Van der Merwe 2009: Creatine and DHT — The Hair Loss Study

Creatine.my Editorial Team · · 5 min read
Fact-checked against peer-reviewed research · Our editorial policy
5 min read
This content is for educational purposes only and is not medical advice. Consult a healthcare provider before starting any supplementation.

Study Overview

Citation: van der Merwe J, Brooks NE,”;”; KH. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sport Medicine, 19(5), 399-404.

This is the single study that launched the widespread concern about creatine causing hair loss. It is one of the most misinterpreted studies in sports nutrition research. Understanding what it actually found — and what it did not find — is essential for informed decision-making.

1 study
Total studies ever showing a creatine-DHT connection — never replicated since 2009

Study Design and Methods

The study was a randomised, double-blind, placebo-controlled trial involving 20 college-aged male rugby players from South Africa. The protocol consisted of a 7-day loading phase (25g creatine per day) followed by a 14-day maintenance phase (5g per day). Researchers measured serum testosterone, dihydrotestosterone (DHT), and the testosterone-to-DHT ratio at baseline, after loading (day 7), and after maintenance (day 21).

Key Findings

What the Study Found

During the loading phase, DHT levels increased by approximately 56% from baseline. During the maintenance phase, DHT remained elevated at 40% above baseline. The testosterone-to-DHT ratio decreased, suggesting increased conversion of testosterone to DHT via the 5-alpha reductase enzyme.

56%
DHT increase during loading — but levels stayed within normal clinical range

Importantly, total testosterone levels did not change significantly. The effect appeared to be specifically on the conversion rate from testosterone to DHT, not on overall androgen production.

What the Study Did NOT Find

The study did not measure hair loss, hair thickness, hair follicle health, or any scalp-related outcome. There was zero observation of actual hair loss in any participant. The connection between this DHT finding and hair loss is entirely theoretical — based on the known role of DHT in androgenetic alopecia (male pattern baldness) in genetically predisposed individuals.

Critical Limitations

  1. Never replicated — No other study has shown creatine increases DHT
  2. No hair loss measured — The study measured hormones only, not hair outcomes
  3. Small sample size — Only 20 participants
  4. Short duration — 21 days total
  5. High loading dose — 25g/day is higher than the standard 20g/day loading protocol
  6. Single population — Young male rugby players; cannot generalise to all demographics
  7. DHT within normal range — Even with the increase, DHT levels remained within normal physiological limits
  8. Exercise confound — Rugby training itself affects hormone levels
(RB et al., 2017)

The DHT-Hair Loss Connection Explained

DHT is a potent androgen that plays a role in male pattern baldness — but only in individuals who are genetically predisposed. The mechanism involves DHT binding to receptors in hair follicles, causing miniaturisation and eventual hair loss.

However, several important caveats apply. Normal daily DHT fluctuations from exercise, diet, and stress can equal or exceed the increase seen in this study. Millions of men with normal DHT levels experience hair loss. Many men with elevated DHT have full heads of hair. Genetic predisposition is the primary determinant, not DHT levels alone.

What the Broader Research Shows

Multiple studies examining creatine and hormonal profiles have not found significant changes in DHT or testosterone. A 2021 systematic review and meta-analysis examined 22 studies on creatine and testosterone, finding no significant effect on total testosterone, free testosterone, or DHT levels.

Malaysian Relevance

Hair loss is a significant concern across all demographics in Malaysia. This study’s findings should be viewed in context: a single unreplicated study with no actual hair loss measurement. Malaysian men concerned about hair loss should consider that genetics, age, and overall health are far more significant factors than creatine supplementation.

Sources and References

  • van der Merwe J, et al. (2009). Three weeks of creatine monohydrate supplementation affects DHT to testosterone ratio. CJSM, 19(5), 399-404.
  • Kreider RB, et al. (2017). ISSN position stand. JISSN, 14, 18.
  • Antonio J, et al. (2021). Common questions and misconceptions about creatine supplementation. JISSN, 18, 13.

Study Design and Methodology

Understanding how a study was designed helps assess the strength of its conclusions. Key methodological factors to evaluate include:

  • Sample size — larger studies (n=50+) provide more reliable results than small studies (n=10-15). Small sample sizes increase the risk of false positives and limit the ability to detect moderate effect sizes
  • Study duration — creatine research requires adequate duration for muscle saturation (minimum 4 weeks for maintenance dosing, 1 week for loading). Studies shorter than this may miss the full effect
  • Blinding — double-blind, placebo-controlled designs (where neither researchers nor participants know who receives creatine) are the gold standard for minimising bias
  • Population studied — results from trained athletes may not fully apply to untrained individuals, and vice versa. Age, sex, and dietary habits (particularly vegetarian status) also influence creatine response
  • Outcome measures — direct measures (muscle biopsy, MRS imaging) are more informative than indirect proxies (blood markers, performance tests) for assessing creatine uptake and metabolism

Clinical Implications and Practical Relevance

This research contributes to our understanding of creatine in several practical ways:

For athletes and fitness enthusiasts: The findings support the use of creatine monohydrate as a safe, effective ergogenic aid. The standard dosing protocol of 3-5g daily remains well-supported by the cumulative evidence base including this study.

For healthcare professionals: Understanding the specific mechanisms and safety data from studies like this helps clinicians provide evidence-based guidance to patients who ask about creatine supplementation. The research consistently shows a favourable safety profile at recommended doses.

For the Malaysian context: While most creatine research is conducted in Western populations, the fundamental biochemistry (ATP-phosphocreatine system) is universal. Malaysian consumers can apply these findings with confidence, adjusting for local factors like tropical climate (increased hydration needs) and halal dietary requirements (synthetic creatine monohydrate is permissible).

How This Fits Into the Broader Evidence

No single study should be used to make definitive claims about creatine supplementation. Instead, this research should be viewed as one piece of a much larger evidence base:

For a complete overview of the evidence, explore our Research Library which covers 60+ landmark creatine studies.

Further Reading

Sources & References

Full citations available in our Research Library.

Frequently Asked Questions

Does creatine cause hair loss?

There is no direct evidence that creatine causes hair loss. The van der Merwe 2009 study found a DHT increase but did not measure hair loss. DHT levels remained within normal clinical ranges.

How many studies have linked creatine to hair loss?

Only one study (van der Merwe 2009) found a DHT increase with creatine. It has never been replicated, and the study did not measure hair loss as an outcome.

Should I avoid creatine if I am worried about hair loss?

Based on current evidence, creatine supplementation at recommended doses is unlikely to cause hair loss. If you have a genetic predisposition to male pattern baldness, discuss with your doctor.

What did the van der Merwe study actually measure?

The study measured testosterone, DHT, and the T:DHT ratio in college-aged rugby players. It found a 56% increase in DHT during the loading phase, but DHT remained within normal ranges.