Creatine is one of the most popular performance supplements used by athletes and fitness enthusiasts. Its reputation for enhancing strength and muscle growth is well-established, but a persistent concern often arises regarding its potential to cause hair loss or accelerate male pattern baldness. This fear stems from a theory involving hormonal changes, requiring an examination of creatine’s mechanisms and the research that proposed this controversial connection.
What Creatine Does in the Body
Creatine functions primarily by enhancing the body’s energy production system in skeletal muscle tissue. It helps quickly regenerate adenosine triphosphate (ATP), the fundamental energy currency of cells.
The body stores creatine largely as phosphocreatine within the muscles, which acts as a rapid energy buffer. When ATP is used during high-intensity activities, phosphocreatine quickly restores ATP levels, allowing for sustained high-power output. Supplementing with creatine increases these muscle stores, translating directly to improved strength and enhanced performance during anaerobic exercise.
The Proposed Link to Dihydrotestosterone Levels
The concern linking creatine to hair loss originated from a 2009 randomized controlled trial involving college-aged male rugby players. This study found that after a seven-day loading phase, participants experienced a significant increase in the concentration of dihydrotestosterone (DHT) in their blood. Serum DHT levels rose by 56% after one week, remaining 40% above baseline after the two-week maintenance period.
Dihydrotestosterone is a potent androgen hormone created when the enzyme 5-alpha reductase converts testosterone. The observed rise in DHT suggested that creatine might increase the activity of this conversion enzyme, even though total testosterone levels did not change. High levels of DHT are strongly implicated in Androgenic Alopecia, the scientific term for male pattern baldness.
In genetically susceptible individuals, DHT binds to hair follicle receptors, causing them to shrink and eventually stop producing hair. Importantly, even with the observed increase in the 2009 study, the participants’ DHT levels remained within the normal clinical range for healthy adult males.
Scientific Consensus on Creatine and Hair Loss
Subsequent research has not supported the idea that creatine causes baldness. Multiple clinical trials investigating creatine’s effects on hormonal markers have largely failed to replicate the rise in DHT. Most studies examining the hormonal impact of creatine found no changes in total testosterone, free testosterone, or DHT levels.
A recent 12-week randomized controlled trial provided the first direct assessment of hair follicle health following supplementation. This study found no differences between the creatine and placebo groups in DHT levels, the DHT-to-testosterone ratio, or measured hair growth parameters like hair density. Baldness is primarily driven by genetic predisposition and sensitivity to normal DHT levels, not by small, temporary fluctuations from supplementation.