Does Creatine Cause Hair Loss? The Evidence Says No.

Creatine is something we take because we want to look and perform better, not worse. If it genuinely caused hair loss, that would be a terrible trade for most of us — bigger lifts in exchange for a thinner hairline is not what anyone signed up for.

That's exactly why this question matters. And the short answer is: you can rest easy.

The scary story most of us have heard — "creatine raises DHT, and more DHT means more baldness" — comes almost entirely from one tiny 3-week study in 2009 that never even looked at hair. Here's why that claim falls apart at every level:

Still have questions? The Q&A below covers the specific creatine worries — what about higher doses, what if you're already prone to balding, what about women, and why so many people online swear it wrecked their hair.

4. How Hair Loss Actually Works (So We Don't Blame the Wrong Thing)

Before we can decide whether creatine is a villain, we need to be clear on what actually causes hair loss. Most people only know the simple story: "DHT shrinks your follicles." That's part of it, but the real picture is more complex – hormones, blood flow, inflammation, scar-like changes in the scalp, and timing all matter. ^{[1] [2] [3]}

For creatine, two buckets are especially relevant:

Once you understand these two, it becomes much easier to see why a small, short-term bump in serum DHT from one 3-week study is not a convincing "creatine = baldness" smoking gun. ^{[1] [3] [4]}

4.1 Androgenetic Alopecia: Pattern Baldness 101

This is the familiar pattern:

• Men: receding temples, thinning at the crown, often progressing to a "horseshoe"
• Women: more diffuse thinning on top; hairline often preserved

By around age 70, up to ~80% of men and about half of women show some degree of AGA. ^{[1] [4]}

The DHT + Receptor Story (The Bit Everyone Knows)

Testosterone is converted into dihydrotestosterone (DHT) by the enzyme 5-α-reductase. ^{[1] [4] [5]}

Hair follicles in certain scalp regions (temples, crown) have more androgen receptors and higher 5-α-reductase activity, so they "see" more DHT and respond more strongly to it. ^{[1] [4] [5]}

Crucial Point: Two people can have similar blood DHT levels but very different hairlines, because what really matters is local follicle sensitivity and local scalp DHT, not just a single serum number. ^{[1] [4] [5]}

That's why a small, short-term change in serum DHT (like the 2009 creatine study reported) does not automatically mean "you're going bald now." ^{[1] [3] [4]}

Blood Flow: Why Balding Scalp Is Under-Fed

DHT isn't the whole story.

• A classic study on early male pattern baldness found subcutaneous blood flow in balding scalp was ~2.6× lower than in age-matched men with full hair. ^[2]
• More recent work shows that androgen signalling in the dermal papilla (the "control centre" at the base of the follicle) is associated with regression of tiny blood vessels around the follicle in balding areas. ^{[3] [6]}

Less blood flow means less oxygen and fewer nutrients reaching follicles. That's one reason minoxidil helps even though it doesn't block DHT: it's a vasodilator that increases local blood flow and pro-growth signals to follicles. ^{[1] [7]}

Inflammation, Fibrosis, and Scar-Like Tissue Around Follicles

On top of hormones and blood flow, balding areas often show: ^{[8] [9]}

• more inflammatory markers around follicles
• more fibrotic (scar-like) tissue in the scalp compared with non-balding areas

Experimental work suggests: ^{[8] [9]}

• Androgens like DHT can activate fibrotic pathways (e.g. TGF-β1, collagen production) around follicles.
• Chronic low-grade inflammation + fibrosis makes the environment more hostile to hair and can physically "strangle" follicles over time.

You don't need every mechanistic detail for a creatine article, but the takeaway is simple:

Pattern hair loss is a slow, multi-factorial process driven by genetics, androgens, blood-flow changes, inflammation, and tissue remodelling – not a single hormone spike on a random Tuesday. ^{[1] [4] [8] [9]}

Dormant vs Dead Follicles: Timing Actually Matters

More recent work has highlighted an important nuance: miniaturised follicles aren't instantly "dead" – they can sit dormant for years. ^{[5] [11]}

• The tiny arrector pili muscle (the one that gives you goosebumps) attaches to the follicle near the stem-cell-rich "bulge" region. ^{[5] [11]}
• In reversible hair loss, this muscle attachment and stem-cell niche are still present.
• In long-standing, irreversible bald patches, that muscle connection is often lost and the bulge region is disrupted – a "point of no return". ^{[5] [11]}

This matters for emotions more than for creatine:

• Early, consistent treatment can revive a lot of "sleeping" follicles.
• Waiting 10+ years and then panicking that creatine is the problem is focusing on the wrong enemy.

