In this guide
- What creatine is and how it works
- What the research says it does
- How to take it: loading or no loading
- Water weight: the “bloated” myth
- Hair loss: the study everyone quotes
- Kidneys, cramps and dehydration
- Is creatine a steroid?
- Creatine and the brain
- Who should be careful
- My take
When men ask me what supplements I would recommend, my answer is usually disappointing. Most of the shelf in a supplement shop is marketing. Protein powder is just food in a convenient form. Caffeine works, but you already drink coffee. And then there is creatine, which is the one supplement that keeps passing the scientific tests.
Even so, creatine has a strange reputation. Guys tell me it is “basically a steroid”, that it makes you bloated, that it will damage your kidneys or make you go bald. I understand why: the gym is full of rumours. So I went to the research.
I am not a doctor or a dietitian, and this is not medical advice. Talk to a doctor before taking any supplement, especially if you have kidney disease or take medication. The facts below come from the International Society of Sports Nutrition (ISSN), the Mayo Clinic and peer-reviewed studies on PubMed. The opinions are mine.
What creatine is and how it works
Creatine is a compound your body makes from amino acids. According to the Mayo Clinic, most of it is stored in your muscles, smaller amounts in the brain, and a typical diet provides about 1 to 2 grams a day, mainly from red meat and seafood (Mayo Clinic: creatine).
Inside the muscle, much of it is stored as phosphocreatine. During short, explosive efforts, like a heavy set of squats, a sprint or a flurry of punches, your muscles burn through their immediate energy supply in seconds. Phosphocreatine helps regenerate that energy quickly. More creatine in the muscle means you can do a little more work at high intensity before you fade.
That is the whole mechanism. It is not magic and it is not a hormone. It is fuel for short, hard efforts.
What the research says it does
The 2017 ISSN position stand is the most complete review of the topic. Its authors conclude that creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes for increasing high-intensity exercise capacity and lean body mass during training, and that short- and long-term supplementation is safe and well tolerated in healthy people, with studies using up to 30 grams a day for five years (Kreider et al., PubMed).
A 2017 meta-analysis of 53 randomised controlled trials focused on upper-body strength. Compared with placebo, creatine improved bench press and chest press performance, with a small-to-moderate overall effect for upper-limb strength in exercises lasting less than three minutes (Lanhers et al., PubMed).
The Mayo Clinic summary agrees: creatine might help people do more work during repeated short bursts of high-intensity exercise, and when combined with resistance training it can lead to greater gains in strength, muscle size and performance (Mayo Clinic: creatine).
Notice the words “combined with resistance training”. Creatine does not build muscle on the sofa. It lets you train slightly harder, and over months that extra work adds up. If you do not have a plan yet, start with my strength training plan for beginners and my guide on how much protein to build muscle.
How to take it: loading or no loading
There are two common approaches, both described in the ISSN position stand (Kreider et al., PubMed):
- Loading: about 0.3 grams per kg of body weight per day, which is roughly 20 grams for most men, split into four doses, for 5 to 7 days. Then 3 to 5 grams a day to maintain.
- No loading: 3 to 5 grams a day from the start. Muscle stores reach a similar level in about three to four weeks.
The 2021 ISSN review of common questions makes the point that loading is not required; it just gets you there faster (Antonio et al., PubMed). Personally, I see no reason for most men to load. A daily 3 to 5 gram dose with a meal is simple and avoids the stomach upset some people get from big doses.
Which form? Creatine monohydrate is the form used in most of the research. The same 2021 review found no convincing evidence that more expensive forms work better. Choose a product with third-party testing, because supplements are not regulated like medicines. The Mayo Clinic makes the same recommendation.
Timing matters much less than consistency. Take it every day, including rest days.
Water weight: the “bloated” myth
Many men stop creatine after a week because the scale jumped. That is normal. Creatine pulls water into the muscle cells, so a gain of around 1 to 2 kg in the first week, especially with a loading phase, is common. The Mayo Clinic lists weight gain as the main side effect.
