Does creatine cause hair loss?

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Although plausible, it seems unlikely that supplementing with creatine causes hair loss.

By binding to androgen receptors in susceptible hair follicles, dihydrotestosterone (DHT; a testosterone metabolite) can cause hair follicles to shrink, ultimately leading to hair loss.[1][2] That said, whether a given hair is more or less likely to fall depends on its location (in male-pattern hair loss, the crown and hairline thin first) and the person’s genetic predisposition to hair loss.[3][4]

A proposed mechanism behind creatine’s effect on testosterone

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The idea that supplemental creatine could be linked to hair loss largely originates from the findings of a 2009 randomized controlled trial.[5] In this trial, college-aged male rugby players who took creatine monohydrate for 3 weeks experienced a 41% increase in their blood levels of DHT. The baseline DHT concentration was 0.98 nmol/L and the concentration after 3 weeks was 1.26 nmol/L, with both values being well within the normal range.

To date, this has been the only trial testing creatine’s effects on DHT. However, 12 other trials have tested creatine’s effects on testosterone. Of these, only two trials (lasting 6 and 7 days) have reported increases in testosterone levels,[6] [7] while the remaining 10 trials (which ranged in duration from 6 days to 12 weeks) found no effect.[8][9][10][5][11][12][13][14][15][16] Importantly, 5 of these trials specifically tested creatine’s effects on free testosterone, the form of testosterone that gets converted to DHT, and found no significant increases.[8][11][13][9][15]

Lastly, and perhaps most importantly, the effect of supplemental creatine on hair loss hasn’t been directly studied, so all we can do is make educated guesses.

To sum up: (i) Only one trial has reported an increase in DHT levels with supplemental creatine; (ii) although DHT levels increased, they stayed well within the normal range; (iii) no other trials have looked at the effect of supplementing with creatine on DHT levels, but 10 of the 12 trials looking at the effect of supplemental creatine on testosterone, five of which also looked at free testosterone, reported no effect; and (iv) the effect of supplemental creatine on hair loss hasn’t been directly studied.

With the above in mind, we can conclude that, although plausible, it seems unlikely that supplementing with creatine causes hair loss.

References
2.^Trüeb RMMolecular mechanisms of androgenetic alopeciaExp Gerontol.(2002 Aug-Sep)
3.^Nyholt DR, Gillespie NA, Heath AC, Martin NGGenetic basis of male pattern baldnessJ Invest Dermatol.(2003 Dec)
4.^Rathnayake D, Sinclair RMale androgenetic alopeciaExpert Opin Pharmacother.(2010 Jun)
6.^Vatani DS, Faraji H, Soori R, Mogharnasi RThe Effects of Creatine Supplementation on Performance and Hormonal Response in Amateur SwimmersScience and Sports.(2011 Nov)
8.^Cooke MB, Brabham B, Buford TW, Shelmadine BD, McPheeters M, Hudson GM, Stathis C, Greenwood M, Kreider R, Willoughby DSCreatine supplementation post-exercise does not enhance training-induced adaptations in middle to older aged malesEur J Appl Physiol.(2014 Jun)
9.^Cook CJ, Crewther BT, Kilduff LP, Drawer S, Gaviglio CMSkill execution and sleep deprivation: effects of acute caffeine or creatine supplementation - a randomized placebo-controlled trialJ Int Soc Sports Nutr.(2011 Feb 16)
11.^Hoffman J, Ratamess N, Kang J, Mangine G, Faigenbaum A, Stout JEffect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletesInt J Sport Nutr Exerc Metab.(2006 Aug)
13.^Volek JS, Ratamess NA, Rubin MR, Gómez AL, French DN, McGuigan MM, Scheett TP, Sharman MJ, Häkkinen K, Kraemer WJThe effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreachingEur J Appl Physiol.(2004 May)
15.^Rahimi R, Faraji H, Vatani DS, Qaderi MCreatine supplementation alters the hormonal response to resistance exerciseKinesiology.(2010)
16.^Volek JS, Boetes M, Bush JA, Putukian M, Sebastianelli W, Wayne J, Kraemer, WJResponse of Testosterone and Cortisol Concentrations to High-Intensity Resistance Exercise Following Creatine SupplementationJSCR.(1997 Ayg)