4.2 Telogen Effluvium: The Delayed Stress Shedding People Love to Blame on Creatine

Now the other huge piece of the puzzle: telogen effluvium (TE).

Your hair grows in cycles: ^[6]

• Anagen (growth) – years of active growth
• Catagen (transition) – brief in-between phase
• Telogen (resting/shedding) – a few months of "chilling" before the hair falls out and a new one starts

At any moment, most hairs are in anagen; a smaller percentage are in telogen.

Telogen effluvium happens when some kind of stress pushes a large number of hairs out of growth and into telogen at the same time. ^{[6] [12]}

The key "gotcha":

The heavy shedding usually starts 2–3+ months after the trigger – not immediately. ^{[6] [12]}

So the real-world pattern is often:

1. You go through a stressor (illness, heavy diet, major life event).
2. Your body quietly shoves a chunk of anagen hairs into telogen.
3. Two or three months later, those telogen hairs all start shedding at once – often 200–300+ hairs per day instead of the usual ~50–100. ^{[6] [12] [13]}

Some hallmark features of TE: ^{[6] [12] [13]}

• Diffuse shedding – all over the scalp, not just temples/crown.
• The scalp itself usually looks normal (no scarring, no obvious inflammation).
• It's usually self-limited – once the trigger settles, regrowth happens over 3–6 months.
• The follicles aren't dead; they're just cycling differently.

Dermatology sources hammer three points: ^{[6] [12] [13]}

1. TE is a common cause of sudden, heavy shedding.
2. Shedding often peaks a few months after the trigger.
3. It usually resolves with time once the underlying stressor is sorted.

4.3 Why This Matters When People Blame Creatine

Putting it together:

Neither of those maps neatly onto:

"I took 5 g/day of creatine for a few weeks and suddenly my hair vanished – therefore creatine did it."

5. Why People Think Creatine Causes Hair Loss

If creatine doesn't actually have good evidence of causing hair loss, why are so many people convinced it does?

It mostly comes down to four things:

• 1. The 2009 Rugby Study A single, small study that showed a DHT bump but never measured hair.
• 2. Guilt by Association Creatine gets lumped in with steroids, which do cause hair loss.
• 3. Unfortunate Timing Men start creatine at the exact age (20s) when genetic hair loss naturally begins.
• 4. The Internet Echo Chamber Scary anecdotes go viral; "my hair is fine" stories are boring and invisible.

5.1 The 2009 Rugby Study That Refuses to Die

Almost every scary creatine–hair-loss claim eventually traces back to one paper:

"Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players." ^[14]

Here's what actually happened:

That's it. That's the whole thing.

• 20 guys
• 3 weeks
• big loading dose
• a short-term serum DHT bump
• zero hair data

But those details got lost. What survived online was the simplified story:

"Creatine increases DHT. DHT causes baldness. Therefore creatine causes baldness."

That's where the myth starts.

5.2 Creatine's "Guilt by Association" with Steroids

The second big reason the myth sticks: people keep lumping creatine in with anabolic steroids.

In gyms and on social media you'll hear things like:

• "Creatine is basically a mild steroid."
• "Anything that boosts performance that much must mess with your hormones."

The creatine myth papers hammer this point home: ^{[15] [16]}

• Creatine does not act like an androgen
• It does not consistently raise testosterone or DHT across studies
• It's regulated more like a food/supplement, not like a hormone drug

But because:

1. a lot of lifters use both creatine and steroids, and
2. hair loss is a well-known side effect of real androgens in susceptible men ^[18],

…creatine ends up "guilty by association" when someone on a full PED stack starts losing hair and lists creatine alongside the actual culprits.

5.3 Age & Timing: Guys Start Creatine Right When Hair Loss Naturally Begins

Most guys don't start creatine at age 10. They start when they get serious about lifting – typically in their late teens, early 20s, or even late 20s to early 30s when they finally decide to "bulk and cut properly."

