Creatine Monohydrate in Adolescent Athletes: A Critical Narrative Review of Performance, Safety, and Responsible Use
Abstract
Creatine monohydrate is among the most evidence-supported ergogenic aids in adults, but its use by adolescent athletes remains controversial because age-specific trials are sparse. This critical narrative review evaluated performance effects, safety, and conditions for responsible use in adolescent athletes. PubMed/MEDLINE, Google Scholar, Semantic Scholar, the Cochrane Library, and ClinicalTrials.gov were searched from 1992 through 19 June 2026, with reference-list screening. Direct sport-specific evidence remains limited, heterogeneous, short term, and predominantly male. Trials in soccer, swimming, basketball, weightlifting, and rehabilitation suggest possible improvements in power, repeated-sprint performance, jumping, selected technical outcomes, and recovery-related measures; however, small samples and narrow endpoints preclude conclusions about overall competitive performance. A 32-week uncontrolled cohort in female football players found no clinically meaningful biochemical safety signal, whereas a single high-dose loading case reported acute kidney injury; neither design can estimate causal risk. Controlled studies have not shown consistent clinically important adverse effects at studied doses, yet long-term safety, sex- and maturation-specific responses, and uncommon events remain insufficiently characterized. Creatine should therefore be neither routinely recommended nor categorically prohibited. Consideration should be restricted to mature, trained adolescents…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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