Creatine for Women: Why It’s Becoming a Must-Have Supplement

If you’re ever wondering just how staggeringly wrong health researchers and so-called fitness experts can be when they jump to conclusions, look no further than the way many of them initially reacted to the growing popularity of creatine, and particularly its use among women.

As a case in point, when world-class tennis player Mary Pierce admitted to taking creatine in 1999, she was quickly called out for having acquired a monstrous, manly physique in the sports columns of several newspapers. Then, when accusations were being leveled at Pierce in the pages of The Irish Independent that she was taking “creatine — a legal steroid,” legendary women’s tennis star Steffi Graf condemned Pierce’s toned physique by saying “I don’t like to see muscles,” and added that muscular women would make women’s tennis less appealing and cause it to lose its appeal.

Notwithstanding the fact that the 5’10” Pierce only weighed 150 pounds, it was plainly obvious that she was playing some of the best tennis of her career, which would culminate in a championship victory at the 2000 French Open. Meanwhile, despite mounting evidence to the contrary, experts were still insisting that creatine was of next to no value to athletes.

During a 1999 roundtable of the American College of Sports Medicine, physiology professor Ron Terjung was quoted by the Associated Press as insisting that creatine only provided sprint athletes with a minimal performance boost of two to three percent performance at best. Moreover, Terjung added that any ostensible gains of muscle mass were likely to be the superficial results of additional water being drawn into muscle tissue, without a commensurate boost in long-term strength.

As hundreds of thousands of athletes — primarily men, but also a growing number of women — continued to flock to creatine in the succeeding years, these talking points were parroted across the globe, and an additional layer of misinformation was added to them when the discussions of creatine supplementation turned specifically to women.

For example, in the Health section of an April 2007 edition of The Greensboro News & Record, two well-meaning local “health experts” — a county health department employee and a YMCA health director — began their dissection of creatine’s capabilities by saying “creatine does not create muscle mass” and that supplementation with creatine monohydrate merely “gives the appearance of larger muscles.” 

After adding that the optimal time to take creatine is “one hour before exercise,” and that people taking creatine should “stop wasting their money” if they didn’t see any results in “one to two months,” the publication’s experts also cautioned that “pregnant women should refrain from taking creatine.”

Decades removed from such uninformed pronouncements, we know that all of the advice supplied on that day was wrong, from the capacity of creatine to accelerate the growth of muscle mass (very effective at it) to the ideal time to take creatine to achieve benefits from it (post-workout for optimal muscle recovery and growth), to its influence on the pregnancies of women (highly beneficial). 

Not only is the undeniable effectiveness of creatine no longer considered to be a topic that is subject to debate according to the International Society of Sports Nutrition, but the total knowledge of its specific benefits to women is only continuing to grow with time. The new reality is that if women were limited to only one supplement that they should take from the onset of adulthood and continue to take throughout the duration of their lives, creatine is a solid candidate. 

Creatine and Women’s Strength 

In the early stages of creatine’s rise in popularity, it was presumed that creatine had nothing to offer women. Much of this was driven by the belief that creatine was essentially a “natural steroid” that only served to make its customers musclebound, and that women wouldn’t be interested in its effects.

The aforementioned Grand Slam success of the aforementioned Mary Pierce — who was not a giant muscular specimen — helped to build understanding of what creatine could do for women’s athletic performance, and allayed fears that creatine would instantly turn female tennis players into racket-wielding bodybuilders.

Today, we live in the aftermath of decades of studies that have explored the advantages that women receive when they supplement with creatine during athletic training. One of the most compelling studies involved the performance measures of women who had already received significant resistance training.

After a group of women had been randomly assigned to placebo and creatine-supplementation groups for a four week period, their body mass was measured, and they were tested in their performance of the half squat and leg press. At the conclusion of the study, the group that took supplemental creatine completed a significantly greater number of repetitions of the half squat and leg press exercises than the placebo group, while also demonstrating far less perceived exertion than the placebo group. (1)

To summarize, not only did the tested women display greater strength output through less effort than the placebo group, but as women who had already undergone substantial resistance training, these were women who were the least likely to experience dramatic strength gains during a one-month period. This makes it all the more credible that creatine is able to have dramatic effects on women's bodies when it comes to measures of athleticism and fitness.

Creatine and Women’s Endurance

While there is clear value to increased strength, especially over short-term sprints, most sporting exertions require sustained efforts that last anywhere from 30 seconds to multiple minutes without rest. Certainly, it’s important to see how creatine affects women’s bodies over extended periods of focused, all-out effort.

In a study involving 1,000 m testing of 28 male and 10 female test subjects — all of whom were trained rowers — the rowers who supplemented with creatine experienced an average time improvement of 2.3 seconds, compare to no average improvement for the placebo group. (2) However, the results are more striking when you dig more deeply into the data.

