Creatine and Teenagers: What the Research Actually Says

If you search for whether creatine is safe for teenagers, you will find two confident answers that contradict each other. Supplement sites tell you it is fine. Pediatric organizations tell you to wait. Both sides can point to real evidence, and neither one usually tells you the whole story.

Here is the short version. The physiological safety data on creatine in adolescents is thin but so far reassuring, with the small number of studies that exist reporting no consistent harm to kidneys, liver, or heart markers over their study periods. At the same time, the American Academy of Pediatrics recommends against performance enhancing substances, creatine included, for anyone under 18, mostly because the adolescent evidence base is small rather than because it is alarming. And there is a separate line of research, growing fast since 2020, connecting muscle building supplement use in young people to eating disorder symptoms and muscle dysmorphia, a preoccupation with not being muscular enough. That research is about association rather than proof of cause, but it is the part of the picture that almost never makes it into articles about creatine for teenagers, and it deserves to.

This article walks through all three of those bodies of evidence, names the actual studies, and is honest about what each one can and cannot tell you. By the end you should be able to have a genuinely informed conversation about it, ideally with a pediatrician, which is where this question ultimately belongs.

Why This Question Is Harder Than It Looks

For healthy adults, the safety question around creatine monohydrate is about as settled as supplement science gets. The International Society of Sports Nutrition, in its 2017 position stand on creatine safety and efficacy, reviewed studies of short and long term supplementation and concluded that doses up to 30 grams per day for as long as five years were well tolerated in healthy individuals. That is a striking amount of human data for an over the counter product.

Teenagers are a different question for two reasons, and it helps to keep them separate because they get blurred constantly.

The first is the direct physiological question. Adolescents are still growing, their kidneys and hormonal systems are developing, and almost all of that adult safety data was collected in people over 18. You cannot simply assume it transfers, and researchers who study this area say so themselves.

The second is the behavioral question. Teenagers do not take creatine in a laboratory under supervision at a measured dose. They take it in locker rooms and bedrooms, often alongside other products, often motivated by how they feel about their bodies, in a life stage when eating disorders and body image disorders most commonly begin. A supplement can be chemically benign and still sit inside a pattern of behavior that is not.

Most articles on this topic answer only the first question. The honest answer requires both.

How Many Teenagers Are Actually Taking Creatine

More than most parents expect, and the numbers have been high for a long time.

Back in 2001, a survey of 1,103 middle and high school athletes in New York, published in Pediatrics as Creatine Use Among Young Athletes, found creatine use in every grade from 6 through 12, with 8.8 percent of boys and 1.8 percent of girls reporting use, rising toward levels seen in college athletes by grades 11 and 12. Two details from that study still matter today. Users cited performance as a reason 74 percent of the time, and improved appearance 61 percent of the time. Appearance was nearly as big a driver as sport, twenty five years ago, before fitness influencers existed.

The numbers since then have only grown. The 2016 Monitoring the Future survey found close to 17 percent of twelfth grade boys reporting creatine use, according to a summary by pediatricians at Children’s Hospital of Orange County. A 2020 commentary in Pediatrics by two American Academy of Pediatrics sports medicine physicians noted that roughly one third of all youth use creatine, protein powders, or similar dietary supplements, with even higher rates among athletes. And in a large Canadian study of adolescents and young adults published in Substance Use and Misuse, just over half of boys and young men reported using creatine monohydrate in the previous twelve months. Across studies, lifetime and twelve month prevalence estimates run roughly 15 to 50 percent for boys and young men and 2 to 10 percent for girls and young women.

So whatever position you hold on whether teenagers should take creatine, the descriptive reality is that huge numbers already do, usually without medical input. That reality shapes how the research community talks about it.

What the Physiological Safety Data Shows

Here is where the supplement industry’s favorite talking points come from, and to be fair, the underlying data is genuinely not scary. It is just small.

The most thorough attempt to gather the adolescent specific evidence is a 2021 review of creatine supplementation in children and adolescents by Andrew Jagim and Chad Kerksick, published in Nutrients. Their conclusion is worth quoting in spirit rather than letter: the studies that exist in adolescent athletes generally report performance improvements and consistently report no adverse events, but the authors describe this evidence as limited in scope, and much of what we believe about safety in youth is extrapolated from adults. Interestingly, some of the most reassuring pediatric data comes from clinical medicine rather than sport, since creatine has been studied in children with muscular dystrophies and other conditions, sometimes for months at a time, without safety signals.

A more recent effort, a 2026 systematic review in Cureus on renal, hepatic, and cardiometabolic outcomes, searched a decade of literature for studies of creatine monohydrate safety in adolescents and physically active youth. It found exactly five studies that qualified. Across those five, creatine was generally well tolerated, with no consistent short term safety signals in kidney function, liver enzymes, or cardiometabolic markers within the study periods, and no serious adverse events attributed to supplementation. The authors then said the quiet part clearly: adolescent specific data remains limited and heterogeneous, and properly designed adolescent trials with standardized dosing and safety monitoring are still needed.