That same age window often comes with stressors that can trigger telogen effluvium: big training blocks, aggressive diet phases and cuts, high work or life stress, and illnesses.

And remember: TE has a built-in time delay. Shedding typically starts 2–3+ months after a stressor. ^{[6] [12]} The shedding is diffuse, sudden, and dramatic – which makes it very memorable and easy to misattribute.

The Timeline That Tricks Everyone:

From your perspective: "I started creatine → my hair started falling out → creatine did it."

The Reality: Dermatology reviews emphasise that the trigger and shedding are often separated by 3–4 months, making it incredibly easy to blame the wrong thing. ^{[6] [12]} Creatine just happens to be the new, visible variable when the shedding finally shows up.

5.4 Anecdotes + The Internet Amplification Loop

Finally, there's the way stories spread online. A few psychological quirks make "creatine killed my hair" feel much stronger than it really is.

Availability Bias: Dramatic Stories Are Over-Represented

"I lost hair after starting creatine" is dramatic and gets posted everywhere. "I took creatine for 5 years and nothing happened" is boring and rarely gets shared.

Your feed fills up with drama and stays silent about the countless people who used creatine without issues. This creates a false impression of how common the problem really is.

No Control Group: You Don't Know What Would Have Happened Anyway

The guy reporting hair loss on creatine almost never knows if he would have lost hair without it, especially if he:

• Has a strong family history of baldness
• Is in the age window where AGA normally starts
• Had recent stress, illness, dieting, or is taking other drugs

All of that gets collapsed into "creatine did it" because creatine is the simplest thing to point at.

Everything Changes at Once

When someone "gets serious" about training, they usually change multiple things simultaneously: new training program, calorie shifts, added cardio, more caffeine or pre-workout, maybe even TRT or other performance enhancers, and often less sleep from the increased workload.

The Internet Rewards Simple, Scary Stories

The creatine myth papers sum it up: The belief that creatine causes hair loss is driven far more by anecdotes and that one 2009 DHT study than by any consistent signal in the actual creatine literature. ^{[15] [16]}

The internet rewards loud, scary, simple narratives – not quiet, boring "no effect" results.

6. Evidence at a Glance: Key Studies on Creatine & Hair

Here's the short version of what the actual research says.

6.1 The Main Studies

6.2 What All of This Actually Means

At normal gym doses (around 3–5 g/day), creatine has not been shown to cause hair loss in healthy men in controlled trials. ^{[19] [17] [15] [16]}

The entire "creatine → DHT → bald" narrative is built on one small 3-week study in 20 rugby players that used a big loading dose, measured blood DHT only, did not look at hair, and has never been replicated. ^{[14] [15] [16]}

Larger position stands and myth reviews now basically say the same thing: there is no good evidence that creatine, used as recommended, causes hair loss. ^{[17] [15] [16]}

7. Limitations of the Current Evidence

So far we've mostly talked about what the creatine data does show. To be honest and not oversell it, we also need to be super clear about what the data can't tell us (yet).

7.1 Timeframe: Mostly Weeks to Months, Not Years

The best hair-specific trial we have (Lak 2025) used 5 g/day creatine monohydrate, in resistance-trained men, for 12 weeks, and found no differences vs placebo in hormones or any hair metric. ^[19]

That's solid short-term evidence. But:

There are long-term safety data on creatine (up to 5 years at doses as high as 30 g/day in some clinical populations) showing no issues with kidney, liver, or general health markers. ^{[17] [20]} But those studies weren't designed to track hair.

Bottom line: Good short-term data for hair, good long-term data for general safety, but no giant "5-year hair RCT".

