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Dr. Stacy Sims: Should women take creatine? A physiology-based masterclass for midlife hormones
~36 min
Episode Brief·YouTube

Dr. Stacy Sims: Should women take creatine? A physiology-based masterclass for midlife hormones

Stacy Sims
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TL;DR

The four things you'd lose by not watching

4 items

TL;DR

The four things you'd lose by not watching

4 items
1

Dr. Stacy Sims recommends creatine monohydrate at 3–5 grams daily for all women—especially peri- and postmenopause—to support brain, gut, mood, and muscle function via the body's fast energetics; saturation takes about 3 weeks, no loading required.

2

She dismisses the myth that creatine causes hair loss (zero evidence) and explains that low-dose creatine (3–5 g) does not cause the water-weight gain or bloating associated with bodybuilding protocols of 20 g/day with carbohydrates.

3

For quality, she advises using Creapure (water-wash manufacturing) to avoid gastric distress; she personally partners with Momentous, which uses Creapure, and discloses that affiliation.

4

The 'big three' supplements for women are creatine, omega-3 fatty acids, and vitamin D3; everything else is individual-specific and should follow a food-first philosophy.

Protocols

Concrete recipes — what, when, how much, and why

5 items

Daily low-dose creatine for women’s health

WhatTake creatine monohydrate, 3–5 grams once daily, without carbohydrate, any time of day, every day (including rest days). No loading phase.
WhenEvery day, consistently for at least 3 weeks to achieve full tissue saturation.
Dose3–5 grams per day; for the cautious, start at 1.5 g and gradually increase (see related protocol).
For whomAll women, especially perimenopausal and postmenopausal; also noted as beneficial during pregnancy (consult doctor).
WhySupports fast energetics in brain, heart, gut, and muscle; improves mood, cognition, gut integrity, muscle function; women have lower natural stores and dietary intake.
CaveatsUse Creapure-quality creatine to avoid acid-wash side effects like bloating and nausea. Low dose does not cause water-weight gain or hair loss. Do not use 20 g/day bodybuilding doses.

Dr. Sims emphasizes that the traditional bodybuilding creatine protocol (20 g/day with carbs) is designed only for muscle performance, causing water retention and GI distress. In contrast, a woman-focused protocol saturates all fast-energetic tissues slowly, avoiding side effects. She points out that women have 70–80% lower creatine stores than men and eat less creatine-rich food, making supplementation more critical during hormonal transitions. The constant daily dose is necessary because creatine doesn't have an acute effect; it requires cumulative saturation. She references the ISSN position stand and emerging health research on creatineforhealth.com. She also notes that women can start low to avoid any fear of bloating, and that over weeks, the gut, brain, and muscle improvements become evident.

Mechanism

Creatine is part of the ATP-PC (phosphocreatine) system, providing immediate energy for tissues with high and rapid energy demands. The brain, gut mucosal cells, heart, and muscle rely on this system. Supplementing increases tissue creatine and phosphocreatine stores, enhancing cellular energy buffering, maintaining cell integrity, and improving stress resilience. Saturation over three weeks ensures all tissues benefit rather than just muscle.

We're looking at 3 to five grams a day. Over the course of 3 weeks, your body will fully saturate. … For the general woman who's looking for health and performance benefits, you don't have to do a loading strategy. You just have to do that three to five grams a day.

Also said
“Women have about 70 to 80% of the stores that men do by the nature of having less muscle mass. And unfortunately, women don't eat enough to really supply what they need.”— Explains why women need supplementation beyond diet.
“It's an illusion that people should only take creatine on days that they're working out.”— Emphasizes daily use for non-muscle benefits.
“Creatine monohydrate is the most studied supplement in all of the research across years and it's super beneficial for health and performance.”— Reinforces safety and breadth of evidence.

High-stress creatine protocol for intense fatigue or sleep deprivation

WhatTake 5 grams of creatine monohydrate twice per day (morning and evening) during periods of severe fatigue, sleep deprivation, or high stress.
WhenTwo doses daily during the stressful period; may be short-term.
Dose5 grams twice daily (total 10 g/day).
For whomWomen undergoing acute severe fatigue, sleep loss, or depressive episodes where standard dose is insufficient.
WhyUnder extreme duress, the body's creatine demand increases; higher dosing improves stress resilience, helps reset circadian rhythm, and maintains body composition and cognitive function.
CaveatsHigher doses can cause nausea if not tolerated (ensure Creapure quality); this is not a maintenance dose.

Dr. Sims cites studies showing that during sleep deprivation, individuals on a higher creatine dose (she mentions the effective dose as 5 g twice daily) maintain better cognitive focus and body composition. She references its use as an adjunct to SSRIs in depression, where 5 g twice daily helps pull women out of depressive episodes. This protocol is for acute periods, not lifelong, and works within the body's fast energetics framework.

