Is creatine supplementation associated with patchy hair loss?

Creatine Supplementation and Patchy Hair Loss

There is no evidence that creatine supplementation causes patchy hair loss. The most recent and highest quality evidence directly examining this relationship found no connection between creatine use and hair loss 1.

Evidence Overview

Direct Evidence on Creatine and Hair Loss

• A 2025 randomized controlled trial specifically investigating creatine's effects on hair follicle health found no significant differences in hair-related outcomes between creatine and placebo groups after 12 weeks of supplementation 1.
• The study measured total testosterone, free testosterone, DHT levels, and directly assessed hair follicle health using Trichogram tests and the FotoFinder system (measuring hair density, follicular unit count, and cumulative hair thickness).
• No group-by-time interactions were observed for any hormones or hair-related outcomes, providing strong evidence against the claim that creatine contributes to hair loss 1.

Patchy Hair Loss Etiology

• Patchy hair loss is most commonly associated with alopecia areata, an autoimmune condition where the immune system attacks hair follicles 2.
• Alopecia areata is characterized by well-defined patches of hair loss and is not linked to nutritional supplements in clinical guidelines 2.
• Treatment options for alopecia areata include topical or intralesional corticosteroids, contact immunotherapy, and other immunomodulating therapies 2.

Creatine Safety Profile

• Creatine monohydrate is generally considered safe and well-tolerated in healthy individuals 3, 4.
• The most commonly reported side effect is transient water retention in the early stages of supplementation 3, 4.
• Comprehensive reviews of creatine supplementation do not list hair loss as a recognized side effect 5, 6.

Differential Diagnosis for Patchy Hair Loss

If experiencing patchy hair loss, consider these more likely causes:

1. Alopecia areata: Characterized by well-defined patches of hair loss, often with "exclamation mark" hairs at the periphery 2.

2. Nutritional deficiencies:

   • Iron deficiency may contribute to hair loss, though evidence is mixed 2.
   • Zinc deficiency has been associated with hair loss in some studies 2.
   • Vitamin D deficiency has been consistently demonstrated in patients with alopecia areata 2.

3. Endocrine therapy-induced alopecia: Characterized by grade 1 alopecia primarily on the crown and recession of frontal and bitemporal hairline 2.

4. Chemotherapy-induced alopecia: Usually results in diffuse grade 2 alopecia on the entire scalp 2.

Conclusion for Clinical Practice

If a patient taking creatine supplements presents with patchy hair loss, clinicians should:

1. Consider alopecia areata or other common causes of patchy hair loss rather than attributing it to creatine supplementation.

2. Evaluate for nutritional deficiencies, particularly iron, zinc, and vitamin D levels 2.

3. Recognize that the current scientific evidence does not support a causal relationship between creatine supplementation and hair loss 1, 5.

4. Understand that standard creatine supplementation protocols (loading with 20g/day for 5-7 days followed by maintenance of 3-5g/day, or simply 2-5g/day for 28 days) are generally safe and well-tolerated 3.

The most recent and highest quality evidence directly examining this relationship demonstrates that creatine supplementation does not contribute to hair loss 1.