Creatine for Teenagers: Safety, Dosing, and What Parents Should Know

Prevalence of Creatine Use in Adolescents

Survey data consistently show that creatine is among the most widely used dietary supplements by teenage athletes. Metzl et al. (2001), in a study published in Pediatrics, surveyed middle school and high school students and found that creatine use increased markedly with age, with rates highest among male high school athletes. Sports most associated with adolescent creatine use included football, wrestling, hockey, and other strength- and power-dependent activities.

Jagim et al. (2018) provided more recent data on adolescent supplement use patterns. Their survey of high school athletes revealed that creatine was among the top three supplements used, alongside protein powder and multivitamins. Notably, many adolescent users reported receiving their information about creatine from coaches, peers, or online sources rather than from healthcare providers. This information asymmetry has contributed to both unfounded fears about creatine and instances of improper dosing in this population.

What the Safety Data Shows

The safety profile of creatine in adults is well-established through hundreds of clinical trials and multiple systematic reviews. The extrapolation of this data to adolescents is generally considered reasonable by researchers, given that creatine is a naturally occurring compound found in the normal human diet and synthesized endogenously by the body at all stages of life, including childhood.

Direct safety data in adolescents, while less extensive than in adults, is reassuring. Several studies have administered creatine to participants aged 13-18 without reporting adverse effects beyond those seen in adult populations (primarily mild GI symptoms during loading). Creatine has even been used therapeutically in pediatric clinical populations. Children with creatine synthesis disorders (genetic conditions affecting AGAT or GAMT enzymes) are treated with creatine supplementation from infancy, and children with traumatic brain injuries have been given creatine in clinical trials without safety concerns.

Hayashi et al. (2014) conducted a study of creatine supplementation in adolescent swimmers (ages 10-17) and reported no adverse effects over the study period. The authors noted normal renal function parameters throughout the supplementation period. While this is a single study in a specific population, it adds to the body of evidence suggesting that adolescent physiology does not respond differently to creatine than adult physiology.

Position Stands and Expert Opinions

The relationship between professional organizations and adolescent creatine use has evolved over time. Early position statements were generally cautious, reflecting the limited adolescent-specific data available at the time.

The American Academy of Pediatrics (AAP) historically advised against creatine use in adolescents under 18, primarily as a precautionary stance rather than one based on evidence of harm. This position was rooted in the general principle that dietary supplements should not be recommended for children and adolescents in the absence of specific deficiency or clinical indication.

The American College of Sports Medicine (ACSM) has acknowledged that creatine is the most extensively studied ergogenic supplement and has a strong safety profile, but has not issued a specific endorsement for adolescent use.

The ISSN position stand (Kreider et al., 2017) is more permissive. While noting that most creatine research has been conducted in adults, the position stand states that creatine supplementation appears to be generally safe and potentially beneficial in younger populations when proper dosing protocols are followed. The authors note that the inherent safety of creatine as a dietary constituent (present in meat and fish consumed by people of all ages) supports a low risk profile.

Jagim et al. (2018) specifically argued that the blanket prohibition of creatine for adolescents is not well-supported by evidence, and that appropriately supervised creatine supplementation in adolescent athletes may be preferable to the unregulated use patterns currently observed. Their position was that medical supervision and informed consent (involving both the athlete and parents) represent a more productive approach than prohibition.

Creatine Is Not an Anabolic Steroid

A common misconception among parents and coaches is that creatine is a steroid or a drug. This conflation likely arises from the association of creatine with muscle building and athletic performance. In reality, creatine is a naturally occurring compound — a combination of three amino acids (arginine, glycine, and methionine) — that is present in ordinary foods and synthesized by the human body every day.

Creatine does not affect hormonal systems. It does not alter testosterone, growth hormone, cortisol, or any other hormone. Its mechanism of action is entirely bioenergetic: it increases the availability of phosphocreatine in muscle cells, enabling faster regeneration of ATP during high-intensity exercise. This is a fundamentally different mechanism from anabolic steroids, which bind to androgen receptors and directly modify gene expression related to muscle protein synthesis.

The distinction matters for parental decision-making. The safety concerns that legitimately apply to anabolic steroids (hormonal disruption, liver toxicity, cardiovascular risk, psychological effects) do not apply to creatine. Evaluating creatine through the lens of steroid safety is a category error that leads to unnecessary restriction of a well-studied, low-risk supplement.

Dosing Adjustments for Teenagers

Adolescents span a wide range of body sizes, from early teenagers weighing 40-50 kg to late-adolescent athletes exceeding 90 kg. The weight-based dosing approach is particularly appropriate for this population to avoid over-dosing smaller individuals or under-dosing larger ones.

The recommended approach:

• Loading (if used): 0.3 g/kg/day for five to seven days, divided into four or more doses. A 60 kg teenager would load at 18 g/day (4 doses of 4.5 g). A 45 kg teenager would load at 13.5 g/day (3-4 doses of approximately 3.5-4.5 g).
• Maintenance: 0.03 g/kg/day, or approximately 3-5 g/day for most teenagers. A smaller teenager (45-55 kg) can use 2-3 g/day. A larger teenager (75-95 kg) should use 3-5 g/day.
• No-loading approach: Simply start with the maintenance dose. Saturation occurs in approximately 28 days. This is the preferred approach for many adolescent users as it avoids the GI discomfort associated with loading and is simpler to implement.

Regardless of the approach chosen, the supplement should be creatine monohydrate. This is the only form with a robust evidence base and established safety profile. Alternative creatine forms (HCl, buffered, ethyl ester) lack equivalent supporting data and offer no demonstrated advantages. The ISSN position stand specifically identifies creatine monohydrate as the form of choice.

