Findings dovetail with the trends of 'looksmaxxing' and teen fitness culture
U.S. teens report far less anabolic steroid use than they did two decades ago, but creatine use has risen rapidly in recent years, according to a new University of Michigan study.
Combined with declining perceptions of steroid harm and slightly softer disapproval of steroid use, the findings suggest teens may be growing more accepting of muscle-enhancing products, including legal supplements and potentially steroids.
"I did this study given the rise in social media trends that glorify toxic gym culture, along with the rise in 'looksmaxxers,'" said study author Philip Veliz, research associate professor with appointments at the U-M School of Nursing and Institute for Social Research.
Looksmaxxing refers to an online subculture and self-improvement practice-often geared toward boys and young men-that focuses on maximizing physical attractiveness, sometimes by extreme measures.
The study, published in Annals of Epidemiology, examines trends in past-year steroid use, past-year creatine use and attitudes toward steroid use among U.S. adolescents from 2001 to 2024. Creatine is a naturally occurring compound produced by the body and obtained through diet that supports muscle growth; it is also available as a supplement.
Key takeaways
- The rapid increase in creatine use among adolescents is concerning because pediatric guidance recommends that adolescents avoid these products due to limited evidence on safety and efficacy in youth.
- While creatine is legal, its rise may be accompanied by other pre- and post-workout routines that can be harmful for teens, including highly caffeinated pre-workout mixes or energy drinks.
- 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.
"What surprised me was that steroid use did not increase over the past five years among adolescents," Veliz said. "This is a positive finding, but additional research is needed."
What if my teen uses creatine?
The rapid rise in creatine use, he said, 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. These influencers are sometimes called looksmaxxers, who may promote extreme methods to achieve physical attractiveness.
Interestingly, the study found that girls' creatine use increased 168%, compared with a 90% increase among boys, though boys still made up the largest share of users.
Veliz said teen creatine use is not necessarily cause for alarm, but it may be a cautionary signal that someone is using products to enhance muscularity or performance. That could potentially lead to riskier behaviors, including overconsumption of energy drinks, use of other supplements or, in some cases, illegal substances such as steroids.
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 said. Social media is teeming with influencers peddling these messages.
"What is yet to be determined is whether this will eventually translate into steroid use as they age into young adulthood," he said.
Steroids and attitudes
The substantial decline in adolescent steroid use since 2001 may reflect the broader decline in adolescent drug use, Veliz said. Still, it is concerning that perceived harmfulness and disapproval of steroids declined slightly even as use fell.
More accepting attitudes, he said, could increase the risk of future use.
Gender, body image and looksmaxxing
Although looksmaxxing is often framed as an issue affecting boys and men, Veliz said body image pressures affect both boys and girls.
"There is a big emphasis on body image regardless of sex, particularly for girls," he said. "Further, many adolescent girls lift weights and try to increase muscularity in gendered ways-for instance, lifting to target leg muscles to increase size or definition."
The study drew on nationally representative data from Monitoring the Future, a long-running survey of U.S. adolescents conducted by scientists at the University of Michigan's Institute for Social Research.
Co-authors: Jingze Li, Karam Mattar, Ryan Pero and John Jardine, U-M School of Nursing.
