Beyond the Needle: Creatine Surges and Steroids Plummet in New Era of Teen Fitness

Published: May 18, 2026

ANN ARBOR, Mich. — A definitive shift is reshaping how American teenagers pursue muscle growth and athletic performance. According to a landmark study published on May 13, 2026, in the Annals of Epidemiology, illicit anabolic steroid use among U.S. adolescents has plummeted to its lowest level in two decades. However, this decline has been accompanied by a massive surge in the use of legal creatine supplements. This rapid adoption has sparked urgent warnings from pediatric health experts regarding social media’s impact on adolescent body image and long-term health.

The study, led by researchers at the University of Michigan, analyzed national data spanning from 2001 to 2024 via the federally funded Monitoring the Future survey. The findings map out a distinct behavioral pivot: while teens are increasingly rejecting illegal performance-enhancing drugs, they are rapidly turning to over-the-counter dietary supplements to modify their appearance.

The Metrics of a Muscle Boom

The University of Michigan data shows that the downward trajectory of steroid use mirrors a broader, multi-decade decline in overall adolescent substance abuse. In stark contrast, creatine—a legal compound used to increase rapid-burst energy in muscles—has seen unprecedented growth.

The surge is particularly pronounced among female adolescents, though the behavior remains highly gendered in absolute numbers:

While the percentage increase among girls is steep, adolescent boys still comprise the absolute majority of creatine consumers.

“What surprised me was that steroid use did not increase over the past five years among adolescents,” stated study author Philip Veliz, Ph.D., a research associate professor at the University of Michigan School of Nursing and Institute for Social Research. “This is a positive finding, but additional research is needed.”

Social Media and the Rise of “Looksmaxxing”

Researchers attribute this dietary pivot directly to shifting digital subcultures. Specifically, the study highlights the rise of “looksmaxxing”—an online movement predominantly targeting adolescent boys that emphasizes maximizing physical attractiveness through strict, often extreme fitness, grooming, and dietary regimens. Social media platforms are heavily saturated with fitness influencers promoting multi-step supplement routines.

“The rapid rise in creatine use may reflect the growth of social media influencers—both men and women—who create gym content and share what they do to build muscle, including the use or promotion of supplements,” Veliz explained.

Crucially, experts emphasize that these digital pressures are not isolated to a single gender. “There is a big emphasis on body image regardless of sex, particularly for girls,” Veliz noted, adding that many adolescent girls now engage in targeted heavy weightlifting designed to increase muscular size and definition rather than traditional weight-loss routines.

Pediatric Safety: The Regulatory and Physiological Grey Zone

While creatine is naturally occurring in foods like red meat and is thoroughly researched in adults, major health organizations—including the American Academy of Pediatrics (AAP) and the American Society for Sports Medicine—explicitly recommend against its use by individuals under the age of 18.

The primary medical concerns include:

• Absence of Juvenile Data: Very few high-quality, long-term studies evaluate how supplemental creatine affects a developing, pediatric musculoskeletal and metabolic system.

• The Regulation Gap: Under federal law, dietary supplements are not subject to pre-market approval or rigorous safety testing by the Food and Drug Administration (FDA). Consumers have no absolute guarantee of product purity or accurate labeling.

• Adverse Side Effects: Documented side effects in adolescents include rapid water-weight gain, muscle cramping, gastrointestinal distress, joint stiffness, and potential renal (kidney) stress if consumed in excessive doses.

“When used at appropriate doses, creatine seems to be safe in healthy athletes of all ages, but due to inadequate studies, we don’t know what long-term effects it may have on young athletes,” warns Dr. Goldberg, a pediatric specialist not involved in the study. “For that reason, medical societies do not recommend creatine use under age 18.”

The Paradox of Declining Perceived Steroid Harm

The study exposed an unexpected paradox that has public health officials on high alert. Even though fewer teenagers are actively using anabolic steroids, the perceived risk and social disapproval associated with steroids have softened over the last five years. This shift in attitude is particularly visible among adolescent boys.

“The decline in perceived harmfulness of steroids is concerning given the serious health risks associated with steroid use. These declines were greater among boys, which may suggest increased risk for future use,” the study authors warned.

Medical literature establishes that anabolic steroids cause profound, often irreversible damage to an adolescent body:

                  ┌────────────────────────────────────────┐
                  │  ADOLESCENT STEROID HEALTH RISKS      │
                  └───────────────────┬────────────────────┘
                                      │
         ┌────────────────────────────┼────────────────────────────┐
         ▼                            ▼                            ▼
┌─────────────────┐          ┌──────────────────┐         ┌──────────────────┐
│  PHYSIOLOGICAL  │          │ GENDER-SPECIFIC  │         │  PSYCHOLOGICAL   │
├─────────────────┤          ├──────────────────┤         ├──────────────────┤
│• Premature growth│          │• Males: Testicle │         │• "Roid Rage"     │
│  plate fusion   │          │  shrinkage &     │         │  aggression      │
│• Severe acne    │          │  gynecomastia    │         │• Severe anxiety  │
│• Hypertension   │          │• Females: Voice  │         │  & paranoia      │
│• Cardiovascular │          │  deepening &     │         │• Clinical        │
│  strain         │          │  amenorrhea      │         │  depression      │
└─────────────────┘          └──────────────────┘         └──────────────────┘

Gateway Behaviors and Practical Guidance for Parents

Public health experts caution that early supplement adoption can act as a behavioral bridge. Prior longitudinal research from the University of Minnesota School of Public Health found that adolescents who used over-the-counter muscle-building supplements were two to five times more likely to try anabolic steroids later in young adulthood.

Furthermore, the escalation often starts with legal, highly caffeinated “pre-workout” powders or energy drinks, which can stress the cardiovascular system when combined with heavy training.

“What is yet to be determined is whether this will eventually translate into steroid use as they age into young adulthood,” Veliz noted, calling the surge a “cautionary signal.”

Recommendations for Families and Providers

To support healthy development without relying on synthetic aids, pediatricians recommend that parents and clinicians guide adolescents toward foundational fitness principles:

• Prioritize Nutritional Fundamentals: The adolescent body naturally produces the necessary hormones for muscle hypertrophy. This is optimal when fueled by a balanced, protein-adequate diet and 8 to 10 hours of sleep.

• Verify Third-Party Testing: If an older adolescent insists on using supplements, choose brands certified by independent organizations (such as NSF Certified for Sport or Informed-Choice) to ensure the product is free of heavy metals or banned contaminants.

• Intervene on Visual Obsessions: Monitor for signs of muscle dysmorphia (an obsessive belief that one’s body is too small or insufficiently muscular), which is frequently driven by fitness algorithms.

“The fact that steroid use is down while creatine use is up points to a shift in the importance of muscularity and fitness among teens,” Veliz concluded. For now, the medical community urges a return to basics, emphasizing that a teenager’s long-term health should never be traded for a short-term physical aesthetic.

Medical Disclaimer

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References

• https://www.earth.com/news/steroid-use-in-teens-has-decreased-quite-a-bit-while-creatine-use-is-on-the-rise/