Creatine: Frequently Asked Questions and Misconceptions

Creatine is one of the most widely used nutritional supplements among athletes and physically active individuals. Due to its positive effects on muscle mass, strength, performance, and recovery, it has been extensively studied in both sports science literature and clinical research for many years. Despite the existence of over 500 scientific studies on creatine today , various misconceptions and misinformation surrounding this supplement persist.

The aim of this article is to address the most frequently asked questions and misconceptions about creatine supplementation in light of current scientific evidence, and to provide unbiased, understandable, and evidence-based answers. Each topic discussed has been evaluated based on experimental studies, clinical trials, and systematic reviews. The goal is to enable the reader to distinguish claims about creatine from scientific facts.

A 2021 article published in the Journal of the International Society of Sports Nutrition reviewed numerous studies in an effort to answer questions about creatine.

We will also use this article as a basis for our argument:

• Does creatine cause hair loss?

• Does creatine cause water retention?

• Is creatine an anabolic steroid?

• Is creatine harmful to the kidneys?

We will answer your questions.

WHAT IS CREATINE?

Creatine is a compound that is naturally synthesized in the human body and plays an important role in energy metabolism. Creatine synthesis in the body occurs primarily through the amino acids arginine, glycine, and methionine , and creatine is then transported to tissues via the bloodstream.

Approximately 95% of the creatine in the body is found in skeletal muscle. Within muscle cells, creatine is converted into phosphocreatine, enabling the rapid resynthesis of ATP . This system is critical for meeting energy needs, especially during short bursts of high-intensity exercise. Therefore, creatine acts as a kind of "energy buffer" for muscle cells and plays a significant role in generating explosive power.

Creatine is not produced in the body; it can also be obtained from animal foods such as red meat and fish . However, since the amount of creatine obtained through diet is limited, supplementation is commonly used to increase intramuscular creatine stores.

In addition to muscle tissue, creatine is also found in tissues with high energy requirements, such as the brain and nervous system. This indicates that creatine is a compound associated not only with performance but also with overall cellular energy metabolism.

DOES CREATINE CAUSE HAIR LOSS?

The claim that there is a link between creatine use and hair loss, although frequently mentioned in the literature, is one of the weakest scientifically supported claims. This view largely stems from generalizing the results of a single study .

This study reported increased dihydrotestosterone (DHT) levels in young male athletes who used creatine supplementation for a short period. DHT is a testosterone metabolite associated with hair follicle shrinkage in individuals with a genetic predisposition. However, the DHT levels measured in this study remained within clinically normal limits , and hair loss was not assessed in the study.

As highlighted in the article, these findings have not been replicated in other studies to date . The vast majority of other studies examining the effects of creatine supplementation on testosterone, free testosterone, or DHT levels have found no significant hormonal changes . Furthermore, there are no clinical studies directly demonstrating hair loss associated with creatine use.

Therefore, current scientific evidence does not support the claim that creatine supplementation causes hair loss. This belief is based on a misinterpretation of limited data.

DOES CREATINE CAUSE WATER RETENTION?

One of the most common beliefs about creatine supplementation is that it causes significant water retention in the body. This view stems from a misinterpretation of early studies showing that creatine use led to rapid weight gain.

Creatine is an osmotically active molecule, meaning that when taken into muscle cells, it can cause an increase in intracellular water volume . However, this increase does not usually translate into extracellular fluid accumulation or edema . Several studies reviewed in the Journal of the International Society of Sports Nutrition article show that creatine use can increase intracellular water in the short term, but long-term use does not result in a clinically significant increase in total body water or extracellular fluid volume .

Long-term exercise studies have reported that in individuals using creatine, intracellular and extracellular fluid distribution changes proportionally with muscle mass, and pathological water retention does not develop. Furthermore, it is suggested that increased intracellular water may be a positive cellular signal stimulating muscle protein synthesis .

In conclusion, creatine supplementation does not lead to general "water retention" or edema in the body. The observed weight gain is mostly related to increased intramuscular fluid and increased muscle mass.

IS CREATINE AN ANABOLIC STEROID?

One common misconception about creatine is that it has similar effects to anabolic steroids or should be considered in the same group. This false perception stems from the association of creatine use with increased muscle mass and performance.

Anabolic steroids are synthetic derivatives of testosterone and exert their effects through hormonal mechanisms . These substances enter cells, bind to androgen receptors, and directly alter gene expression, thereby increasing muscle protein synthesis. Therefore, anabolic steroids are classified as pharmacological agents and are legally regulated.

Creatine, however, acts through a completely different biological mechanism. It increases ATP production capacity by supporting the phosphocreatine system in muscle cells . This effect allows for higher exercise intensity and volume, indirectly contributing to muscle growth. However, creatine has no hormonal effect , does not interact with androgen receptors, and does not exhibit a testosterone-like effect.

Therefore, considering its biochemical structure, mechanism of action, and legal status, associating creatine with anabolic steroids is not scientifically accurate. Creatine is a nutritional supplement used in sports nutrition and is not a pharmacological substance.

IS CREATINE HARMFUL TO THE KIDNEYS?

One of the most common and longest-debated concerns regarding creatine supplementation is the claim that it may negatively affect kidney function. This concern stems largely from the frequent confusion between creatine metabolism and the concept of creatine itself .

In muscle tissue, creatine and phosphocreatine are converted to creatinine. Creatinine then passes into the blood and is filtered by the kidneys and excreted in the urine. In clinical practice, serum creatinine levels are used as an indirect indicator of kidney function. However, creatinine levels can also be affected by factors such as muscle mass, meat consumption, and creatine supplementation. Therefore, an increase in creatinine seen in individuals using creatine does not directly indicate kidney damage .

The article reviewed numerous controlled studies evaluating the effects of creatine supplementation on kidney health . In the vast majority of these studies, no adverse changes in kidney function were found in healthy individuals using creatine at recommended doses (typically 3–5 g/day) .

The few case reports in the literature describing renal impairment due to creatine use generally involve significant confounding factors such as pre-existing renal disease , concomitant medications, overdoses, or use with other supplements. Therefore, the generalizability of such case reports is limited.

In conclusion, according to the evidence evaluated in this article, creatine supplementation does not cause kidney damage in healthy individuals when used at the recommended doses . However, individuals with pre-existing kidney disease are advised to seek medical evaluation before using creatine.

Reference:

• Antonio J, Candow DG, Forbes SC, Gualano B, Jagim AR, Kreider RB, Rawson ES, Smith-- Ryan AE, VanDusseldorp TA, Willoughby DS, Ziegenfuss TN. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021 Feb 8;18(1):13. doi: 10.1186/s12970-021-00412-w. PMID: 33557850; PMCID: PMC7871530.