But “water in the muscle” is not the same as “bloated face and soft belly”. The 2021 ISSN review concluded that creatine does not consistently increase total body water relative to muscle mass over the long term, and that it does not increase fat mass (Antonio et al., PubMed). If you are cutting for an event or photos, you may notice the first-week change on the scale, so plan for it. If you are trying to see real fat loss, track your waist, not only your weight. I explain that in how to lose belly fat.
Hair loss: the study everyone quotes
This is the myth I hear most. It comes from one study.
In 2009, researchers in South Africa gave 20 college rugby players creatine (25 g a day for a week, then 5 g a day for two weeks) or a placebo. Testosterone did not change, but DHT, a hormone linked to male pattern hair loss, rose by 56 percent after the loading week and stayed 40 percent above baseline during maintenance (van der Merwe et al., PubMed).
That sounds scary, so let us be precise. The study was small. It used a high loading dose. It did not measure hair loss at all. Since then, no study has shown that creatine makes men go bald. The 2021 ISSN review concluded that the current body of evidence does not indicate that creatine supplementation increases total testosterone, free testosterone or DHT, or causes hair loss or baldness (Antonio et al., PubMed).
Could a man with a strong genetic tendency to hair loss be more sensitive? We do not know. If you are worried, skip loading and use a standard daily dose, or talk to a dermatologist. Hair loss in men is mostly genetic, and I covered the treatments with real evidence in my men’s grooming routine.
Kidneys, cramps and dehydration
Creatine raises blood levels of creatinine, a waste product doctors use as one marker of kidney function. That can make a routine blood test look worse than your kidneys really are. Tell your doctor you take creatine before a blood test.
As for real damage: the Mayo Clinic says studies in healthy people taking recommended doses have not found that creatine harms kidney function, while research in people with existing kidney disease is limited (Mayo Clinic: creatine). The ISSN reviews reached the same conclusion for healthy people.
Cramps and dehydration? The Mayo Clinic notes that research does not show a higher risk of muscle cramps or injury in people taking creatine, and the 2021 ISSN review found no evidence that it causes dehydration. Drink normally; my guide on how much water men should drink covers the basics.
Is creatine a steroid?
No. Anabolic steroids are synthetic versions of testosterone that act on androgen receptors. Creatine is a compound made from amino acids that your body already produces and that you eat in meat and fish. It is permitted in sport and is not on anti-doping prohibited lists. The 2021 ISSN review addresses this question directly and calls the comparison a misconception.
If you want to understand what actually affects testosterone, sleep, body fat and overall health matter far more. I explain that in testosterone and sex drive.
Creatine and the brain
Because the brain also uses creatine, researchers have looked at memory and thinking. A 2018 systematic review of six randomised trials found that creatine may improve short-term memory and reasoning in healthy people, with the clearest effects in older adults and possibly in stressed or sleep-deprived conditions (Avgerinos et al., PubMed). The Mayo Clinic describes this research as early. Interesting, but not a reason on its own to start taking it.
Who should be careful
Creatine is not for everyone. Speak to a doctor first if you:
- Have kidney disease or reduced kidney function.
- Have diabetes or another condition that affects the kidneys.
- Take medication that affects the kidneys.
- Are under 18.
The Mayo Clinic also notes a possible interaction with caffeine, where high caffeine intake might reduce creatine’s effects, though more research is needed.
My take
If I could recommend only one supplement to a man who already trains, eats enough protein and sleeps properly, it would be creatine monohydrate. It is cheap, it is boring, and it has more research behind it than almost anything else on the shelf.
But it is the last 5 percent, not the first 95. Creatine will not compensate for a bad plan, junk food and five hours of sleep. Get the basics right, then add 3 to 5 grams a day if you want the edge.
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Sources
- Kreider RB 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.
- Antonio J et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? Journal of the International Society of Sports Nutrition, 2021.
- Lanhers C et al. Creatine supplementation and upper limb strength performance: a systematic review and meta-analysis. Sports Medicine, 2017.
- van der Merwe J et al. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sport Medicine, 2009.
- Avgerinos KI et al. Effects of creatine supplementation on cognitive function of healthy individuals. Experimental Gerontology, 2018.
- Mayo Clinic. Creatine.
- NHS. Physical activity guidelines for adults aged 19 to 64.
