What is hair loss?
Hair loss, also known as alopecia, refers to the loss of hair on the body. There are various types of hair loss, all of which tend to differ in their underlying causes, prevalence, and the pattern in which hair is lost. Common types of hair loss include male- and female-pattern hair loss (collectively referred to as androgenic alopecia; AGA), alopecia areata, telogen effluvium, and anagen effluvium.[1]
What are the main signs and symptoms of hair loss?
Male-pattern hair loss typically begins with hair loss at the front of the hairline and/or on the crown of the head, with hair loss progression over time.[2] Female-pattern hair loss tends to feature diffuse hair thinning and hair loss across the top of the head, especially near the center of the scalp.[2] Alopecia areata involves hair loss in patches, which can regrow or precede complete loss of hair. Telogen effluvium and anagen effluvium both involve hair thinning and hair loss across the scalp.
How is hair loss diagnosed?
A medical professional may use various methodologies to diagnose hair loss, including visual examination, medical history, biopsy, and laboratory testing.[3]
One procedure often employed is a hair pull test.[4] In this test, a small section of hair is grasped and gently pulled on, with the process repeated at various areas of the scalp. The number of hairs that come out upon pulling can indicate if hair loss is occurring and its severity.
What are some of the main medical treatments for hair loss?
The only two drugs currently approved by the FDA for the treatment of androgenic alopecia are minoxidil (used topically) and finasteride (taken orally).[1] Of these, minoxidil is approved for the treatment of both male- and female-pattern hair loss, while finasteride is only approved for men with male-pattern hair loss. Other treatments used for androgenic alopecia include dutasteride, prostaglandin analogs (e.g., latanoprost), injection with platelet-rich plasma, and anti-androgens (for women with hair loss due to high androgen levels).
The first-line treatment for alopecia areata is the injection of corticosteroids into sites of hair loss.[5]
Have any supplements been studied for hair loss?
Several RCTs have tested the effect of individual supplements on hair loss, given either orally (including vitamin E and saw palmetto) or applied topically to the scalp (including pumpkin seed oil, melatonin, and procyanidin from apples).[6] A number of studies have also examined the effect of oral supplements containing a mixture of compounds, typically a combination of nutrients (e.g., amino acids and vitamins).
How could diet affect hair loss?
Research on the effect of diet on hair loss is very limited. One small case-control study found that men with high intakes of either raw vegetables or fresh herbs were less likely to have AGA.[7] In rare cases, certain nutrient deficiencies may lead to hair loss (especially in susceptible individuals), with one example being iron deficiency anemia.[8]
Are there any other treatments for hair loss?
Red light therapy involves the application of red and infrared light onto areas of the scalp, and available evidence indicates LLLT can prevent hair loss and potentially support hair regrowth in AGA.[9]
Microneedling (a procedure in which the skin is repeatedly punctured by a large number of very small needles) may be able to enhance the effects of minoxidil in preventing hair loss and producing hair regrowth in AGA.[10]
Ketoconazole is an antifungal medication that may reduce hair loss and potentially promote hair regrowth in AGA when applied to the scalp via medicated shampoo.[11]
What causes hair loss?
Male-pattern baldness is due in large part to an androgen (a so-called “male hormone") called dihydrotestosterone (DHT), which can sometimes contribute to female-pattern baldness as well. Other factors – like aging and genetics – can also increase the risk of male- and female-pattern baldness.
Alopecia areata is the result of the body's immune cells attacking hair follicles, resulting in inflammation and eventual hair loss.
Hair loss can also be the result of medical conditions, medications, and infection.
Examine Database: Hair Loss
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Frequently asked questions
Hair loss, also known as alopecia, refers to the loss of hair on the body. There are various types of hair loss, all of which tend to differ in their underlying causes, prevalence, and the pattern in which hair is lost. Common types of hair loss include male- and female-pattern hair loss (collectively referred to as androgenic alopecia; AGA), alopecia areata, telogen effluvium, and anagen effluvium.[1]
Male-pattern hair loss typically begins with hair loss at the front of the hairline and/or on the crown of the head, with hair loss progression over time.[2] Female-pattern hair loss tends to feature diffuse hair thinning and hair loss across the top of the head, especially near the center of the scalp.[2] Alopecia areata involves hair loss in patches, which can regrow or precede complete loss of hair. Telogen effluvium and anagen effluvium both involve hair thinning and hair loss across the scalp.
A medical professional may use various methodologies to diagnose hair loss, including visual examination, medical history, biopsy, and laboratory testing.[3]
One procedure often employed is a hair pull test.[4] In this test, a small section of hair is grasped and gently pulled on, with the process repeated at various areas of the scalp. The number of hairs that come out upon pulling can indicate if hair loss is occurring and its severity.
