I got laughed at by Mr. Universe

Creatine has suddenly become the supplement everyone is talking about, especially for women over 50. But here's the funny part: creatine is not new. Not even close.

And I'll confess something up front. Even as a physician who spends her days thinking about muscles, joints, and performance, I was very late to this party. Absurdly late. Embarrassingly late.

I joined my first gym when I was 16. Within minutes, they were trying to sell me personal training. Of course they were. That's what gyms do. But I was 16 working 15 hours a week for $7.25 an hour at Hollywood Video. I had no money for that kind of thing.

So I joined the gym and skipped the trainer. I also noticed the wall of vitamins and supplements they wanted me to buy, including something called creatine. Back then it came in pills. Big pills. I recall them trying to sell me a one-month-supply bottle for $35, and the pitch was simple: it'll make your muscles bigger.

So what? I didn’t want bigger muscles. I wanted to lose body fat. For years, I thought creatine was strictly for the gym bros who wanted big puffy muscles.

Fast forward to my sports medicine rotation. I spent time in a physical therapy clinic with two people who knew a thing or two about muscle: a former Mr. Universe, and a Certified Strength and Conditioning Specialist who also happened to be a physical therapist.

When it came up that I had never taken creatine, they nearly laughed me out of the room. They couldn't believe it. Twenty years in the fitness industry, and Dr. Stevens had never even tried creatine?

Me: “I always thought it was an overpriced supplement with fringe benefit.”

Mr. Universe: “Nooo! It’s one of the cheapest supplements out there. You can get a year’s supply for around $35. I buy it by the kilo.”

They also told me it was one of the most well-studied and safest supplements out there. See, creatine is a key component of an explosive energy system I understood very well. Since I was feeling, well… older… clears throat.. dare I say peri-menopausal, with less pep, could it not help give me a little “get up and go?”

So I took the leap. I bought a jar of creatine monohydrate powder (the only type you’ll ever need) and started taking 5 grams a day.

Are you kidding me?! Lo and behold, I felt like I was in my 20s again. I was lifting and repping out sets with a vigor I hadn't felt in a very long time. It’s not like I felt like I was in my 20s all the time—nothing can do that—but when I approached a weight, the thing just felt lighter.

But here is the part nobody warns you about, so consider yourself warned: the water weight. A few pounds of early weight gain is common and expected. It's water stored inside the muscle, not fat. I packed on 4 lbs of water overnight. I carry a good amount of muscle, and every one of those muscle fibers was happy to pull in extra water along with the creatine.

After my initial panic, and an excessive amount of pinching at my waistline, I realized it really was just water. Despite my jeans feeling tighter around the legs, my muscles felt harder, leaner, and more responsive than they had in years.

French chemist Michel Chevreul discovered creatine in meat in 1832. Over the following century, researchers worked to understand how creatine and phosphocreatine help cells replenish their energy supply.

Creatine’s rise as a supplement began in 1992, when researchers demonstrated that oral creatine monohydrate could substantially increase muscle creatine stores. Studies published the following year linked those increases to better performance during high-intensity exercise. By the time I joined my first gym around 2000, creatine was still a relatively new supplement, and a month’s supply cost me $35. Today, large-scale production means that same $35 can buy me enough for a year.

Bodybuilders and competitive athletes used it to build strength, boost power, and get more out of their training. Those benefits remain among its best-supported uses.

Every muscle contraction runs on ATP, the body's energy currency. The catch is that your muscles only keep about two seconds' worth of ATP on hand. To keep you moving, your body has three energy systems that remake ATP, each trading speed for staying power:

Here's how the CP system works. Your muscles store creatine phosphate as an instant energy reserve. When ATP (adenosine tri-phosphate) gets used up, it loses a phosphate and becomes ADP (adenosine di-phosphate). Creatine phosphate hands its phosphate right back, rebuilding ATP almost instantly. No oxygen, no lag time.

The limitation is supply. Those stores run low after about 10 seconds of maximal effort and take a few minutes of rest to fully recharge. That's exactly why you rest between heavy sets.

Your body produces about a gram of creatine each day, and eating meat and fish can provide roughly another gram. Even so, your muscles usually have room to store more. Creatine monohydrate helps fill that reserve, increasing muscle creatine by around 20 percent on average. That extra energy reserve can help you squeeze out another rep, recover a little faster between sets, and get more from your training. Over time, those small gains in training capacity can add up to greater strength and muscle. Like an interest rate compouding.

That’s exactly what I noticed in the gym.

Eventually, researchers began looking beyond muscle: if creatine helps cells replenish their energy, where else might it make a difference?

Researchers are exploring creatine’s potential role in age-related muscle loss (sarcopenia), rehabilitation, cognition, mental fatigue, sleep deprivation, mood, and neurodegenerative disease. Research on depression in women and brain health is especially interesting, but in some areas, excitement is outpacing the evidence.

The strongest evidence still supports muscle benefits, especially when creatine is combined with resistance training. After menopause, preserving muscle, strength, mobility, and metabolic health becomes increasingly important—even as doing so can become more challenging.

Some analyses suggest that women gain less lean mass and strength from creatine than men do. Findings on bone density during and after the menopause transition are inconsistent, while research on cognition, mood, and benefits specific to menopause is still developing.

That doesn’t mean creatine isn’t worth considering. It means keeping expectations grounded in the evidence.

Creatine gets an emphatic “heck yeah!” from me. It’s affordable, generally low risk, and offers meaningful benefits.

It complements adequate protein and resistance training. It can help you get more from each workout, but it won’t rebuild muscle you aren’t challenging. You still have to do the work.

At this point in my life, I’m drawn to practical, evidence-based ways to preserve strength, function, and independence without spending a fortune or chasing speculative longevity trends. Creatine has earned a place in my routine. I only wish I’d given it a chance sooner.

Talk soon,
Dr. Stevens

General health information only — not a diagnosis, not treatment, and not a substitute for care from your own physician. Talk to your doctor before changing your exercise, diet, or medication routine, especially if you have an existing condition.