Mechanism

The brain's energy demands surge during stress and sleep deprivation, relying heavily on phosphocreatine; additional creatine supports brain energetics and may blunt the biochemical markers of stress.

Personal experience

The expert used a similar approach during her father's illness: disrupted sleep and depressive episodes, and she turned to creatine instead of SSRIs, reporting positive effects.

under fatigue and you're under high stress, if you are dosing with creatine five grams twice a day, it improves the capacity to be more stress resilient.

Also said
“people who have depressive episodes where their actual pharmaceutical isn't working as well, they can top it up with creatine and it helps get them out of depressive episodes.”— Shows therapeutic potential beyond standard dose.
“We see more people have talked about getting better focus and that has to do with better brain metabolism as well.”— Cognitive benefit from consistent creatine.

Gradual creatine introduction for the cautious

WhatStart with 1.5 g of creatine monohydrate daily for one week, increase to 3 g the next week, and then to 5 g the third week, maintaining 5 g thereafter.
WhenAny time of day, daily; use this ramp-up when first starting supplementation.
Dose1.5 g, 3 g, then 5 g over consecutive weeks, then maintain at 5 g.
For whomWomen who are sensitive to supplements, have never supplemented before, or have concerns about side effects.
WhyAllows the body to adapt slowly, preventing GI upset or fear of bloating; still achieves full saturation over about 3–4 weeks.
CaveatsNot strictly necessary if using Creapure and tolerating 5 g immediately, but recommended for compliance and comfort.

She relates the host's experience of taking 10 g and feeling nauseous to the fact that a large bolus can overload the gut's fast energetics, causing distress. By starting small, the body accumulates creatine steadily, avoiding the nausea and bloating that can occur with a sudden surge. This approach addresses women's common fear of creatine side effects and improves adherence.

Mechanism

Creatine saturation is a gradual process; low-dose buildup still loads tissues without overwhelming any single system.

I tell women they should start with maybe one and a half if they're afraid of supplementing because some women don't supplement and they're not sure how they're going to react. So, if we go one and a half grams for one week and then work up to three grams the next week and then on the third week you're starting to get that five gram dose in, then you're slowly accumulating and saturating the body, but you're not overwhelming any one particular system.

Vitamin D3 supplementation for women

WhatTake vitamin D3 daily, especially in winter or if spending little time outdoors.
WhenDaily.
DoseNot specified, but she emphasizes the need for supplementation because outdoor exposure is insufficient.
For whomAll women, particularly in perimenopause and menopause.
WhyVitamin D is critical for osteoporosis prevention, muscle and immune function, brain health, and iron absorption.

vitamin D3 A lot of us don't spend enough time outside and even the time we spend outside isn't enough to bring our levels up to where they are needed and it's really important for things like osteoporosis prevention. We see it's important for muscle and immunity also really important for brain health

Also said
“vitamin D is really important for absorbing and maintaining iron stores.”— Adds iron synergy benefit.

Omega-3 fatty acids for cellular health

WhatConsume omega-3 fatty acids daily, through diet or supplementation, for anti-inflammatory and cellular support.
WhenDaily.
DoseNot specified.
For whomAll women, especially peri- and postmenopause.
WhyOmega-3s mitigate cellular damage from oxidative stress, support brain health, and reduce inflammation, which is particularly important during hormonal transitions.
Mechanism

She mentions they have antioxidative properties, helping mitigate free radical damage during cell stress.

omega-3s all help with cellular components to reduce inflammation. Um, so those would be the big three, creatine, omega-3s, and our vitamin D.

Also said
“When we're thinking about perry and postmenopause and our body's under a lot of stress and our cells are going through a lot of changes and relying on different um signaling, we want to support it with omega-3s. Also, for our brain, it's really important for brain health as well.”— Specifics on peri/menopause brain and cell support.

What's new

Personal practice updates, fresh positions, predictions

4 items

Creatine repositioned as a health supplement for women, not just bodybuilding

Low-dose creatine (3-5 g/day) is repositioned as a health essential for women, supporting gut integrity, brain metabolism, mood, and muscle function without the side effects of bodybuilding loading protocols.

Why this matters: Challenges the long-held perception that creatine is only for male bodybuilders and causes weight gain; it is an underutilized tool for female physiology, especially in perimenopause.

Background

Creatine supplementation originated in bodybuilding with high doses and loading phases, leading to a widespread belief that it causes bloating and weight gain. Women have avoided it due to fear of these side effects.

Dr. Sims details how the bodybuilding dose (20 g/day in divided doses with carbs) saturates muscles for performance and causes water retention, but that is not what women need. For health, a much lower dose over time saturates all fast-energetic tissues—brain, heart, gut, muscle—providing cognitive, mood, and gut benefits without water weight or gastric issues. She highlights that women store 70–80% less creatine than men and eat less creatine-rich food, making supplementation crucial, especially in perimenopause when estrogen fluctuations increase gut distress and brain fog. The ISSN position stand and the creatineforhealth website are now compiling evidence beyond muscle, shifting the narrative. She emphasizes that the daily low dose works for all tissues, not just on workout days.