Practical Concerns for Parents

Product quality: The dietary supplement industry in the United States is not subject to the same pre-market approval requirements as pharmaceutical drugs. Products can vary in purity, and some have been found to contain contaminants or incorrect amounts of the stated ingredient. Parents should look for creatine monohydrate products that carry third-party certification from organizations such as NSF International (specifically their Certified for Sport program), Informed Sport, or USP. These certifications verify that the product contains what the label claims and is free from banned substances.

Hydration: Creatine increases intracellular water content in muscle cells. While this does not cause dehydration (a persistent myth), ensuring adequate daily fluid intake is always appropriate for athletes, and creatine supplementation provides an additional reason to maintain good hydration habits. Standard hydration guidelines (drinking to thirst, monitoring urine color) are sufficient. There is no evidence that creatine supplementation increases the risk of heat illness or dehydration, as documented in the ISSN position stand and in the work of Lopez et al. (2009).

When to consult a physician: Adolescents with pre-existing kidney disease, any condition affecting kidney function, or a family history of kidney disease should consult a physician before beginning creatine supplementation. While creatine has not been shown to impair healthy kidneys, the prudent approach for individuals with compromised renal function is to seek medical guidance. Similarly, adolescents taking medications that affect kidney function should obtain clearance from their prescribing physician.

Setting realistic expectations: Creatine provides a modest performance benefit, typically in the range of 5-15% improvement in high-intensity exercise capacity and 1-2 kg of lean mass gain over several months of combined supplementation and training. It is not a substitute for proper training, nutrition, sleep, and coaching. Parents and teenage athletes should understand that creatine is an incremental tool, not a transformative one.

NCAA and WADA Regulatory Status

Creatine is not a banned substance under any major sports regulatory framework. The World Anti-Doping Agency (WADA) does not include creatine on its Prohibited List and has never done so. Athletes subject to WADA testing can use creatine without risk of a positive test or sanction.

The NCAA situation is slightly more nuanced. Creatine is not banned by the NCAA. However, NCAA rules prohibit institutions from providing certain supplements to student-athletes, and creatine falls into a category of "impermissible" supplements that schools cannot distribute. This does not prevent student-athletes from purchasing and using creatine on their own, and it does not mean creatine is banned from competition. The NCAA's restriction pertains to institutional distribution, not individual use.

High school athletic associations vary by state. Most do not specifically address creatine. Coaches and athletes should be aware of their specific state or league regulations. In general, creatine is widely considered a legal dietary supplement for athletic competition at all levels.

The distinction between "banned" and "not provided by the school" is important for adolescent athletes and their families. A teenage athlete competing in NCAA-governed sports should understand that while creatine use is permitted, their university cannot supply it. They must obtain it independently.

The Role of Nutrition First

A consistent theme in sports nutrition guidance for adolescents is that supplementation should complement, not replace, a well-structured diet. For teenage athletes, the priorities in order of importance are: adequate total caloric intake to support growth and activity, sufficient protein intake (approximately 1.2-2.0 g/kg/day depending on sport), adequate carbohydrate to fuel training, appropriate fat intake, micronutrient sufficiency (especially calcium, iron, and vitamin D), and proper hydration. Creatine supplementation sits further down this hierarchy.

An adolescent athlete who is chronically under-eating, consuming insufficient protein, or significantly under-hydrated will benefit far more from addressing these fundamental nutritional deficiencies than from adding creatine. Supplementation should be considered after the dietary foundation is established, not as a shortcut around it.

This is not to suggest that creatine should be withheld until dietary perfection is achieved — few adults meet that standard either. Rather, it means that the decision to supplement should be accompanied by attention to overall nutritional quality, ideally with guidance from a sports dietitian or knowledgeable healthcare provider.

Creatine and the Developing Brain

An emerging area of creatine research relevant to adolescents involves its role in brain metabolism. The brain is a significant consumer of ATP, and the phosphocreatine system plays an important role in cerebral energy buffering. Several studies have shown that creatine supplementation can improve cognitive performance under conditions of stress, sleep deprivation, and mental fatigue in adults.

The relevance to adolescents is twofold. First, the adolescent brain is undergoing significant development, with high energy demands. Whether creatine supplementation could support cognitive function in this population is an open research question. Second, adolescents involved in contact sports (football, hockey, soccer) face concussion risks, and preclinical data suggest that elevated brain creatine may have neuroprotective properties. Clinical trials of creatine for concussion prevention and recovery in adolescent athletes are an active area of investigation.

These potential cognitive and neuroprotective benefits should not be considered established. The evidence is preliminary and largely extrapolated from adult or animal studies. They are noted here because they represent a legitimate direction of inquiry that may, in the future, provide additional justification for adolescent creatine use beyond athletic performance.

Summary

Creatine supplementation in teenagers is more common than many parents realize, and the safety data — while less extensive than in adults — does not indicate any adolescent-specific risks. Creatine is not a steroid, does not affect hormones, and operates through a well-understood bioenergetic mechanism. Position stands vary in their level of endorsement, but the trend in the research community is toward acceptance of supervised adolescent creatine use at appropriate doses. Weight-based dosing (0.03 g/kg/day maintenance) is appropriate for the wide range of body sizes in this age group. Creatine monohydrate from third-party tested sources is the only recommended form. Creatine is not banned by WADA, the NCAA, or most athletic governing bodies. Proper nutrition should be established as a foundation before supplementation, and a physician should be consulted if any pre-existing health conditions are present.

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