The only two drugs currently approved by the FDA for the treatment of androgenic alopecia are minoxidil (used topically) and finasteride (taken orally).[1] Of these, minoxidil is approved for the treatment of both male- and female-pattern hair loss, while finasteride is only approved for men with male-pattern hair loss. Other treatments used for androgenic alopecia include dutasteride, prostaglandin analogs (e.g., latanoprost), injection with platelet-rich plasma, and anti-androgens (for women with hair loss due to high androgen levels).
The first-line treatment for alopecia areata is the injection of corticosteroids into sites of hair loss.[5]
Several RCTs have tested the effect of individual supplements on hair loss, given either orally (including vitamin E and saw palmetto) or applied topically to the scalp (including pumpkin seed oil, melatonin, and procyanidin from apples).[6] A number of studies have also examined the effect of oral supplements containing a mixture of compounds, typically a combination of nutrients (e.g., amino acids and vitamins).
Research on biotin for hair growth is highly limited. Although biotin has been included in multicomponent supplements for hair loss,[18] no clinical trials have looked at the effect of biotin alone on hair growth or hair loss. Biotin deficiency often results in hair loss, but biotin deficiency is extremely rare, meaning it can’t be assumed that biotin will improve hair health in the vast majority of people.[19] Still, one study found that low biotin levels (<100 ng/L) were common among women with hair loss due to telogen effluvium.[20] Unfortunately, until clinical trials are performed, it is premature to say whether supplementation with biotin can promote hair growth.
Research on the effect of diet on hair loss is very limited. One small case-control study found that men with high intakes of either raw vegetables or fresh herbs were less likely to have AGA.[7] In rare cases, certain nutrient deficiencies may lead to hair loss (especially in susceptible individuals), with one example being iron deficiency anemia.[8]
Red light therapy involves the application of red and infrared light onto areas of the scalp, and available evidence indicates LLLT can prevent hair loss and potentially support hair regrowth in AGA.[9]
Microneedling (a procedure in which the skin is repeatedly punctured by a large number of very small needles) may be able to enhance the effects of minoxidil in preventing hair loss and producing hair regrowth in AGA.[10]
Ketoconazole is an antifungal medication that may reduce hair loss and potentially promote hair regrowth in AGA when applied to the scalp via medicated shampoo.[11]
Male-pattern baldness is due in large part to an androgen (a so-called “male hormone") called dihydrotestosterone (DHT), which can sometimes contribute to female-pattern baldness as well. Other factors – like aging and genetics – can also increase the risk of male- and female-pattern baldness.
Alopecia areata is the result of the body's immune cells attacking hair follicles, resulting in inflammation and eventual hair loss.
Hair loss can also be the result of medical conditions, medications, and infection.
It is sometimes believed that male-pattern baldness is inherited only from the mother’s side and not from the father's side. In reality, existing research shows quite clearly that genetic susceptibility to male-pattern baldness is determined by genes inherited from one’s mother and father.[12][13] It’s possible this myth of maternal-specific inheritance of hair loss comes from the fact that the X chromosome (which, for biological males, comes entirely from the mother’s side) carries the androgen receptor (AR) gene and mutations to this gene are known to have a major impact on the risk of male-pattern baldness. However, genes carried on autosomes (i.e., from both parents) seem to have a larger cumulative effect on hair loss than those from the X chromosome.
While higher testosterone levels help explain why baldness is common among men and uncommon among women, this is an incomplete picture of the underlying physiology. Rather, it is a testosterone metabolite called dihydrotestosterone (DHT) that contributes to male-pattern hair loss and mediates the discrepancy in baldness rates between sexes.
One of the most effective treatments for male-pattern hair loss is finasteride, a drug that inhibits the conversion of testosterone into DHT.[14] In fact, by blocking the metabolism of testosterone in this way, finasteride can increase testosterone levels,[15][16] further emphasizing the limitations of testosterone as a marker of hair loss risk.
Having very low levels of circulating testosterone can reduce the amount of DHT synthesized, explaining why women (and men with very low testosterone) seem more resistant to baldness.[17] However, it is not necessarily the case that alterations to testosterone levels within normal levels will automatically translate into changes in DHT levels or, more importantly, risk of hair loss.
Although plausible, it seems unlikely that supplementing with creatine causes hair loss.
Although plausible, it seems unlikely that supplementing with creatine causes hair loss.
