If you’ve read articles by me on supplements before, you’ll know that I tend to be more negative than positive about certain supplements. Creatine is one of the products I’m positive about. Since writing the original article, I’ve written several more about creatine, all of which are positive about its effects or don’t mention any adverse effects on the kidneys or the body’s own production of creatine with long-term use.
Hair Loss Due to Creatine
With genuine reluctance, I have something negative to report after inquiries about creatine and hair loss. Creatine has been mentioned more than once as a cause of baldness, and not without reason. In short, there are two assumptions that suggest this.
- Creatine leads to higher DHT levels.
- DHT causes hair loss.
Creatine and DHT
For an extensive explanation of creatine, you can click here. In short, creatine provides more energy by increasing ATP levels, the primary source of energy during short-duration high-intensity efforts (about 45 seconds). The contribution of creatine (phosphate) is one of the most well-researched and substantiated topics regarding dietary supplements. It is also one of the most popular and sold supplements, particularly for strength athletes.
DHT stands for dihydrotestosterone. This is a metabolite of the male sex hormone testosterone. This means that testosterone in the body can be converted into dihydrotestosterone. This occurs through the enzyme 5-alpha-reductase. This takes place in the testes, prostate, adrenal glands, and hair follicles. In men, approximately 5% of testosterone is normally converted into DHT. Both hormones have different effects on, among other things, muscle growth, the production of the female hormone estradiol…..and hair loss.
So, the androgenic properties (masculinizing properties including those related to the degree of muscle growth) of DHT are stronger than those of testosterone. Moreover, DHT is not partially converted into the female hormone estradiol as is the case with testosterone. This latter phenomenon leads to side effects in some anabolic users with high testosterone levels, such as bitch tits and shrinking testicles. More testosterone converted into DHT is therefore a good thing you might think? Yes, for the muscles, but not for some other things, including your hair.
DHT is, in fact, the biggest cause of androgenetic alopecia, or male pattern baldness. This is the most common form of baldness in men, affecting approximately 60-70 percent of men at some point, albeit to varying degrees. The well-known receding hairline that results in the monk-like hairstyle that some men hilariously try to cover up by sticking a few strands of hair from the side over the bald spot. It should not be surprising that a male hormone can cause this since mainly men go bald. As mentioned, DHT is produced, among other places, in the hair follicles. The body reacts in various ways to the hormone both positively and negatively. It causes body and facial hair to increase while decreasing that on the scalp. For the scalp, it can cause hair loss until the hair follicles eventually shrink and lead to baldness.
Increased Conversion of Testosterone to DHT
Okay, so DHT leads to hair loss, and creatine provides more energy. Who says creatine also leads to more DHT? That’s what researchers from Stellenbosch University in South Africa said when they published the results of their study on the influence of creatine on DHT:T ratio in the Journal of Sports Medicine [2]. They gave half of 20 rugby players creatine and glucose (to better absorb creatine) for 3 weeks and the other half a placebo. The creatine-glucose group received 25 grams of creatine and 25 grams of glucose in a loading phase for a week. In weeks two and three, the amount of creatine decreased to the usual 5 grams per day. In addition to the expected increase in lean body mass and a decreased fat percentage, they observed another effect when they looked at hormone levels. After the first week, DHT levels increased by 56%. In the following two weeks, this decreased as the creatine intake decreased, but the level remained elevated compared to the control group that received a placebo.
Creatine supplementation may, in part, act through an increased rate of conversion of T to DHT. Further investigation is warranted as a result of the high frequency of individuals using creatine supplementation and the long-term safety of alterations in circulating androgen composition. -J. van der Merwe, Stellenbosch University
How exactly creatine causes a greater conversion of testosterone to DHT, the researchers did not know. They suspect that this is because creatine increases the activity of the enzyme 5α-reductase. Besides the possibility that creatine works not only by increasing ATP but also by increased conversion of testosterone to DHT to increase muscle strength and mass, this would mean that creatine could indirectly lead to this unpleasant side effect of DHT, causing hair loss and baldness. However, there are some points to note about this study. In the table on the right, we see that the 56% increase was only after the loading phase. After that, it decreased by about 10%. Ultimately, the increase compared to the baseline was almost 40%. However, this was still about halfway within the normal range [clinical bioch]. Not particularly high, therefore.
DHT Blockers, Finasteride
In the majority of men with male pattern baldness endogenous production of DHT is markedly increased, providing a rationale for therapeutic 5[alpha]-reductase inhibition in this disorder. -H. Vierhapper, University of Vienna
The above quote comes from a study in Austria that found six out of eight bald men examined had increased DHT [1]. Reducing the activity of the enzyme 5-alpha-reductase responsible for the conversion to DHT could be a potential remedy. Since DHT is seen as the culprit in baldness, methods to reduce the conversion of testosterone to DHT have been explored. So-called DHT blockers inhibit the action of the enzyme 5α-reductase, reducing the conversion of testosterone to DHT. However, as mentioned, DHT has a much stronger androgenic effect, about 3 to 4 times stronger. This poses problems when there is too much DHT (including prostate enlargement), but also problems when there is too little. Potential side effects of popular drugs like Finasteride include a shrunken prostate, potency and erectile dysfunction, reduced libido, and possibly worsened sperm quality and reduced fertility. More success at the bar with your hair, but then less success in bed to put it bluntly. Any side effects disappear when the treatment is stopped.
Muscles or Hair?
The range for normal amounts of DHT is quite large, between 1.00 and 3.00 nmol/L (although these vary somewhat between different institutions). The values in the study increased in the creatine group from an average of 0.96, which is a bit low, to 1.53 nmol/L and after the loading phase to 1.38 nmol/L. So, these remain well within the reference values. Moreover, you usually don’t use creatine continuously, but a few weeks followed by a few weeks without. So, you have to weigh the increased DHT levels against the period you use creatine, although it’s unfortunate that the researchers didn’t look at how long it takes for DHT to decrease after stopping creatine. Finally, testosterone is converted into DHT in various places, not just in the hair follicles. The study does not answer where that extra DHT is produced. So, it’s not clear to what extent the total increase in DHT also means an increase in DHT produced in the hair follicles. The hereditary sensitivity of the hair follicles to DHT therefore seems more important than the amount of DHT itself, although this naturally influences the result of both factors. It is therefore plausible that the use of creatine does not suddenly cause you to go bald while you had a full head of hair down to your butt. All we know from this is that there is a chance that existing predisposition for hair loss and baldness is reinforced, although you may doubt the extent. Whether you stop using creatine because of this is personal. If your father was completely bald at 25 and you consider your hair as important as the cast of New Jersey Shore or if you comb your hair during halftime of a Euro Cup match like Ronaldo, then you may find a full head of hair more important than extra muscle mass (although the guys from Jersey Shore use substances other than creatine). In the words of Blacksheep: “The choice is yours!”. If you’re thinking, “A bald head is not for me,” also consider whether the photo of Sergio Oliva shown next to it, where his arms seem bigger than his head, would be as impressive if he had a big afro on his head 😉
References
- Vierhapper H, Nowotny P, Maier H, Waldhäusl W. Production rates of dihydrotestosterone in healthy men and women and in men with male pattern baldness: determination by stable isotope/dilution and mass spectrometry. J Clin Endocrinol Metab. 2001 Dec;86(12):5762-4.
- van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clin J Sport Med. 2009 Sep;19(5):399-404.
- file:///H:/2013-03-26-clinical-bioch~ence-ranges-handbook.pdf
