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Research · Supplements

Creatine

Meta-analyses of randomized trials find creatine taken during resistance training adds about 1.1 to 1.4 kg of lean mass and small strength gains over placebo. Two meta-analyses found small memory gains. Mood effects are smaller and less certain. Serum creatinine rises about 0.13 mg/dL, and directly measured filtration did not change.

Add to Bio HackChecked 2026-11-09
Status
Dietary supplement in the US.
Also called
creatine monohydrate, CrM, micronized creatine, creatine HCl, Creapure
Taken for
strength, muscle gain, lean mass, power, aging muscle, memory, brain health, depression, bone density

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help4

Reported risks3

What people take it for, and what was found

Shown to help4

Strong

Lean mass during resistance training

Shown to add about 1 kg of lean mass over placebo alongside resistance training, and almost none without exercise.

The numbers and sources
Effect
Across 35 RCTs (1,192 participants), creatine raised lean body mass by 0.68 kg over placebo overall, and by 1.10 kg (95% CI 0.56 to 1.65) when combined with resistance training. With no exercise the difference was 0.03 kg (95% CI -0.65 to 0.70) [1]. In older adults training 2 to 3 days a week, the gain was 1.37 kg (95% CI 0.97 to 1.76) [2]. In postmenopausal women it was 0.37 kg (95% CI 0.05 to 0.69) [3].
Population
Healthy adults of all ages [1]; 721 adults with mean ages of 57 to 70 across 22 trials lasting 7 to 52 weeks [2]; 608 postmenopausal women in 7 trials lasting 12 to 104 weeks [3].
Sources
[1], [2], [3]
Caveats
Men gained 1.46 kg (95% CI 0.47 to 2.46) and women 0.29 kg (95% CI -0.43 to 1.01), a difference that did not reach significance for women [1]. Lean mass by DXA counts water, and creatine raises muscle water, so lean mass is not the same measure as contractile tissue. Several authors of [3] also authored the ISSN position stand [4]. In a 2026 analysis of 11 RCTs in adults aged 60 and over, the added muscle mass was not significant (g 0.35, 95% CI -0.09 to 0.78, low certainty) [5].
Strong

Strength

Shown to add a small amount of strength on upper and lower body lifts, including in older adults.

The numbers and sources
Effect
For upper body exercises under 3 minutes, the effect size for bench and chest press at the end of supplementation was 0.265 (95% CI 0.132 to 0.398) [6]. For the lower body, effect sizes were 0.336 (95% CI 0.047 to 0.625) for squat and 0.297 (95% CI 0.098 to 0.496) for leg press [7]. In older adults, leg press SMD was 0.24 (95% CI 0.05 to 0.43) [2]. Postmenopausal women gained 7.5 kg more on leg press 1RM (95% CI 2.2 to 12.8, 3 trials, 111 women) [3].
Population
53 trials with 1,138 people for upper limb [6]; 60 trials with 1,297 people for lower limb [7]; older adults [2]; postmenopausal women [3].
Sources
[2], [3], [6], [7]
Caveats
Effect sizes in the 0.24 to 0.34 range are small by conventional thresholds. The strength trials pool short protocols and long training blocks together. In 69 studies (1,937 participants), creatine with resistance training raised bench press by 1.43 kg and squat by 5.64 kg over placebo, and handgrip and leg press did not differ. Gains were significant in younger adults and men, and not in older adults or women [8]. A 2026 analysis limited to adults aged 60 and over found a small strength gain (g 0.31, 95% CI 0.18 to 0.45, moderate certainty) [5].
Strong

Memory and cognition

Shown to improve memory scores modestly, most in older adults, with no change in people aged 11 to 31.

