“Looksmaxxing” trend boosts creatine use while steroid use drops among US teens

According to a report on US teens, adolescents are using anabolic steroids much less than they did two decades ago, despite softening perceptions of steroid dangers. Meanwhile, creatine use has risen rapidly in recent years as a muscle-building sports nutrition supplement. 

The authors are concerned about the rapid increase in creatine use among adolescents because pediatric guidance recommends that adolescents avoid these products due to limited evidence on safety and efficacy in youth.

“I did this study given the rise in social media trends that glorify toxic gym culture, along with the rise in ‘looksmaxxers,’” says study author Philip Veliz, research associate professor with appointments at the University of Michigan School of Nursing and Institute for Social Research, US.

Popular among younger male netizens, looksmaxxing is a term referring to the practice of maximizing physical attractiveness, sometimes by extreme measures. The trend is driven by male and female content creators who create gym content and share what they do to build muscle, while promoting various supplements. 

Perceived harms of steroid use

Published in Annals of Epidemiology, the study examines trends in steroid use and creatine supplementation, as well as changing attitudes toward steroid use among US adolescents between 2001 and 2024.

The authors are concerned about the rapid increase in creatine use among adolescents because pediatric guidance recommends that adolescents avoid these products due to limited evidence on safety and efficacy in youth.The study drew on nationally representative data from Monitoring the Future, a long-running survey of US adolescents conducted by scientists at the University of Michigan’s Institute for Social Research.

The sample included 874,931 adolescents with an average of 16; 50.9% of whom were girls and 53.0% self-identified as White.

Between 2019–2020 within the overall analysis timeline, 8.71% of boys reported using creatine, which surged to 16.57% by the 2023–2024 period. Usage among girls similarly trended upward, rising from 1.22% to 3.27% between those two periods.

On the longer timeline between a 2001–2002 baseline toward 2023–2024, the overall popularity of creatine shows a steady long-term increase. Past-year use among all respondents climbed from 6.29% to 9.68%, representing a total growth of 3.39 percentage points.

While creatine is legal, the study authors warn that 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.

This finding was evidenced in a previous study of teen supplementation habits, which found that the use of protein powders and shakes in adolescence is strongly correlated with anabolic steroid use in early adulthood for boys.

The authors of the current paper warn there has been a concerning decline in perceived harmfulness of steroids, 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,” says Veliz. “This is a positive finding, but additional research is needed.”

He adds that the substantial decline in adolescent steroid use since 2001 could potentially signal a broader decline in adolescent drug use. However, the risk of future risk may still rise if attitudes are increasingly accepting.

Differences between males and females

While looksmaxxing is often framed as a trend involving young boys and men, Veliz stresses that body image pressures affect both boys and girls.

“There is a big emphasis on body image regardless of sex, but particularly for girls,” he adds. “Furthermore, 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.”

Notably, the study found that girls’ creatine use increased 168% over the duration of the study, compared to a 90% increase among boys.

Veliz believes teen creatine use is not necessarily a cause for alarm, but may be a cautionary signal that someone is using products to enhance muscularity or performance.

He says this could potentially lead to riskier behaviors, including overconsumption of energy drinks, use of other supplements, or 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 adds. “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.”