By how much does creatine supplementation increase serum dihydrotestosterone (DHT) levels?

Creatine Supplementation and DHT Levels

Based on the single controlled trial that directly measured DHT, creatine supplementation increased DHT levels by 56% after 7 days of loading (25g/day) and remained 40% above baseline after 14 days of maintenance dosing (5g/day), with the DHT:testosterone ratio increasing by 36% initially and remaining 22% elevated during maintenance 1.

The Evidence Landscape

The Original Finding

The 2009 study by van der Merwe et al. 1 in college-aged rugby players (n=20) remains the only published research that directly measured DHT changes with creatine supplementation. This double-blind, placebo-controlled crossover study found:

• After 7 days loading phase (25g/day): DHT increased 56%, DHT:T ratio increased 36%
• After 14 days maintenance (5g/day): DHT remained 40% above baseline, DHT:T ratio remained 22% elevated
• Testosterone levels did not change significantly
• The effect was statistically significant (P < 0.001 for DHT, P < 0.01 for DHT:T ratio)

The Contradictory Evidence

However, a much more recent and methodologically superior study directly contradicts these findings. The 2025 randomized controlled trial 2 in 38 resistance-trained males using 5g/day creatine monohydrate for 12 weeks found:

• No significant differences in DHT levels between creatine and placebo groups
• No changes in DHT:testosterone ratio
• No effects on hair follicle health (the first study to directly assess this)
• Longer duration (12 weeks vs 3 weeks) and more clinically relevant dosing (5g/day throughout, no loading)

Critical Analysis and Recommendation

The 2025 study 2 should supersede the 2009 findings for several reasons:

1. More recent and rigorous methodology: Direct assessment of the clinical concern (hair loss), longer duration, and appropriate statistical power
2. Clinically relevant dosing: Used 5g/day maintenance dosing throughout rather than high-dose loading
3. Failed replication: After 16 years, no other study has replicated the DHT findings from 2009
4. Sample size: While both studies were small, the 2025 study had better retention and more comprehensive outcomes

Important Caveats

• The 2009 study used a loading phase (25g/day) which may have produced transient hormonal effects not seen with standard maintenance dosing
• Neither study had sufficient power to detect small hormonal changes
• The 2009 study was conducted during competitive season in athletes, potentially introducing confounding variables
• No guidelines from endocrine societies address creatine and DHT because this is not considered a clinically significant concern in testosterone therapy monitoring 3, 4

Clinical Bottom Line

For patients using standard creatine dosing (5g/day), there is no reliable evidence of clinically significant DHT elevation. The single positive study used supraphysiologic loading doses and has not been replicated in 16 years, while the most recent direct investigation found no effect. The endocrine literature on testosterone therapy monitoring 3, 4 does not identify creatine as a concern for androgen-related adverse effects, further supporting that any DHT changes are likely clinically insignificant.