7.2 Who We've Actually Studied (and Who We Haven't)

Most of the detailed creatine research (including the hair trial) is in young to middle-aged men (often 18–40), healthy with no major endocrine disease, doing resistance training, and using standard doses. ^{[19] [17] [15] [16]}

Where the Evidence Is Thin or Basically Absent:

• Women, especially women with PCOS or other hyperandrogenic conditions, and women in perimenopause/postmenopause
• Older adults (50–60+) specifically in the context of hair, even though creatine itself has been studied in older populations for strength and health ^{[17] [20]}
• People on TRT or anabolic steroids, where androgen levels are already high
• People with hair disorders being medically treated (e.g., on finasteride/dutasteride/minoxidil) – we don't have formal trials asking "add creatine vs no creatine" in that setting

The big reviews are very explicit about this: they say creatine is generally safe across many populations, but most performance-oriented hormone data are in male athletes, and there is very little hair-specific data in women or special populations. ^{[17] [15] [16] [20]}

7.3 Doses and Forms: Standard Monohydrate vs Weird Mega-Dosing

The evidence base is basically built on creatine monohydrate, dosed as either: ^{[17] [15] [20] [22]}

• "Classic" protocol: ~0.3 g/kg/day for 5–7 days (≈20 g/day for a 70 kg person), then ~0.03 g/kg/day (~2–3 g/day) maintenance; or
• Simplified protocol: straight 3–5 g/day with no loading

The hair RCT (Lak 2025) used 5 g/day monohydrate with no crazy tricks. ^[19]

What We Don't Really Have:

• Long-term data on people habitually using silly-high doses (like 10–20 g/day) for months or years just for training
• Hair-specific data on non-standard forms (creatine ethyl ester, buffered creatine, random proprietary blends) – and frankly most of those forms don't even beat monohydrate for performance ^{[17] [20] [22]}

We do have safety data that even high-dose, long-term creatine (up to 30 g/day for months to years) doesn't mess with kidney function or basic health markers in various clinical and athletic populations. ^{[17] [20] [21]} But again: those studies weren't checking hair.

7.4 What's Actually Being Measured in Most Creatine Studies

Another important limitation: hair is almost never the endpoint.

Most creatine trials are about performance (strength, power, sprinting, lean mass), body composition, blood markers (kidney, liver, lipids, glucose), sometimes mood/cognition, and occasionally hormones (testosterone, DHT, cortisol). ^{[17] [15] [20] [22]}

Hair-related outcomes are:

• not mentioned at all in the vast majority of studies;
• only indirectly addressed via hormone changes;
• directly measured (with trichoscopy/trichogram) in basically one RCT so far. ^[19]

That means if creatine caused some very subtle, very slow effect on hair in a small subset of people, most existing trials wouldn't be powered or designed to notice it.

What we can say is that creatine is used widely, we've looked closely at many health markers for years, and a "whoa, creatine users are going bald in droves" signal has not popped up in the clinical literature or big safety analyses. ^{[17] [20] [21] [22]}

7.5 Hair Is Messy and Multi-Factorial

Finally, hair loss itself is a moving target. Androgenetic alopecia depends on genetics, local follicle sensitivity, lifetime androgen exposure, blood flow, and tissue changes – not just one hormone reading. ^[1] Telogen effluvium adds another layer with delayed, stress-triggered shedding that can appear months after illness, dieting, surgery, or major psychological stress. ^[6]

Trying to isolate the effect of one supplement on something this complex, over years, in the real world is genuinely hard.

Even if someone did a big observational study saying "we followed lifters for 10 years", you'd still be juggling genetics, androgens/TRT/steroids, illness and stress, diet changes and weight cycling, hair treatments, random supplements, and just… aging.

That's why the cleanest piece of data we have is that 12-week RCT with placebo and direct hair measurements – and in that controlled environment, creatine did nothing different to hair vs placebo. ^[19]

7.6 What We Can Say (and What We Can't)

Putting all of that together:

8. Is There Even a Plausible Mechanism for Creatine to Cause Hair Loss?

At this point you might be thinking: "Okay, but could creatine logically make me lose hair, even if the studies haven't shown it yet?"

To answer that, we need to look at what creatine actually does in the body and see if there's any believable chain of events that ends in "more baldness".

8.1 What Creatine Really Does (in One Paragraph)

Creatine is not a hormone, not a steroid, and not some mystery "mass builder".

Your body already makes around 1–2 g of creatine per day from amino acids (arginine, glycine, methionine), and you get another 1–2 g/day from food if you eat meat or fish. ^{[17] [22]}

Supplementing creatine monohydrate basically increases your muscle and brain phosphocreatine stores, improves the ATP–phosphocreatine energy buffer, and lets you squeeze out a bit more work in short, high-intensity efforts (sets, sprints), which over time helps with strength and lean mass. ^{[17] [22]}

That's it. It's an energy buffer, not a hormone bomb.