By binding to androgen receptors in susceptible hair follicles, dihydrotestosterone (DHT; a testosterone metabolite) can cause hair follicles to shrink, ultimately leading to hair loss.[21][22] That said, whether a given hair is more or less likely to fall depends on its location (in male-pattern hair loss, the crown and hairline thin first) and the person’s genetic predisposition to hair loss.[23][24]
A proposed mechanism behind creatine’s effect on testosterone
The idea that supplemental creatine could be linked to hair loss largely originates from the findings of a 2009 randomized controlled trial.[25] In this trial, college-aged male rugby players who took creatine monohydrate for 3 weeks experienced a 41% increase in their blood levels of DHT. The baseline DHT concentration was 0.98 nmol/L and the concentration after 3 weeks was 1.26 nmol/L, with both values being well within the normal range.
To date, this has been the only trial testing creatine’s effects on DHT. However, 12 other trials have tested creatine’s effects on testosterone. Of these, only two trials (lasting 6 and 7 days) have reported increases in testosterone levels,[26] [27] while the remaining 10 trials (which ranged in duration from 6 days to 12 weeks) found no effect.[28][29][30][25][31][32][33][34][35][36] Importantly, 5 of these trials specifically tested creatine’s effects on free testosterone, the form of testosterone that gets converted to DHT, and found no significant increases.[28][31][33][29][35]
Lastly, and perhaps most importantly, the effect of supplemental creatine on hair loss hasn’t been directly studied, so all we can do is make educated guesses.
To sum up: (i) Only one trial has reported an increase in DHT levels with supplemental creatine; (ii) although DHT levels increased, they stayed well within the normal range; (iii) no other trials have looked at the effect of supplementing with creatine on DHT levels, but 10 of the 12 trials looking at the effect of supplemental creatine on testosterone, five of which also looked at free testosterone, reported no effect; and (iv) the effect of supplemental creatine on hair loss hasn’t been directly studied.
With the above in mind, we can conclude that, although plausible, it seems unlikely that supplementing with creatine causes hair loss.
References
Examine Database References
- Hair Regrowth - Arca E, Açikgöz G, Taştan HB, Köse O, Kurumlu ZAn open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopeciaDermatology.(2004)
- Hair Regrowth - Berger RS, Fu JL, Smiles KA, Turner CB, Schnell BM, Werchowski KM, Lammers KMThe effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trialBr J Dermatol.(2003 Aug)
- Hair Regrowth - Ulrike Blume-Peytavi, Kathrin Hillmann, Ekkehart Dietz, Douglas Canfield, Natalie Garcia BartelsA randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in womenJ Am Acad Dermatol.(2011 Dec)
- Hair Regrowth - Price VH, Menefee E, Strauss PCChanges in hair weight and hair count in men with androgenetic alopecia, after application of 5% and 2% topical minoxidil, placebo, or no treatmentJ Am Acad Dermatol.(1999 Nov)
- Hair Regrowth - Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJA randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in menJ Am Acad Dermatol.(2002 Sep)
- Hair Regrowth - Olsen EA, Whiting D, Bergfeld W, Miller J, Hordinsky M, Wanser R, Zhang P, Kohut BA multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in menJ Am Acad Dermatol.(2007 Nov)
- Hair Regrowth - Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG, Savin RC, Tharp MDA randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair lossJ Am Acad Dermatol.(2004 Apr)
- Hair Regrowth - Tsuboi R, Arano O, Nishikawa T, Yamada H, Katsuoka KRandomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese menJ Dermatol.(2009 Aug)
- Hair Regrowth - Rossi A, Mari E, Scarno M, Garelli V, Maxia C, Scali E, Iorio A, Carlesimo MComparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year studyInt J Immunopathol Pharmacol.(2012 Oct-Dec)
- Hair Regrowth - Beoy LA, Woei WJ, Hay YKEffects of tocotrienol supplementation on hair growth in human volunteersTrop Life Sci Res.(2010 Dec)
- Hair Regrowth - Lueangarun S, Visutjindaporn P, Parcharoen Y, Jamparuang P, Tempark TA Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved, Home-use, Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology.J Clin Aesthet Dermatol.(2021-Nov)
- Hair Regrowth - Mori-Ichioka A, Sunada Y, Koikeda T, Matsuda H, Matsuo SEffect of applying Lactiplantibacillus plantarum subsp. plantarum N793 to the scalps of men and women with thinning hair: a randomized, double-blind, placebo-controlled, parallel-group study.Biosci Microbiota Food Health.(2024)
- Hair Regrowth - García-Navarro A, Vasallo-Morillas MI, Navarro-Belmonte R, Vilanova C, Torrent D, Kilasoniya A, Moles-Ugeda I, Gallego-Herrera E, Ramírez-Boscá ARandomized Clinical Trial to Evaluate the Effect of Probiotic Intake on Androgenic Alopecia.Nutrients.(2024 Aug 30)