Creatine monohydrate is a naturally occurring active ingredient used as a neuroprotectant, antioxidant, and dietary supplement. Creatine monohydrate is claimed to have the effect of increasing muscle mass and strength as well as facilitating recovery, and is widely used in adolescents and young adult populations. Estimates of lifetime and 12-month use range from 15-50 per cent for boys and young men and 2-10 per cent for girls and young women. However, in trained populations, supplementation with creatine monohydrate is ineffective for endurance performance. In addition, the use of Creatine monohydrate may be a risk factor for future symptoms of muscle dysmorphia.

Muscle dysmorphia is a complex mental health condition with symptoms focused on the preoccupation with a perceived lack of muscularity, significant drive for muscularity, and functional impairment. A prospective association study between Creatine monohydrate use and Muscle dysmorphia in adolescents analysed data from 912 adolescents in the Canadian Study of Adolescent Health Behaviors. Creatine monohydrate use over the past 12 months was assessed at Wave 1, and muscle dysmorphia symptoms were measured using the Muscle Dysmorphia Disorder Inventory (MDDI) at Waves 1 and 2. The results showed that creatine monohydrate use at wave 1 was prospectively associated with both total muscle dysmorphic symptoms (B 1.34, 95 % CI 0.27, 2.42) and more severe appearance intolerance at wave 2 (B 0.52, 95 % CI 0.02, 1.03). Importantly, these findings were not associated with prior symptoms of muscle dysmorphia, lifetime use of anabolic androgenic steroids, and lifetime frequency of smoking and alcohol abuse. Creatine monohydrate is commonly used in adolescents and young adults. The results of this study provide the first evidence that that creatine monohydrate use may be a risk factor for future symptoms of muscle dysmorphia. The findings emphasise the need for appropriate assessment and intervention for adolescent and young adult creatine users, in order to reduce the incidence of muscle dysmorphic symptoms.