported hair loss. No assessment of scalp hair density, thickness, or shedding was conducted. The study measured a hormonal marker (DHT) that is associated with androgenetic alopecia, and the internet connected the dots.

The Logical Chain and Where It Breaks

The implicit reasoning behind the myth is straightforward: creatine raises DHT, DHT causes hair loss, therefore creatine causes hair loss. Each link in this chain deserves scrutiny.

Does creatine reliably raise DHT? Based on the available evidence, this has not been confirmed. The van der Merwe study is the only published study reporting elevated DHT following creatine supplementation. Multiple other studies have measured testosterone and related androgens in creatine users without finding similar results. Kalman et al. (2000), for instance, found no significant changes in testosterone levels following creatine supplementation. A 2021 meta-analysis by Antonio et al., examining the effects of creatine on testosterone across multiple studies, found no significant impact of creatine supplementation on total testosterone or free testosterone levels, undermining the proposed hormonal mechanism.

The van der Merwe study used a small sample (n=20) with no placebo control group receiving the same training and dietary protocol. The DHT values, while statistically elevated, remained within normal physiological ranges. An increase within the normal range is biologically different from an increase into supraphysiological territory.

Does elevated DHT automatically cause hair loss? Not necessarily. Androgenetic alopecia is mediated by DHT binding to androgen receptors in hair follicles, but susceptibility depends on the density and sensitivity of those receptors, which is genetically determined. Many men with normal or high DHT levels retain full hair throughout their lives. Others lose hair despite normal DHT levels. The relationship between circulating DHT and follicular DHT sensitivity is complex, and systemic DHT levels are a poor predictor of individual hair loss patterns.

Did the study show hair loss? No. It did not measure, observe, or report any hair loss in any participant. This is the most critical point. The entire myth is built on an extrapolation from a hormonal marker that was incidentally measured in a non-replicated study that remained within normal ranges.

Why This Study Has Not Been Replicated

In the years since 2009, no published study has replicated the finding that creatine supplementation elevates DHT. This is notable because creatine is one of the most frequently studied supplements in the world. If creatine produced a reliable, reproducible increase in DHT, the signal would have appeared in the hormonal panels routinely included in creatine research.

Several factors may explain the original finding. The study population was young South African rugby players undergoing intense training. Exercise itself can transiently alter hormone levels. The absence of a properly matched control group makes it difficult to isolate the creatine effect from training effects, dietary effects, or normal hormonal fluctuation. The small sample size increases the likelihood that the finding represents statistical noise rather than a real biological effect.

What Other Studies Show About Creatine and Hormones

Numerous studies have measured testosterone and related hormones in creatine users. The consistent finding is that creatine supplementation does not significantly alter testosterone levels. This is relevant because testosterone is the precursor from which DHT is synthesized via the enzyme 5-alpha reductase. If creatine does not alter the precursor, the mechanism for a downstream DHT effect is unclear.

Volek et al. (2004) examined the hormonal response to creatine supplementation combined with resistance training. No significant changes in resting testosterone or DHT were observed. Cook et al. (2011) measured salivary testosterone before and after creatine supplementation and found no significant effects. The weight of evidence across multiple studies points consistently away from creatine having meaningful androgenic effects.

Antonio et al. (2021) conducted a systematic review and meta-analysis specifically addressing whether creatine supplementation affects testosterone. Analyzing data from 22 studies with a combined total of over 700 participants, they found no significant effect of creatine on total testosterone, free testosterone, or DHT. This meta-analysis represents the most comprehensive assessment of this question and directly contradicts the isolated finding of the van der Merwe study.

The Psychology of the Myth

Understanding why this myth persists requires acknowledging the demographic overlap between creatine users and the population most susceptible to androgenetic alopecia. Men in their late teens through thirties are the primary consumers of creatine supplements. This is also the age range when male pattern baldness typically begins. When a young man starts taking creatine and subsequently notices hair thinning, the temporal association creates a compelling narrative of causation, even when none exists.

Androgenetic alopecia affects approximately 50% of men by age 50, with onset commonly beginning in the twenties. The base rate is so high that coincidental timing between starting creatine and noticing hair loss is statistically expected in a large population of users, regardless of any causal relationship.

What the Evidence Actually Supports

The honest summary of the evidence is that one small study found an acute elevation in DHT (within normal ranges) during a creatine loading protocol in rugby players, without measuring or observing any hair loss. This finding has not been replicated. Multiple studies and a comprehensive meta-analysis have found no effect of creatine on testosterone or DHT levels. No study has ever documented hair loss as a consequence of creatine supplementation.

This does not prove that creatine cannot, under any circumstances, influence hair loss in genetically susceptible individuals. Proving a negative is epistemologically impossible. But the evidence required to support the positive claim (that creatine causes hair loss) does not exist. The gap between a single unreplicated hormonal finding and a definitive causal claim about hair loss is enormous, and no research has bridged it.

Practical Guidance

If you are genetically predisposed to androgenetic alopecia and concerned about DHT, the decision to take creatine should be informed by the actual evidence rather than by internet speculation. The current evidence does not support the claim that creatine accelerates hair loss. However, hair loss is deeply personal, and individual comfort levels with theoretical risks vary.

If you begin creatine supplementation and notice hair changes, the most likely explanation is coincidental timing with the natural progression of androgenetic alopecia. A dermatologist can evaluate whether your hair loss pattern is consistent with genetic factors, and hormonal panels can assess whether your DHT levels are within normal ranges.