In the control group, 10 of the rowers improved their times while 7 rowers rowed slower, and two turned in identical performances. In the supplemental creatine group, the three rowers who rowed more slowly were all within 0.4% of their original performances. Meanwhile, the remaining 16 rowers in the supplemental group all improved upon the performances they turned in prior to supplementation, and all five of the women in the supplemental group achieved significant improvements. 

In a cycling test involving both male and female test subjects, the women who received loading-phase level doses of creatine for five days prior to the testing and maintenance-level doses on the testing days significantly increased both their total time to exhaustion and their total work output in comparison to the control group. (3)

What’s striking about the test in retrospect is that the women who took supplemental creatine doses during the study were able to produce their significantly improved performances despite taking what would now be considered suboptimal creatine doses. The 2.25 grams of creatine taken on testing days would not reach the lower level of the modern-day recommended level of 3.0 grams for maintenance doses.

Given the short-term nature of these studies, they clearly display the rapid responsiveness of trained female athletes to creatine, and particularly in the realms of aerobic and anaerobic endurance.

Creatine and Women’s Muscle Growth

The fact of the matter is that women — on average — tend to have a different sort of aesthetics in mind than most men do when they start visiting the gym with the goal of reshaping their bodies. The “problem areas” generally listed for women are familiar, and they tend to include arms that are toned, but not large, a flat stomach, and a backside that ranges from tight to ample, and usually with minimal adipose tissue if possible.

As a result of these desires, much of the marketing relating to muscle growth and women tends to be focused on lower-body muscle growth, and particularly in the glutes. This includes the advertising efforts of protein and creatine supplements targeting female consumers. 

The research backs up the notion that creatine can help women to efficiently build muscle mass in whatever part of the body they’re attempting to grow.

In the same study in which the strength of women divided into creatine-intake and placebo groups was measured, the group that took creatine also enjoyed a substantial increase in body mass over and above that of the placebo group, indicating that the strength gains were accompanied by a significant increase in muscle mass. (1) Moreover, the fact that the gains in size and strength were demonstrated in the lower body indicates that women who supplement with creatine are likely to experience gains where they want it the most.

Creatine and Women’s Mental Health

It’s an unfortunate but true reality that women tend to suffer from mental health issues with greater frequency than men, and many of the issues are hormonally driven. Most women’s bodies are replete with two hormones in particular — estrogen and progesterone — and the elevation or reduction in the levels of these two hormones alone can have massive consequences on women’s moods.

Estrogen is linked to the release of dopamine and serotonin — two hormones that influence levels of positive feelings — while progesterone sends signals to GABA receptors, which help to keep people calm. In a worst-case scenario, if the levels of these two hormones fluctuate too widely, they can lead to instances when women simultaneously feel atypically angry, and have fewer hormonal obstacles in place to prevent them from lashing out.

Even if you were to ignore the activities of these two hormones, women would still contend with depression at higher rates than men, as their rate of depression is twice that of men overall. (4) Fortunately, creatine has demonstrated the ability to modulate hormone levels, while also supplying the brain with a larger reservoir of energy. 

A link has been found between the intensity of depressive episodes and the concentration of creatine found in the brain, indicating a link between brain creatine metabolism and depression. (5)  Follow-up research found that creatine supplementation seemed to induce a pro-energetic effect in the brain chemistry of women suffering from major depressive disorders. (6) Therefore, creatine seemingly offsets multiple contributors to depressive thoughts by use of different mechanisms.

Creatine and Reproductive Health

One of the classic knocks on creatine, during the period when it was painted with the misleading identity of being a “natural steroid,” was the belief that it might elevate testosterone levels, and potentially make women more genetically male. As a consequence of this, incorrect assumptions were made about creatine potentially interfering with female hormones, and being harmful to the reproductive health of women. 

Time and research have now corrected these misapprehensions about creatine and its mechanisms of action. First of all, there is no evidence that creatine directly increases testosterone levels, although increased levels of muscle tissue produce larger amounts of myostatin, which signals for the creation of more testosterone. However, the creatine itself does not introduce more testosterone into the body. 

Second, all evidence indicates that creatine is wildly beneficial to a woman’s reproductive health. Low birth weight and preterm birth has been linked with low creatine stores in women’s bodies; creatine supplementation is believed to reduce the likelihood of these problems occurring. Furthermore, creatine is believed to contribute to a reduction in intra-partum and postpartum complications that would otherwise arise due to a depletion of cellular energy. (7)

In short, with no reported drawbacks to taking creatine, and considerable benefits to be gained from the practice, creatine has clear value as a just-in-case supplement for women to be taking in order to alleviate much of the discomforts of pregnancy, while limiting the potential of several of the post-partum inconveniences that might arise. 

Creatine and Menopause

When women have completed menopause and are in the postmenopausal phase of life, they are typically forced to contend with the aftereffects of experiencing a drastic reduction of estrogen. This is punctuated by decreases in muscle mass and bone mass, and a corresponding dip in strength. 

