Creatine
Creatine is a widely used supplement best known for improving short-burst strength, power output, and exercise performance. Outside of athletics, it’s sometimes promoted for cognitive energy, fatigue reduction, and mood support. Because it’s widely viewed as “safe” and common in gym culture, people with PFS/PSSD/PAS may run into recommendations to try it as a low-risk way to boost energy or training capacity. In community discussions, however, outcomes are mixed: some people report no issue (or modest benefit), while others report clear symptom flares after starting creatine—sometimes severe enough that they stop quickly.
In the PFS/PSSD/PAS context, creatine is discussed as potentially relevant because it can meaningfully alter cellular energy buffering (phosphocreatine/ATP dynamics), and there is also human data suggesting creatine supplementation can increase DHT in some individuals. That does not mean everyone’s DHT rises, nor does it prove causation of any syndrome—but it does suggest creatine isn’t “biologically neutral” for an androgen-sensitive audience. Since many people with PFS/PSSD/PAS describe instability around androgen signaling, neurosteroids (e.g., allopregnanolone), and downstream nervous-system tone, some individuals may be more vulnerable to destabilization from shifts that other people barely notice. Community “crash” reports describe worsening in domains like anhedonia/emotional blunting, anxiety, cognition/brain fog, fatigue, and sexual symptoms, and the upside is usually modest (mainly training performance).
Crash Anecdotes (Community Reports):
https://www.reddit.com/r/PSSD/comments/yzagf1/does_anyone_know_if_creatine_is_safe_to_take/
https://www.reddit.com/r/FinasterideSyndrome/comments/164h32q/creatine_crashed_me/
How to Interpret This Page
This page summarizes anecdotal reports and community observations, not medical evidence. “Risk” here refers to how frequently severe or prolonged symptom worsening is reported, not to proven causation or population-wide probability. Individual responses vary widely, and absence of issues in some users does not rule out significant reactions in others.
Risk Signal Based on User Reports
Reports of Flares/Crashes in a Subset, Benefits Often Modest (for PFS/PSSD/PAS):
Among individuals who already have PFS/PSSD/PAS, creatine is commonly described as unpredictable: many tolerate it, but a meaningful subset report symptom flares after starting—sometimes described as intense enough to discontinue. Reports that describe worsening often involve mood/anhedonia shifts, anxiety, cognitive dysfunction/brain fog, fatigue, and sexual symptom worsening. Given that creatine’s typical benefits are non-essential (primarily performance in the gym and modest “energy” effects), some people judge the risk–benefit tradeoff as unfavorable during stabilization or recovery attempts.
For individuals without these conditions, creatine is widely used and generally well tolerated at standard doses, though individual reactions still vary. In an androgen-sensitive population, community discussions often caution against “loading phases,” high doses, and stacked pre-workout blends, and emphasize stopping promptly if a clear, consistent worsening appears.
Evidence basis: General sports nutrition literature; a limited number of human findings suggesting possible DHT changes in some contexts; anecdotal reports (online forums, self-reports); no controlled studies examining PFS/PSSD/PAS-specific outcomes.