The numbers and sources
Effect
Pooled across 8 RCTs, memory scores improved over placebo with an SMD of 0.29 (95% CI 0.04 to 0.53, I² 66%). In adults aged 66 to 76 the SMD was 0.88 (95% CI 0.22 to 1.55, I² 83%). In people aged 11 to 31 it was 0.03 (95% CI -0.14 to 0.20) [9]. Across 16 RCTs (492 participants), creatine improved memory (SMD 0.31, 95% CI 0.18 to 0.44, moderate certainty), attention time and processing speed time, and did not change overall cognition or executive function [10]. A systematic review of 6 studies in 1,542 adults aged 55 and over found 5 reported a positive link between creatine and cognition, mostly memory and attention [11].
Population
Healthy people, 10 RCTs reviewed and 8 pooled, doses 2.2 to 20 g a day for 5 days to 24 weeks [9]; adults aged 20.8 to 76.4, healthy and with specific diseases [10]; older adults, 2 supplement trials and 4 diet surveys [11].
Sources
[9], [10], [11]
Caveats
Heterogeneity was high in [9]. The reviews disagree on who benefits: [9] found the effect in older adults and none at 11 to 31, while [10] found more benefit at 18 to 60, in women and in people with diseases. Only memory reached moderate certainty, and the other domains were low [10]. In the older adult review, 4 of 6 studies were cross-sectional diet surveys and 3 were rated poor quality [11].
Limited

Depression symptoms

Limited evidence: lowered depression scores about 2 points, below the 3 points counted as a meaningful change.

The numbers and sources
Effect
Across 11 trials (1,093 participants), creatine reduced depression scores by an SMD of -0.34 (95% CI -0.68 to -0.00), equal to 2.2 points on the 17-item Hamilton scale. The minimal important difference on that scale is 3.0 points. Remission odds were higher in 3 trials (OR 3.60, 95% CI 1.76 to 7.56), and response did not differ in 2 trials (OR 0.72, 95% CI 0.28 to 1.88) [12]. A systematic review of 5 RCTs (238 participants with a mental disorder) found creatine added to escitalopram or to cognitive behavioral therapy outperformed placebo in major depression, and found no difference from placebo in female adolescents on medication or in bipolar depression [13].
Population
People with and without diagnosed depression, mostly creatine added to other treatment [12].
Sources
[12], [13]
Caveats
GRADE certainty was very low. Heterogeneity was 71.3%, and trim-and-fill analysis indicated bias favoring creatine. The authors write that the true effect may be trivial or null [12].

Not shown to help1

Strong

Bone density

Not shown to change bone density in postmenopausal women or in older adults who exercise.

The numbers and sources
Effect
Bone mineral density did not change overall versus placebo in postmenopausal women [3]. In 20 trials (1,093 older adults, 69% women) of creatine with exercise training, total body bone mineral density did not change (MD 0.009 g/cm², p 0.557) [14].
Population
Postmenopausal women, 7 RCTs, 12 to 104 weeks [3]; older adults in exercise programs [14].
Sources
[3], [14]
Caveats
Each review had few bone trials. Neither found a bone effect.

Doses studied

Some trials used a loading phase followed by a lower daily dose. One used 25 g a day for 7 days, then 5 g a day for 14 days [15]. A 12-week trial used 5 g a day [16]. Across 685 clinical trials the average dose was 0.166 g per kg per day, about 12.5 g a day, for an average of 64.7 days, in studies lasting up to 14 years [17]. Memory trials used 2.2 to 20 g a day [9]. In postmenopausal women, effects appeared at 5 g a day or more combined with resistance training; trials using 3 g a day or less without training showed no measurable effect [3]. The ISSN position stand reports supplementation up to 30 g a day for 5 years in its reviewed literature [4].

