Creatine monohydrate is among the most extensively studied dietary supplements, functioning as a cellular energy substrate that regenerates ATP through the phosphocreatine system in tissues with high energy demand, including skeletal muscle and the brain.
Its best-established clinical value is the preservation and accrual of lean body mass, muscle strength, and functional capacity, particularly when paired with resistance training—benefits that extend to bone health in older and postmenopausal populations. A growing body of randomized evidence also points to modest cognitive benefits, most consistently for memory and processing speed, reflecting creatine’s role in maintaining neuronal energy homeostasis under metabolic stress such as fatigue or sleep deprivation.
For BHRT providers, creatine is broadly relevant because the hormonal shifts of menopause and andropause accelerate the loss of muscle mass, strength, and bone density while contributing to fatigue and cognitive complaints. Creatine stands on its own clinical merits as a bioenergetic support, complementing hormone optimization by reinforcing the musculoskeletal and neuronal substrate on which hormonal signaling acts—without substituting for it. Women store substantially less endogenous creatine than men and may derive particular benefit across the lifespan, especially during and after the menopausal transition.
During Brain Health Awareness in July, anchored by World Brain Day, creatine’s role in cerebral energy metabolism makes it a timely and widely applicable consideration for hormone-focused patients. Clinical Note (Dosing): Creatine monohydrate is the most studied and reliable form. A common approach is 3–5 g daily, which saturates muscle stores over three to four weeks; an optional loading phase of approximately 0.3 g/kg/day (about 20g in divided doses) for five to seven days reaches saturation more quickly before transitioning to 3–5 g daily. Benefits for muscle and bone are maximized when combined with resistance training, and select cognitive, older-adult, and postmenopausal outcomes have been studied at higher doses.
Safety Considerations: Creatine monohydrate is well tolerated and carries no evidence of renal harm in healthy individuals; however, caution and clinical monitoring are appropriate in patients with pre-existing kidney disease. Clinicians should note that creatine can modestly raise serum creatinine as a benign laboratory effect that does not reflect declining renal function, which is relevant when interpreting routine labs. Transient water retention or mild gastrointestinalupset may occur with high loading doses and ca n be minimized using divided or lower daily doses. Current evidence does not demonstrate meaningful changes in testosterone or dihydrotestosterone.
Key References
Kreider, R. B., Kalman, D. S., Antonio, J., et al. (2017). 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, 14, 18. Antonio, J., Candow, D. G., Forbes, S. C., et al. (2021). Common questions and misconceptions about creatine supplementation: What does the scientific evidence really show? Journal of the International Society of Sports Nutrition, 18(1), 13. Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine supplementation in women’s health: A lifespan perspective. Nutrients, 13(3), 877. Xu, C., Bi, S., Zhang, W., & Luo, L. (2024). The effects of creatine supplementation on cognitive function in adults: A systematic review and meta-analysis. Frontiers in Nutrition, 11, 1424972.