Five studies. That is the honest size of the direct evidence base on which the internet’s confident reassurance rests.

The ISSN position stand goes further than the pediatric literature does, stating that with proper precautions and supervision, creatine monohydrate in child and adolescent athletes is acceptable and may offer a safer alternative to anabolic steroids. Two things belong next to that sentence. First, the position stand frames this as conditional on serious, supervised training, a balanced diet, and adult oversight, conditions that describe almost no real world teenage use. Second, several of its authors disclose financial relationships with companies that sell creatine or work in the supplement industry, which does not invalidate the science but is exactly the kind of context a careful reader should have. This site sits inside that industry too, which is one more reason to say it plainly.

So on pure physiology, the fair summary is this. Nothing in the adolescent data suggests creatine damages healthy young kidneys or livers at standard doses over the durations studied. But the durations studied are short, the studies are few, and no one has long term data on supplementation that starts at 14 and continues for a decade. Absence of evidence of harm is genuinely encouraging here. It is still not the same thing as evidence of long term safety.

Why the American Academy of Pediatrics Still Says No

Given all that, you might expect pediatric guidance to have softened. It has not, and the reasoning is worth understanding rather than dismissing.

The American Academy of Pediatrics addressed this in its 2016 clinical report on the use of performance enhancing substances in young athletes, which recommends against performance enhancing substances broadly for people under 18. An earlier AAP News piece put the creatine specific position bluntly in its title: creatine use by adolescents is not recommended due to limited data. The 2001 Pediatrics study reached the same conclusion, stating that until safety can be established in adolescents, use should be discouraged.

Notice what the AAP position is not. It is not a claim that creatine has been shown to harm teenagers. It is a judgment call about how to act under uncertainty, made by people whose job is to be conservative about children’s health, layered on top of a few additional concerns that have little to do with creatine molecules themselves.

One of those concerns is product quality. Supplements in the United States are regulated under the Dietary Supplement Health and Education Act, which means the FDA does not approve them before sale, and independent analyses have repeatedly found supplements that are mislabeled or contaminated, occasionally with substances like anabolic steroids. An adult can weigh that risk. A 15 year old buying whatever powder is cheapest online mostly cannot.

Another is what researchers call the gateway pattern. A prospective study published in Pediatrics in 2020 found that use of legal performance enhancing substances in young people was associated with later substance use problems, and related cohort work has linked legal muscle building product use to later anabolic steroid use. In Project EAT, a long running cohort following about 1,500 people from adolescence into young adulthood, adolescent boys who used protein powders and shakes had roughly double the risk of starting steroids or other muscle building substances as young adults. None of this proves that one product causes the next. It does mean pediatricians are not being paranoid when they treat early supplement use as a flag worth asking about.

The Body Image Research Nobody Puts on the Label

Now the part of the literature this article exists to tell you about, because supplement industry content almost universally leaves it out.

Since around 2020, a group of researchers, most visibly Kyle Ganson at the University of Toronto and Jason Nagata at the University of California San Francisco, has been studying what they call appearance and performance enhancing drugs and substances, a category that includes creatine, protein products, and pre workout powders, and how their use relates to eating disorders and muscle dysmorphia in young people. Muscle dysmorphia, sometimes described in plain language as a preoccupation with not being muscular enough, involves a strong drive for muscularity, body dissatisfaction, and enough distress or rigidity that it interferes with life.

Three findings stand out.

First, in a study of 7,394 United States college students from the Healthy Minds Study, lifetime use of several of these products was associated with screening positive for an eating disorder, with creatine use specifically associated with a positive eating disorder screen among women, and risk climbing with the number of different products a person had used. Related work in university students had earlier connected ergogenic supplement use to disordered eating behaviors in both men and women.

Second, a 2025 study in PLOS Mental Health of 2,731 Canadian adolescents and young adults found that use of six common muscle building supplements, creatine monohydrate among them, was associated with greater muscle dysmorphia symptom scores, with symptoms increasing as the number of supplements grew.

Third, and most important methodologically, a 2024 study in Eating Behaviors followed 912 Canadian adolescents and young adults over time and found that creatine use at baseline predicted greater muscle dysmorphia symptoms one year later, and that this held even after adjusting for muscle dysmorphia symptoms the person already had at the start. A prospective design like that cannot prove causation, but it rules out the laziest dismissal, which is that people who already had the most symptoms were simply the ones taking creatine. Something about creatine use predicted where symptoms were heading, not just where they already were.