Risks

Reported risks2

StrongHow often is not known

Raised serum creatinine and kidney markers

Shown to raise blood creatinine, which lowers kidney estimates based on it. Kidney function measured another way did not change.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 26 RCTs (1,036 participants), serum creatinine rose 0.14 mg/dL (95% CI 0.05 to 0.22, I² 93.9%) and creatinine-based GFR estimates fell 10.75 mL/min (95% CI -17.48 to -4.02). GFR measured with Cr-EDTA, which does not rely on creatinine, did not differ (5.89 mL/min, 95% CI -0.30 to 12.08), nor did urea, albuminuria or proteinuria [18]. In 20 randomized trials, serum creatinine rose 0.13 mg/dL (95% CI 0.07 to 0.18), and urea and eGFR did not differ (eGFR -5.20 mL/min/1.73 m², 95% CI -15.00 to 4.60) [19]. In 12 studies (440 participants), serum creatinine rose by a mean of 0.07 (95% CI 0.01 to 0.12), significant at 1 week or less and after 12 weeks but not at 1 to 12 weeks. Glomerular filtration rate did not differ from control [20].
Population
Healthy people and people with chronic kidney disease, including a hemodialysis subgroup [18]; 19 RCTs and one crossover trial [19]; mostly healthy adults, 177 on creatine and 263 controls in the creatinine analysis [20].
Sources
[18], [19], [20]
Caveats
Creatinine is a breakdown product of creatine, so a higher reading and a lower creatinine-based GFR estimate can occur without a change in filtration. The authors of [18] attribute the changes to altered creatinine metabolism, since Cr-EDTA GFR did not change. The 2025 abstract reports its creatinine difference in µmol/L, a unit at which 0.07 would be negligible, and the unit may be a reporting error [20]. The authors of [19] call for trials longer than 1 year.
LimitedHow often is not known

Hypomania or mania in mood disorder trials

In mood disorder trials, 2 of 17 people on creatine had hypomania or mania.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In a systematic review of 5 RCTs in major depressive disorder and bipolar depression, 2 of 17 participants on creatine experienced hypomania or mania [13].
Population
238 participants with a mental disorder, 126 on creatine and 112 on placebo, mean age 36 [13].
Sources
[13]
Caveats
Small numbers. The abstract does not say which trials the 17 participants came from or give a placebo rate [13].

Mixed results1

LimitedStudied in menHow often is not known

Hair loss and DHT

Limited evidence: DHT rose in one small study, and a 12-week trial found no change in DHT or hair.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 20 male rugby players, DHT rose 56% after 7 days of loading and stayed 40% above baseline after 14 more days; testosterone did not change. Hair was not measured [15]. A 12-week RCT in 38 resistance-trained men on 5 g a day found no group differences in DHT, DHT to testosterone ratio, hair density, follicular unit count or hair thickness [16].
Population
Young men only [15][16].
Sources
[15], [16]
Caveats
Two small trials that disagree on DHT. No trial has measured hair loss over years or in women.

Checked, no increase found2

Moderate

Side effects in clinical trials

Side effects were about as common on creatine as on placebo across 685 trials.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Across 685 trials (12,839 on creatine, 13,452 on placebo), side effects were reported in 13.7% of creatine study arms and 13.2% of placebo arms. By participant, total side effect frequency was 4.60% on creatine and 4.21% on placebo. GI issues were 5.51% versus 4.05%, and muscle cramping or pain 0.52% versus 0.07%, neither significant by participant count [17].
Population
Clinical trial participants worldwide, plus adverse event databases [17].
Sources
[17]
Caveats
This is a pooled count, not a meta-analysis of randomized comparisons, and trials vary in how they collect side effects. The lead author also led the ISSN creatine position stand [4].
LimitedStudied in children

Use in adolescents

Limited evidence: no consistent short-term changes in kidney, liver or heart markers in adolescents.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
A systematic review of 5 studies, RCTs and cohorts, found no consistent short-term signals in kidney function, liver enzymes or cardiometabolic markers, and no serious adverse events attributed to creatine [21].
Population
Adolescent athletes and physically active youth, including some with medical conditions, in studies published 2015 to 2025 [21].
Sources
[21]
Caveats
Five small studies with short follow-up, found through a PubMed-only search [21].

Claims tested and not found

  1. That creatine builds muscle without training. Without exercise, lean mass differed from placebo by 0.03 kg (95% CI -0.65 to 0.70) [1].
  2. That creatine damages kidneys in healthy people. Filtration measured with Cr-EDTA, urea and urine protein did not change in pooled trials. Creatinine-based estimates moved with the creatinine rise [18][19][20].
  3. That creatine causes hair loss. The one trial measuring hair found no difference from placebo over 12 weeks [16].
  4. That creatine raises bone density. Bone mineral density did not change in two meta-analyses [3][14].