8.2 Does Creatine Act Like an Androgen or DHT Booster?

Mechanistically, no:

• Creatine doesn't bind androgen receptors
• It isn't structurally related to testosterone or DHT
• It doesn't directly stimulate 5-α-reductase, the enzyme that turns testosterone into DHT ^{[17] [22] [15]}

Most hormone-focused studies show no consistent increase in total testosterone, free testosterone, or DHT with creatine at normal doses. ^{[15] [16] [20]}

The big myth-busting reviews explicitly say current evidence does not support the idea that creatine raises T, raises DHT, or causes hair loss. ^{[15] [16]}

The only "hint" we've ever seen is once again that pesky 2009 rugby study where 25 g/day for a week plus 5 g/day for 2 weeks raised serum DHT for 3 weeks in 20 guys – with no hair measurements, no replication, and no known mechanism explaining why that would happen. ^[14]

Even if you take that outlier at face value, you still have to ask: Is a temporary serum DHT bump within the normal physiological range, over a few weeks, enough to meaningfully change local scalp DHT and follicle behaviour in a way that shows up as increased hair loss?

So far, the only trial that actually checked hair directly says no. ^[19]

8.3 Serum DHT vs Local Follicle Biology

This is where Section 4 comes back in: hair follicles care about their local environment, not a single blood test.

Key points from androgenetic alopecia research: ^{[1] [11]}

• Follicles in balding areas (temples, crown) have higher androgen receptor expression, higher local 5-α-reductase activity, and different downstream signalling (like TGF-β1, Wnt, etc.)
• Miniaturisation happens over many hair cycles – we're talking years, not days
• Drugs that meaningfully slow pattern baldness (finasteride, dutasteride) do so by strongly and chronically lowering DHT, often by 50–70%+, not by small flickers on a lab test

By contrast:

• Creatine doesn't systematically alter those local follicle pathways
• Outside the one rugby study, it doesn't consistently raise serum DHT at all ^{[15] [16] [20] [14]}
• And in the 12-week trial with direct hair measurements, no difference appeared in hair density, hair thickness, follicular units, or anagen/telogen ratio between creatine and placebo ^[19]

8.4 What About Indirect Routes? Training, Stress, or Inflammation?

You could also imagine indirect "what if" routes:

Creatine lets you train harder → more training stress → more cortisol → hair issues?

In reality, resistance training done sensibly is not a recognised cause of hair loss, and creatine doesn't chronically spike cortisol. If anything, some studies show lower cortisol with creatine. ^[20]

Creatine changes water balance or cell volume → scalp inflammation or fibrosis?

Creatine does increase intracellular water in muscle, but we don't see evidence that it increases systemic inflammation, triggers fibrosis, or creates a hostile environment for follicles. ^{[17] [22] [20]}

If creatine were meaningfully driving inflammatory or fibrotic scalp changes, you'd expect dermatologists to notice a pattern, more than zero hair-specific trials showing a negative signal, and something in the safety literature flagging unusual hair issues.

So far: nothing. ^{[22] [15] [16] [19]}

8.5 How This All Lines Up With the Actual Data

Mechanism and evidence are telling the same story:

Could there be some exotic, subtle mechanism we haven't discovered yet that only affects a tiny subset of people in obscure conditions? In theory, sure. Biology is messy.

9. What If You Just Mega-Dose Creatine? Do You "Pee It Out" – And Could That Cause Hair Loss?

Let's zoom in on the exact fear a lot of people have but don't say out loud:

"Okay, maybe 3–5 g/day is fine. But what if I've been taking 10–20 g/day for ages? Am I nuking my hair or just wasting powder?"

We'll tackle two things: what actually happens in your body when you mega-dose creatine, and whether that realistically makes hair loss more likely.

9.1 Creatine Saturation: Once the Tank Is Full, It's Full

Your muscles can only hold so much creatine and phosphocreatine.