We're looking at 3 to five grams a day. Over the course of 3 weeks, your body will fully saturate. And what does it do? Right? This is the big question. I should take it, but what does it do? Creatine is really important for every fast energetic in the body. So, we think about the brain and how fast we have neural connections. All of that relies on our ATP CP um fueling system and creatine is part of that. We think about our gut. We think about our heart. We think about also muscle performance. All of those require creatine.

Also said
“Women have about 70 to 80% of the stores that men do by the nature of having less muscle mass. And unfortunately, women don't eat enough to really supply what they need.”— Quantifies the sex difference and dietary gap that justify supplementation.
“It's an illusion that people should only take creatine on days that they're working out.”— Underscores daily use for non-muscle health benefits.

Creatine as a mood disorder adjunct, validated by personal and trial evidence

Dr. Sims used creatine instead of an SSRI during a period of intense grief and sleep deprivation, and RCTs now show creatine enhances recovery from depression and anxiety more than SSRIs alone.

Why this matters: A personal, high-stakes case study that aligns with emerging clinical evidence for mental health applications far outside the traditional muscle narrative.

Background

Standard depression treatment is SSRIs, but side effects and uncertainty about their impact on her PhD work led Dr. Sims to explore creatine, which the brain requires for fast energetics.

She recounts living in New Zealand while her father was dying of cancer on the US East Coast, receiving middle-of-the-night calls that wrecked her sleep. Facing depressive episodes but not wanting to risk an SSRI during her PhD, she delved into research on brain energy metabolism. The brain’s high energetic demand relies on ATP and phosphocreatine; she reasoned that making creatine systemically available would benefit all tissues, including the brain. She later points to randomized controlled trials showing that women taking 3–5 g of creatine come out of depressive episodes faster than those on SSRIs alone, and that under severe fatigue, 5 g twice daily improves stress resilience and circadian rhythm reset.

Personal experience

Dr. Sims described a period when her father was dying of cancer on the other side of the world, causing regular middle-of-the-night calls, severe sleep disruption, and depressive episodes. She chose not to take an SSRI because she was doing her PhD and was unsure of side effects. Instead, she started taking creatine after finding compelling research about its role in brain energetics. She credits creatine with helping her through that dark time.

I didn't want to go on a serotonin reuptake inhibitor because I was doing my PhD and I didn't know how it was going to affect me. So I started looking at creatine and because your brain is a is a very energetic organ and needs a lot of glucose and fast energetics and it was very compelling to read how creatine when it is available through all the body that all the tissues benefit.

Also said
“there have been randomized control trials looking at mood and specifically with regards to depression and anxiety and women who are taking three to five grams of creatine will come out of a depressive episode more so than women who are just using an SSRI.”— Cites clinical evidence for mood benefits plus superiority to SSRI alone.
“under fatigue and you're under high stress, if you are dosing with creatine five grams twice a day, it improves the capacity to be more stress resilient.”— Extends the finding to a higher-dose protocol for acute stress.

Creatine for gut integrity and IBS in perimenopause

Creatine helps maintain the mucosal lining of the intestines, reducing IBS symptoms and GI distress common in perimenopausal women due to estrogen receptor changes.

Why this matters: Connects a supplement usually associated with muscle to a common but rarely discussed perimenopausal symptom—gut dysfunction—and offers a mechanistic rationale.

Background

Many women experience new or worsened IBS-like symptoms during perimenopause, often attributed to hormonal changes that affect gut permeability.

Dr. Sims explains that the gut is a fast-energetic tissue; its mucosal lining requires creatine to maintain tight junctions. In perimenopause, estrogen fluctuations disconnect estrogen receptors, leading to increased intestinal permeability and distress. Supplementing creatine provides fuel to keep the mucosa intact under stress. She notes the 5:1 ratio of women to men experiencing GI distress while running, tied to both estrogen and mucosal integrity. By saturating tissues over three weeks with 3–5 g daily, the gut benefit kicks in, reducing the need to find a bathroom mid-run. This is a stark contrast to bodybuilding creatine protocols that never considered gut health.

Creatine helps maintain the integrity of our intestinal cells because we now have the um creatine that's there to kind of keep the mucosa lining intact even under stress.

Also said
“We see a lot of uptick in gut issues in pmenopause because of a disconnect of our estrogen receptors.”— Links the gut symptom surge to a specific menopausal mechanism.
“We see that there is a greater incidence of GI distress in women… it has to do with estrogen but also has to do with what we call the mucosal lining of the intestines. So we want to maintain the integrity of the mucosal lining and creatine is really important for that.”— Expands on the biomechanics of GI distress and creatine’s protective role.

