Evaluating the Safety of Creatine Monohydrate in Adolescents: A Systematic Review of Renal, Hepatic, and Cardiometabolic Outcomes

Creatine monohydrate is a widely used dietary supplement for performance enhancement among athletes and physically active individuals. Questions regarding its safety in adolescent populations remain an important consideration for clinicians and families. This systematic review evaluates the safety of creatine monohydrate supplementation in adolescent athletes and physically active youth. A comprehensive search of PubMed was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant human studies published between 2015 and 2025. Inclusion criteria required original research involving adolescents or physically active youth receiving creatine monohydrate with reported safety outcomes. Five studies met eligibility criteria and were included in the final analysis, comprising randomized controlled trials and longitudinal cohort studies. Across diverse populations, including youth athletes and adolescents with medical conditions, creatine supplementation was generally well tolerated, with no consistent short-term safety signals reported in renal function, liver enzymes, or cardiometabolic risk markers within the study periods. No serious adverse events were attributed to supplementation. These findings summarize currently available evidence regarding creatine safety in adolescent and physically active pediatric populations and highlight the need for larger prospective studies with standardized dosing protocols and longer follow-up periods.