Classic muscle-biopsy work showed: ^[23]

• Take ~20 g/day of creatine monohydrate for 5–6 days → muscle total creatine increases by about 20% and basically saturates
• After that, you can maintain those levels with just ~2 g/day
• Alternatively, take ~3 g/day for ~4 weeks with no loading → you reach a similar saturation, just more slowly

So yeah – from a muscle/strength perspective: after saturation, taking 10–20 g/day instead of 3–5 g/day is basically "supercharging your toilet". You're not building "extra" muscle beyond what a proper dose can support.

9.2 What Mega-Dosing Actually Changes in the Body

If you hammer high doses long term, what does change?

Mechanistically and from safety data: ^{[17] [22]}

• Blood creatine and creatinine will be higher: Creatinine is a breakdown product of creatine, so more in → more out. That can make your creatinine blood test look higher, which can spook doctors who don't know you supplement – but it doesn't automatically mean kidney damage
• Kidneys just have more creatine/creatinine to filter: Long-term studies up to 20–30 g/day in various populations have not shown actual kidney injury in healthy people ^{[17] [22] [21]}
• Muscle creatine doesn't climb forever: It hits a ceiling and plateaus; more dose does not equal "more storage"

So the main consequences of chronic mega-dosing are:

There's no evidence that mega-dosing suddenly turns creatine into a hormone, steroid, or inflammatory toxin.

9.3 Could Mega-Dosing Creatine Plausibly Cause Hair Loss?

To blame mega-dosed creatine for hair loss, you'd need some kind of believable chain that looks like:

more creatine → some biological change → more androgen signalling / inflammation / fibrosis around follicles → accelerated hair loss

Let's run through the usual suspects.

1. "More Creatine → More DHT?"

As far as we know, creatine does not bind androgen receptors, turn into any androgen, or directly stimulate 5-α-reductase (the enzyme that makes DHT). ^{[17] [15]}

Across multiple studies at normal doses, most find no significant change in testosterone or DHT. ^{[15] [16]} Creatine myth reviews explicitly say the total body of evidence does not support creatine as a testosterone or DHT booster. ^{[15] [16]}

The only counterexample is that one 2009 rugby study with 25 g/day for 7 days, then 5 g/day for 14 more days in 20 guys – DHT increased over 3 weeks, with no hair measurements and no replication since. ^[14]

Even if mega-dosing could replicate that short-term DHT bump (which we don't actually know, because no one's done long high-dose DHT trials), hair biology still works on years-long timescales and is driven by local scalp signalling – not small, transient shifts in serum DHT.

2. "More Creatine → More Stress → More Shedding?"

You could argue: creatine → harder training → more physical stress → telogen effluvium → shedding.

In reality, normal resistance training is not a recognised cause of telogen effluvium. TE is usually linked to significant illness or fever, surgery, crash dieting, childbirth, major psychological stress, or certain meds or deficiencies. ^[6]

If anything, creatine tends to improve training tolerance and reduce perceived fatigue, not wreck you. There's no evidence that high-dose creatine drives the kind of systemic shock that causes telogen effluvium.

So that path is also pretty flimsy.

3. "More Creatine → Inflammation or Fibrosis Around Follicles?"

We know from androgenetic alopecia research that chronic low-grade inflammation and fibrosis around follicles are part of the balding process. ^{[8] [9]}

If mega-dosed creatine was increasing systemic inflammation, damaging microvasculature, or promoting scalp fibrosis, you'd expect some signal in the safety literature: raised inflammatory markers, worsened cardiometabolic risk, more skin/scalp complaints, something.

Instead, long-term creatine supplementation in healthy people generally shows no increase in inflammatory markers, no increase in cardiovascular risk, and no consistent pattern of weird dermatologic issues – and definitely no "everyone's hair is falling out" red flag. ^{[17] [22] [21] [15]}

So that hypothetical route is also pretty unsupported.

9.4 Mega-Dosing vs Hair Loss: What Actually Makes Sense?

Putting it together:

Still, there's zero upside to chronic mega-dosing:

• You don't get more gains once you're saturated
• You move away from the dosing range where the evidence is strongest
• You just add noise if you're trying to troubleshoot anything (hair or otherwise)

10. What To Actually Do If You're Worried About Hair Loss (Even a Little)

Here's the most important part of the whole article: If you're worried about your hair, that alone is a good enough reason to start doing something about it.

You don't have to wait until it looks "bad enough". Statistically, if you're starting to notice changes – or even just stressing about them – early treatment is safer and more effective than waiting. ^{[25] [31]}

And the good news: the most effective first-line combo is relatively simple and very well-studied.

