Does creatine cause hair loss?

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The idea that creatine might increase hair loss stems from a single randomized controlled trial (RCT) whose participants (20 healthy, young, male rugby players) saw a small but statistically significant increase in dihydrotestosterone DHT after supplementing with creatine for 21 days.[1] When DHT, a potent metabolite of testosterone, binds to DHT receptors on the hair follicles of the scalp, those follicles may shrink and stop producing hair.[2][3]

To date, this RCT is the only one to have tested creatine’s effects on DHT. However, a number of RCTs have examined creatine’s effects on testosterone. Out of 12 RCTs, two saw a significant increase in testosterone,[4][5] but 10 saw no effect.[1][6][7][8][9][10][11][12][13][14] Of those 12 RCTs, five also tested creatine’s effects on free testosterone, the form that gets converted into DHT, and all saw no significant increase.[6][7][9][11][13]

A proposed mechanism behind creatine’s effect on testosterone

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Theoretically, creatine could significantly increase DHT without increasing free testosterone. So while it’s technically possible that creatine might have some effect on hair loss, current evidence and mechanistic data indicate it’s quite unlikely.

References
3.^Trüeb RMMolecular mechanisms of androgenetic alopeciaExp Gerontol.(2002 Aug-Sep)
6.^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)
7.^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.^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)
11.^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)
13.^Rahimi R, Faraji H, Vatani DS, Qaderi MCreatine supplementation alters the body's hormonal response to exerciseKinesiology.(2010 JAN)
14.^Volek JS, Boetes M, Bush JA, Putukian M, Sebastianelli WJ, Jraemer WJResponse of Testosterone and Cortisol Concentrations to High-Intensity Resistance Exercise Following Creatine SupplementationJ STRENGTH COND RES.(1997)