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Not medical advice. The Atlas is not a substitute for a clinician who can examine you.

Creatine

Creatine Monohydrate (and the DHT / hair-loss question)

Evidence grade 4 of 5, Strong. Read how the Atlas grades evidence.

The written rationale for this grade is still being prepared.

FDA
Not an FDA drug; GRAS-status dietary supplement

Reference only. Not medical advice.

What can go wrong

Creatine is well tolerated. Early water-weight gain and occasional GI upset are the common complaints. The historical kidney-damage concern is not supported in people with normal renal function; those with kidney disease should consult a clinician. The DHT/hair-loss link remains unproven.

This is something to take to a clinician. The Atlas can tell you what is known about creatine in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.

Creatine monohydrate is among the most validated sports supplements for strength, power, and lean mass, with hundreds of trials. It is repeatedly conflated with testosterone optimization, but the direct hormonal evidence is thin: most controlled trials show no meaningful change in total testosterone. The DHT controversy traces to a single 2009 study in rugby players that has never been replicated.

Strong evidence for strength, weak evidence it touches testosterone, one famous DHT scare.

What people take it for

What it is taken for. Approval, where it exists, covers only some of these.

  • Strength and power performance
  • Lean mass support alongside training
  • Investigated for cognition and recovery

How it works

Creatine increases intramuscular phosphocreatine, regenerating ATP during short high-intensity efforts. This supports greater training volume and overload, which is the indirect route by which it may help an athlete sustain the resistance training that itself supports healthy testosterone, rather than any direct endocrine action.

The DHT study, in context

Van der Merwe et al. (2009) reported that 7 days of creatine loading (25 g/day) then maintenance (5 g/day) raised dihydrotestosterone (DHT) about 56% and the DHT:testosterone ratio about 36% in 20 college rugby players, with total testosterone unchanged. No subsequent study has reproduced this finding, and no trial has shown creatine causes measurable hair loss. The hair-loss narrative is built almost entirely on that one secondary outcome.

What people get wrong

  • Often saidCreatine raises testosterone

    ActuallyControlled trials generally show no meaningful change in total testosterone. Its benefits are on performance and training capacity, not the endocrine axis.

  • Often saidCreatine causes baldness

    ActuallyThis rests on one unreplicated 2009 DHT finding. No trial has demonstrated actual hair loss from creatine.

  • Often saidCreatine is a steroid

    ActuallyIt is a naturally occurring compound in meat and synthesized by the body; it is not a hormone or anabolic steroid.

Who profits, and who pushes back

  • Strength and physique YouTubers

    Sells this. Has a commercial interest in a product sold as this compound, as of July 2026.

    Promotes itAggregate tens of millions

    Many hold creatine brand or affiliate deals; the product itself has strong independent evidence regardless.

  • Sports nutrition reviewers (e.g., Examine)

    Pushes backIndependent evidence aggregators

    The DHT finding is from a single small study and has not been replicated; claims of hormonal change are overstated.

What we do not know

  • Does the 2009 DHT signal reflect a real effect at loading doses or a statistical artifact in a small sample?
  • Are there subgroups (e.g., the androgen-sensitive) for whom DHT effects matter?

At a glance

Typical dose
3-5 g/day (loading optional)
Strength evidence
Very strong (meta-analyses)
Direct T effect
Generally none in RCTs
DHT signal
One unreplicated 2009 study

What this entry does not yet cover

What follows is unfinished work on our side, not a finding about Creatine. A short entry is not a safe entry.

  • Timeline. We have not built the dated record of research and regulatory events.
  • Cost and market. We have not documented what it sells for or who sells it.
  • Supply chain. We have not mapped where it is made.
  • Who uses it. We have not documented the user groups.
  • What could change. No forward-looking summary yet.
  • How it compares. We have not set it against the alternatives.
  • Children and teenagers. We have not checked what is known about younger people.

Sources

The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.

The studies that matter

  • Van der Merwe et al. (rugby players, DHT:T ratio)2009

    DHT rose ~56% and DHT:T ratio ~36% after loading; total testosterone unchanged. Never replicated.

  • Multiple RCTs and reviews on resistance trainingvarious

    Consistent gains in strength/power; no reliable direct increase in testosterone