Creatine for Teen Athletes: Safer Than Locker-Room Rumors Suggest

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Coaches, parents, and pediatricians have been warning teen athletes off creatine for two decades on the basis of largely speculative concerns — kidney damage, dehydration, growth-plate disruption. None of these concerns have held up in the published literature. The International Society of Sports Nutrition (ISSN), in its updated 2017 position stand, explicitly states that creatine monohydrate is safe and effective for adolescent athletes when used at standard doses with proper supervision. That doesn't mean every 14-year-old should be loading creatine, but it does mean that the categorical "no" most parents have been told overstates what the evidence shows.

The Original Concerns and What Studies Found

The most-cited concern was kidney injury. Multiple studies in healthy adolescent and young adult athletes (Jagim 2018, Kreider 2017 ISSN review, Ostojic 2010) measuring serum creatinine, cystatin C, and glomerular filtration rate at standard creatine doses (3–5 g/day maintenance) have found no clinically meaningful changes in renal function. Serum creatinine itself does rise modestly — this is a measurement artifact (creatine is the precursor to creatinine), not a sign of kidney injury. Pediatric nephrology case reports of acute kidney injury attributed to creatine almost universally involve other contributing factors: pre-existing kidney disease, NSAID use, severe dehydration during summer training, or contaminated multi-ingredient products.

Dehydration and Cramping

The "creatine causes cramps and dehydration" claim originated from anecdotal football-camp reports in the late 1990s. Controlled trials (Greenwood 2003 in Journal of Athletic Training; Lopez 2009) have consistently found no increased risk of cramps, heat illness, or dehydration in creatine-supplemented athletes vs controls. Some data suggest creatine slightly increases body water content, which is osmotically protective rather than dehydrating.

Growth and Maturation

No randomized controlled trial has ever demonstrated impaired growth or pubertal development from creatine supplementation in adolescents. The longest pediatric studies are in clinical populations (Duchenne muscular dystrophy, mitochondrial disease) using doses similar to or higher than athletic doses for one to several years — none reported growth disruption.

Performance Effects in Teens

The performance benefits in adolescents are similar in magnitude to those in adults: improvements in repeated high-intensity efforts, modest gains in lean mass with resistance training, and small improvements in strength. The benefit is modest enough that for a young athlete still developing technique, sport-specific training and adequate dietary protein matter more than creatine.

What the AAP Says

The AAP's 2005 Use of Performance-Enhancing Substances policy strongly discouraged creatine in athletes under 18, framing it as the "performance-enhancing substance" gateway. The 2023 update softened this, acknowledging the safety data but still recommending against routine use in pre-competition adolescents because the modest performance gains do not justify potential cultural normalization of supplementation. The current ISSN position and AAP position therefore disagree on policy while broadly agreeing on safety.

If a Teen Is Going to Use It Anyway

Use creatine monohydrate — the only form with a robust safety record. Skip the loading phase; 3–5 g/day is sufficient. Hydrate adequately. Use NSF Certified for Sport or Informed-Sport tested products to avoid contamination with banned substances or other ingredients. Avoid multi-ingredient pre-workouts containing creatine, caffeine, and stimulant blends — the creatine itself is not the safety concern in those products.