Several studies have produced the finding that creatine supplementation combined with resistance training can induce significant gains in muscle mass and muscle strength in postmenopausal women. To be clear, studies also indicate that there are no advantages to be gained from creatine in the areas of muscle mass and strength without the addition of resistance training. (8)

So, while substantial losses of muscle size and strength from your lifetime peak level of potential are inevitable as you age, the combination of creatine supplementation and strength training can not only work to preserve much of that size and strength, but to even boost the muscle size and strength of post-menopausal women who have never engaged in any form of resistance training before.

Creatine and Women’s Sleeping Habits

You might be tempted to believe that something as basic as sleep would be gender-neutral in terms of the range of its effects on men and women. As egalitarian as this might seem, the research suggests otherwise. Women have been found to be more susceptible to sleep deprivation at key stages of life particularly during pregnancy, postpartum, and menopause. 

During studies, creatine supplementation has shown the capability to enhance mental capacity in scenarios where individuals are sleep deprived. While this is true for both men and women, it is true that  women are far more likely to suffer from sleep deprivation than men due to the aforementioned scenarios. Moreover, on average, the effects of sleep deprivation have been perceived to be more damaging to women than they are to men. (9) 

Therefore, creatine can be very helpful to women due to the elevated likelihood that most women will have to contend with sleep deprivation in comparison to their male counterparts, thereby preventing them from being forced to contend with the disproportionate consequences that often result from female sleeplessness.

A Woman’s Lifelong Friend

When it first came to the attention of the general public, creatine was thought of as a muscle-building supplement designed for the use of only the most aggressive of men. Consequently, women who took an interest in creatine were stereotyped as “manly,” and branded with all of the most negative connotations that are associated with that word. 

Since that time, the entire landscape of fitness has shifted, and it has been shown that creatine is capable of helping women physically, mentally, psychologically, and reproductively. In short, creatine doesn’t make women manly; it makes them healthier and happier over the course of a lifetime.

Sources:

1. Azevedo, K.S.; Machek, S.B.; Lewis, A.E.; Azevedo, W.J.S.; Willardson, J.M.; Pereira, R.; Machado, M. Creatine Supplementation Improves Muscular Performance without Additional Impact on the Cardiovascular System in Trained Women. Muscles 2022, 1, 121-132. https://doi.org/10.3390/muscles1030013

2. Rossiter HB, Cannell ER, Jakeman PM. The effect of oral creatine supplementation on the 1000-m performance of competitive rowers. J Sports Sci. 1996 Apr;14(2):175-9. doi: 10.1080/02640419608727699. PMID: 8737325.

3. Prevost MC, Nelson AG, Morris GS. Creatine supplementation enhances intermittent work performance. Res Q Exerc Sport. 1997 Sep;68(3):233-40. doi: 10.1080/02701367.1997.10608002. PMID: 9294877.

4. Bebbington P, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M, Meltzer H. The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Int Rev Psychiatry. 2003 Feb-May;15(1-2):74-83. doi: 10.1080/0954026021000045976. PMID: 12745313.

5. Dager SR, Friedman SD, Parow A, Demopulos C, Stoll AL, Lyoo IK, Dunner DL, Renshaw PF. Brain metabolic alterations in medication-free patients with bipolar disorder. Arch Gen Psychiatry. 2004 May;61(5):450-8. doi: 10.1001/archpsyc.61.5.450. PMID: 15123489.

6. Kondo DG, Sung YH, Hellem TL, Fiedler KK, Shi X, Jeong EK, Renshaw PF. Open-label adjunctive creatine for female adolescents with SSRI-resistant major depressive disorder: a 31-phosphorus magnetic resonance spectroscopy study. J Affect Disord. 2011 Dec;135(1-3):354-61. doi: 10.1016/j.jad.2011.07.010. Epub 2011 Aug 9. PMID: 21831448; PMCID: PMC4641570.

7. De Guingand DL, Ellery SJ, Davies-Tuck ML, Dickinson H. Creatine and pregnancy outcomes, a prospective cohort study in low-risk pregnant women: study protocol. BMJ Open. 2019 Jan 15;9(1):e026756. doi: 10.1136/bmjopen-2018-026756. PMID: 30647050; PMCID: PMC6340624.

8. Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients. 2021 Mar 8;13(3):877. doi: 10.3390/nu13030877. PMID: 33800439; PMCID: PMC7998865.

9. Blatter K, Graw P, Münch M, Knoblauch V, Wirz-Justice A, Cajochen C. Gender and age differences in psychomotor vigilance performance under differential sleep pressure conditions. Behav Brain Res. 2006 Apr 3;168(2):312-7. doi: 10.1016/j.bbr.2005.11.018. Epub 2006 Jan 18. PMID: 16386807.