Creatine Monohydrate in Adolescent Athletes: A Critical Narrative Review of Performance, Safety, and Considerations for Responsible Use

Creatine monohydrate is well supported as an ergogenic aid in adults, but age-specific evidence in adolescent athletes remains limited. This critical narrative review examined performance, safety, dosing, and responsible-use considerations. PubMed/MEDLINE was the primary source; citation tracking, the Cochrane Library, ClinicalTrials.gov, Google Scholar, and Semantic Scholar were used through 19 June 2026. The core athletic synthesis included 17 primary studies: five Tier 1 studies with direct adolescent samples, eleven Tier 2 age-adjacent or mixed-age studies, and one Tier 4 adult study retained for contextual interpretation. Across soccer, swimming, basketball, rehabilitation, and resistance-training settings, controlled studies reported possible task-specific improvements in selected power, repeated-sprint, jumping, technical, and rehabilitation outcomes, whereas other outcomes were unchanged and some favorable findings were limited to within-group analyses. Short-term controlled studies and a 32-week mixed-age cohort did not identify a consistent clinically important safety signal within the protocols studied; however, safety monitoring was often secondary and the evidence remains underpowered for uncommon or long-term events. Creatine monohydrate should therefore be neither routinely recommended nor categorically prohibited in adolescent athletes. Any consideration represents a precautionary, individualized risk-management approach—not a validated adolescent protocol—and should be food-first, family-involved, professionally supervised, and accompanied by product-quality control and planned reassessment.