The authors of that prospective study are careful in a way worth imitating. They note that creatine is generally considered safe with minimal physical health risks, and their conclusion is not that creatine is dangerous but that health professionals should assess and monitor for both creatine use and muscle dysmorphia symptoms in young people. That is the right register. The concern here is not toxicology. It is that for a subset of adolescents, supplement use is a visible marker, and possibly a reinforcing part, of a developing unhealthy relationship with their body.

What Association Does and Does Not Mean

It would be easy to overread the last section, so let’s be precise about it, in both directions.

These are observational studies. They cannot show that creatine causes eating disorders or muscle dysmorphia, and the most plausible reading involves arrows pointing both ways. Young people who feel intense pressure about their bodies are more likely to reach for muscle building products, and immersion in the routines, communities, and content around those products may then deepen the preoccupation. The studies also measure symptoms on screening tools, not clinical diagnoses, and most of the samples mix adolescents with young adults, so the findings are about that combined age range rather than 14 year olds specifically.

But it would be just as wrong to wave the findings away, and here is the test I would apply. If these same cohort studies had found that creatine use prospectively predicted better body image, supplement marketers would cite them constantly and would not spend a sentence on the limitations of observational research. The evidence deserves the same weight when it points the uncomfortable direction. What it supports is modest and real: in young people, use of creatine and similar products clusters with, and prospectively precedes, symptoms of eating disorders and muscle dysmorphia often enough that anyone caring for a teenager should treat supplement use as a reason to ask gentle questions about why.

For a parent, the practical translation is that the question “is creatine safe for my teenager” is incomplete. The fuller question is “what is driving my teenager’s interest in creatine,” and the answer to that determines almost everything.

The Retail Reality

One more piece of research completes the picture of how this actually plays out in the world.

In a 2017 study in Pediatrics, researchers posing as 15 year old high school athletes phoned 244 health food stores across the United States and asked what they would recommend for building muscle. A large share of sales attendants recommended creatine to the caller they believed was 15, and most stores were willing to sell it to a minor, despite AAP recommendations against pediatric use. There is no federal age restriction on creatine, no sports governing body tests for it, and the person behind the counter is working from marketing materials, not pediatric literature.

That is the environment your teenager’s questions land in if they do not land with you or a doctor first. It is also, frankly, the environment that makes honest writing in this space feel necessary. The default information a 15 year old encounters about creatine comes from people with something to sell and nothing to lose.

What Parents and Teenagers Can Actually Do With This

This site does not give medical advice, and this topic is a genuinely medical one, so the central recommendation is boring and firm: a teenager considering creatine should talk to their pediatrician or family doctor first, and a parent who discovers their teenager is already taking it should open that conversation without alarm. Given the prevalence numbers above, no doctor will be surprised by the question.

A few things are worth bringing into that conversation, all drawn from the research covered here.

The dietary route exists and is uncontroversial. Creatine occurs naturally in meat and fish, and every guidance document, including the cautious ones, supports meeting needs through normal food. The AAP’s broader position emphasizes that proper training, sleep, and nutrition are where the large, safe performance gains for adolescents actually live.

If a doctor and family do decide supplementation is reasonable for an older adolescent athlete, the conditions the ISSN attached to its acceptance are the sensible floor rather than fine print: supervised training, a balanced diet, adult oversight, plain creatine monohydrate rather than blends, and third party tested products, since certification programs exist precisely because supplement contamination is a documented problem.

And regardless of what is decided about the supplement, the body image research argues for asking the why questions. Is the interest coming from a sport and a coach, or from comparison, distress, and content feeds? Has eating become rigid, has training become compulsive, is mood tracking the mirror? Those questions matter more than the creatine itself, and if the answers are worrying, they are worth raising with a doctor or a mental health professional whether or not any supplement is involved.

What Remains Unknown and What Would Change the Picture

An honest map of the gaps, because they are the real story here.

There is no long term safety trial of creatine supplementation beginning in adolescence. The direct evidence base is a handful of short studies, and the reassurance beyond them is extrapolated from adults. A well designed, multi year adolescent trial with standardized dosing and proper safety monitoring, which the 2026 Cureus review explicitly calls for, would move this from plausible to established, in either direction.

The body image research needs the same maturation. Current studies show association and one year prospective prediction in mixed adolescent and young adult samples. Studies that separate younger adolescents, use clinical assessment rather than screening tools, and test whether reducing supplement use changes symptom trajectories would tell us whether creatine use is merely a marker of risk or an active ingredient in it.

And pediatric guidance itself may evolve. The AAP position rests on limited data, and data accumulates. If the adolescent safety literature grows and stays clean, and if the behavioral research clarifies who is and is not at risk, a more conditional pediatric position for supervised older athletes is imaginable. It has not happened yet, and this article will change when the evidence does.

Until then, the state of play on creatine and teenagers is this: physiologically unalarming but genuinely understudied, recommended against by the main pediatric authority precisely because of that gap, and entangled with body image risks that the people selling it rarely mention. A teenager deserves the whole answer. So does the adult deciding with them.