10.1 Step 1 – Get a Baseline and Be Honest With Yourself

Before you tweak anything, take clear photos in good light: front, both temples, crown, top-down. Repeat every 1–2 months from the same angles.

This does two things:

• It stops you going insane over day-to-day fluctuations
• It gives you actual evidence of whether things are getting better, worse, or stable

10.2 Step 2 – Start the "No-Regrets" Hair Stack: Microneedling + Minoxidil

If you're worried, this is where you should seriously consider starting – even if you keep creatine in.

Minoxidil (Topical)

Usually 5% foam or liquid once or twice daily (men), lower or once daily for some women depending on the doctor's advice. ^[26]

It increases local blood flow, prolongs the growth phase, and can increase hair counts and thickness. ^{[26] [31]}

Common side effects:

• Scalp irritation, dryness, flaking
• Initial "shedding phase" in the first 2–8 weeks as weak hairs are pushed out and replaced. That's expected, not a sign it's failing ^[26]
• Rarely: dizziness, palpitations, unwanted facial hair if it drips/runs off – if that happens, talk to your doctor

Microneedling

Microneedling (usually with a dermaroller or pen, once weekly or every 2 weeks) creates tiny controlled injuries in the scalp.

Side effects in those trials? Basically just mild redness and slight soreness or tingling for a day or so. No serious adverse events were reported when done properly (clean tools, correct needle depth, not going crazy with pressure). ^[10]

So yes – if you're worried, it is absolutely reasonable to say: "I'm going to start minoxidil + microneedling now, because the odds are strongly in favour of this slowing or reversing my loss, and the downside is small."

10.3 Step 3 – Add Ketoconazole Shampoo as an Easy Extra

This one's low effort: use a 1–2% ketoconazole shampoo a few times per week (often alternating with a regular gentle shampoo).

It has anti-fungal effects, anti-inflammatory action, and some mild anti-androgenic properties in the scalp. ^{[27] [30]}

Studies and reviews suggest ketoconazole shampoos can support other treatments and may help reduce inflammation and micro-environment stuff in androgenetic alopecia. ^{[27] [30]}

Side effects are usually mild: dryness or irritation if overused, rarely contact dermatitis.

10.4 Step 4 – Consider DHT Blockers (With a Doctor)

This is the "big gun" category: oral or topical finasteride / dutasteride.

They work by blocking 5-α-reductase, reducing DHT and slowing miniaturisation. Multiple RCTs show 1 mg finasteride daily slows progression and increases hair counts over years vs placebo. ^{[25] [28] [32]}

So: These are prescription-only for a reason. They're powerful and effective, but they're a "talk frankly with your doctor" move, not a casual supplement.

10.5 Step 5 – Keep Creatine Boring and Evidence-Based

While you're doing all of the above, creatine really doesn't need to be the main character.

If you use it, stick to creatine monohydrate, 3–5 g/day after an optional brief loading phase, which is exactly the dose where performance benefits are clear, long-term safety is strong, and the 12-week RCT found no difference in hair vs placebo. ^{[17] [15] [19]}

If that still makes you anxious, you can always pause creatine for a bit – but do it knowing the bigger win is from treatments that directly target hair loss, not from dropping a supplement that hasn't been shown to cause it.

10.6 Step 6 – Get a Dermatologist Involved (Especially If Nothing Happens)

A dermatologist is worth their weight in gold if:

• Your hair loss doesn't respond to minoxidil + microneedling + ketoconazole after 6–12 months of consistent use
• The pattern looks weird: patchy loss, strong redness/itching, obvious scarring, hair loss in brows/lashes/body hair
• You have other symptoms: fatigue, weight changes, menstrual changes, joint pain, etc.

At that point, the problem might not be simple androgenetic alopecia. It could be telogen effluvium from an undiagnosed medical issue, alopecia areata (autoimmune), a scarring alopecia, or something completely unrelated to creatine. ^{[25] [6] [12] [31]}

A good derm can confirm the diagnosis, tweak or escalate your treatment plan, order the right bloodwork, and make sure you're not missing something bigger.

10.7 Big Picture

If you remember nothing else from this section: