Finasteride and Creatine: Untangling the Overlapping DHT Anxieties
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The creatine-DHT anxiety comes from a single study in rugby players. The finasteride-creatine picture is more nuanced — and less alarming — than the forum discussion suggests.
The creatine and finasteride question is a collision between two things that are both loosely associated with DHT, producing an anxiety that is disproportionate to what the evidence actually shows. Here is the actual picture.
The creatine-DHT study
A 2009 study by van der Merwe et al. examined college-aged rugby players over three weeks of creatine supplementation. The study found that the DHT:testosterone ratio increased by approximately 40% relative to placebo. This result was widely shared in fitness and hair loss communities and created significant anxiety among men taking creatine who were also concerned about hair loss.
What the study did not show: it did not measure absolute serum DHT at levels that were dramatically elevated. The DHT:T ratio changed, which means the conversion rate changed, but absolute DHT values were still within normal physiological range. The study involved a specific athletic population under high-intensity training conditions. No replication study has confirmed the finding in other populations with consistency.
What finasteride does to this picture
Finasteride suppresses DHT production at the 5-AR enzyme by approximately 65–70%. If creatine does modestly raise DHT in some circumstances, it does so within the context of a baseline that has already been reduced by two-thirds. The net DHT level on finasteride with creatine supplementation remains substantially below the untreated baseline.
There is no evidence that creatine meaningfully reduces the efficacy of finasteride in suppressing DHT to its therapeutic level. The direction and magnitude of finasteride's effect vastly exceeds any putative creatine contribution in the other direction.
The practical answer
Men on finasteride who use creatine for its well-evidenced strength and recovery benefits have no strong evidence-based reason to stop. If you are concerned, a serum DHT test before and after creatine addition would provide individual data — and would almost certainly show continued DHT suppression in the 65–70% range regardless. The creatine anxiety, while understandable given the original study's reach, is not well-supported for men on finasteride.
Common questions
Does creatine raise DHT?
One 2009 study in South African rugby players found elevated DHT:testosterone ratios after creatine supplementation. The study has not been consistently replicated, involved a specific population under specific training conditions, and measured DHT:T ratio rather than absolute DHT levels. The evidence is limited and the effect size uncertain.
Does creatine cancel out finasteride?
No. Finasteride suppresses DHT by approximately 65–70% at the source (5-AR enzyme inhibition). Any modest DHT elevation from creatine, if it occurs, operates within that already-suppressed baseline. The direction of finasteride's effect is far larger than any putative creatine effect.
Should I stop creatine if I am on finasteride?
Not based on current evidence. The creatine-DHT link is from one underpowered study. Finasteride's DHT suppression is well-documented and substantial. Stopping creatine based on the 2009 study while on finasteride is unlikely to produce any measurable hair benefit and removes a supplement with well-evidenced strength and recovery benefits.
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Medical disclaimer: This article is for general information only and does not constitute medical advice, diagnosis, or treatment. Finasteride is a prescription medication with a documented side effect profile. Always consult a licensed physician before starting, stopping, or changing any medication.