Sources

  1. Delpino FM, Figueiredo LM, Forbes SC, et al. Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Nutrition. 2022. https://doi.org/10.1016/j.nut.2022.111791
  2. Chilibeck PD, Kaviani M, Candow DG, et al. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access Journal of Sports Medicine. 2017. https://doi.org/10.2147/oajsm.s123529
  3. Naddafha S, Antonio J, Kreider RB, et al. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2026. https://doi.org/10.1080/15502783.2026.2668435
  4. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 2017. https://doi.org/10.1186/s12970-017-0173-z
  5. Yao L, Yang D, Gao J. Effects of resistance training combined with creatine supplementation on muscle strength, physical function, and muscle mass in older adults: a systematic review and three-level meta-analysis. Frontiers in Nutrition. 2026. https://doi.org/10.3389/fnut.2026.1919884
  6. Lanhers C, Pereira B, Naughton G, et al. Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis. Sports Medicine. 2016. https://doi.org/10.1007/s40279-016-0571-4
  7. Lanhers C, Pereira B, Naughton G, et al. Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses. Sports Medicine. 2015. https://doi.org/10.1007/s40279-015-0337-4
  8. Kazeminasab F, Kerchi AB, Sharafifard F, et al. The Effects of Creatine Supplementation on Upper- and Lower-Body Strength and Power: A Systematic Review and Meta-Analysis. Nutrients. 2025. https://doi.org/10.3390/nu17172748
  9. Prokopidis K, Giannos P, Triantafyllidis KK, et al. Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews. 2022. https://doi.org/10.1093/nutrit/nuac064
  10. Xu C, Bi S, Zhang W, et al. The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Frontiers in Nutrition. 2024. https://doi.org/10.3389/fnut.2024.1424972
  11. Marshall S, Kitzan A, Wright J, et al. Creatine and Cognition in Aging: A Systematic Review of Evidence in Older Adults. Nutrition Reviews. 2025. https://doi.org/10.1093/nutrit/nuaf135
  12. Eckert I, Lima J, Dariva AA. Creatine supplementation for treating symptoms of depression: a systematic review and meta-analysis. British Journal of Nutrition. 2025. https://doi.org/10.1017/s0007114525105588
  13. Jeryous Fares B, Zhou C, Fabiano N, et al. The Effect of Creatine Monohydrate on Mental Disorders: A Systematic Review of Randomized Controlled Trials. The Canadian Journal of Psychiatry. 2026. https://doi.org/10.1177/07067437251408171
  14. Sharifian G, Aseminia P, Heidary D, et al. Impact of creatine supplementation and exercise training in older adults: a systematic review and meta-analysis. European Review of Aging and Physical Activity. 2025. https://doi.org/10.1186/s11556-025-00384-9
  15. van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sport Medicine. 2009. https://doi.org/10.1097/jsm.0b013e3181b8b52f
  16. Lak M, Forbes SC, Ashtary-Larky D, et al. Does creatine cause hair loss? A 12-week randomized controlled trial. Journal of the International Society of Sports Nutrition. 2025. https://doi.org/10.1080/15502783.2025.2495229
  17. Kreider RB, Gonzalez DE, Hines K, et al. Safety of creatine supplementation: analysis of the prevalence of reported side effects in clinical trials and adverse event reports. Journal of the International Society of Sports Nutrition. 2025. https://doi.org/10.1080/15502783.2025.2488937
  18. de Souza Almeida A, da Silva LOD, Takahasi BNA, et al. Impact of creatine supplementation on kidney health: a systematic review and meta-analysis. International Urology and Nephrology. 2026. https://doi.org/10.1007/s11255-026-05287-x
  19. Tsiaras A, Loufopoulos G, Theodoridis X, et al. The Effect of Creatine Supplementation on Kidney Function: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Renal Nutrition. 2026. https://doi.org/10.1053/j.jrn.2026.04.010
  20. Naeini EK, Eskandari M, Mortazavi M, et al. Effect of creatine supplementation on kidney function: a systematic review and meta-analysis. BMC Nephrology. 2025. https://doi.org/10.1186/s12882-025-04558-6
  21. Rubinchuk A, Dulkoski Z, Persaud NA, et al. Evaluating the Safety of Creatine Monohydrate in Adolescents: A Systematic Review of Renal, Hepatic, and Cardiometabolic Outcomes. Cureus. 2026. https://doi.org/10.7759/cureus.106808

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