Zero evidence for creatine-induced hair loss

Hair loss blamed on creatine is actually driven by progesterone fluctuations in midlife, not creatine; there is no evidence linking creatine to hair loss.

Why this matters: Directly confronts a pervasive fear that prevents women from taking creatine, distinguishing hormonal reality from internet myth.

Background

Online forums and a single study on DHT gave rise to the myth that creatine accelerates hair loss, scaring many women away from supplementation.

Dr. Sims acknowledges the existence of one study showing a marginal increase in DHT but states clearly that there is no evidence of actual hair loss. She points out that women who start creatine in midlife often experience hair shedding due to progesterone fluctuations during perimenopause, and they erroneously attribute it to creatine. She clarifies that the low-dose, no-carbohydrate protocol recommended for women does not engage the same hormonal pathways that might be affected by bodybuilding doses. This myth-busting is critical because it removes a key psychological barrier to supplementation.

There is no evidence to show that it promotes hair loss. … We see that women who start taking it midlife are complaining about it, but it's actually a progesterone driven thing. We see progesterone and fluctuation progesterone can exacerbate any hair loss.

Also said
“There is a smidgen of evidence that it might increase dihydrotestosterone levels, but it's like one study marginal increase and then people linked dihydrotestosterone to hair loss. And so then the conclusion people drew was that somehow creatine increases hair loss. But you're saying zero evidence? No evidence.”— Traces the origin of the myth and confirms zero evidence for actual hair loss.

Recommendations

Products, supplements, and tools mentioned in the episode

2 items

Creapure (water-washed creatine monohydrate)

Supplement

Not a specific brand, but a German B2B patented creatine manufacturing process using water wash. Found in many high-quality products. She recommends looking for 'Creapure' on the label to avoid side effects from acid-washed creatine.

She explains that cheaper creatine is typically acid-washed, which can cause bloating, stomach discomfort, and nausea. Creapure uses a water-based wash, resulting in a pure form with no real side effects. She cites that many people who switch from generic to Creapure report feeling much better. She stresses she receives no kickback from Creapure.

vs alternatives

Acid-washed creatine monohydrate is associated with gastric distress; Creapure water-washed creatine is purer and gentler on the stomach.

the company that produces Crea Pure. This is a German B2B, meaning business to business, Creapure is patented, and so it uses a water wash. There's no real side effects from using it. It's pure and it's in almost every high quality Creatine monohydrate product that's out there.

Also said
“if you're looking at a cheaper version of creatine monohydrate, it comes as an acid wash because it's cheaper to produce it through acid um evaporative and other things in the lab than it is to use a water wash which is really specific and this is why we start to see a lot of bloating and stomach discomfort and some of the other side effects that we see.”— Explains the side-effect mechanism of acid-washed alternatives.
Find Creapure

Creatine for Health website (creatineforhealth.com)

Service

A resource compiling peer-reviewed studies on creatine for health (brain, gut, mood, pregnancy), not just muscle performance. She recommends it for those wanting the evidence.

She mentions Crea Vitalis, an offshoot of Creapure designed for health (not bodybuilding) and the website as a central repository. The website is pushing the health space for both men and women, with all the RCTs available. It's useful for women to see the breadth of benefits beyond the gym.

there is a website now creatine for health that's publishing all the uh more health oriented creatine research that's out there from pregnancy to mental health.

Find Creatine
Disclosed sponsorships1speaker disclosed

Momentous Creatine (contains Creapure)

Product Sponsored · disclosed

She recommends looking for a clean, third-party tested creatine and states that Momentous fits that bill, using Creapure and having no side effects. She personally uses it.

DisclosureDr. Stacy Sims is a paid partner of Momentous and appears on their podcast; she says 'I partner with them and I agree with them because of their advocacy behind the scenes.'

She emphasizes that she can't tell people in different countries which brand to use, but highlights Momentous because of their quality, advocacy for women's health, and behind-the-scenes policy work. She trusts their products and uses their creatine herself. While she discloses the partnership, she notes that her recommendation is based on alignment with their ethos and product quality.

vs alternatives

Compared to generic creatine monohydrate that may use acid-wash production, Momentous uses Creapure, which is water-washed and less likely to cause GI distress.

I get asked all the time what I use. I can't really tell people what to use in whatever country they're in because there are different regulations. What I can say is you want to look for something that you trust and is really clean. And I say that standing here with lots of products by one company in front of me, Momentous. … I partner with them and I agree with them because of their advocacy behind the scenes.

Also said
“I love their creatine. So I always talk about creatine and looking for crea pure.”— Affirms product quality and Creapure standard.
Find Momentous

Notable quotes

Lines worth pulling out — contrarian, specific, or perfectly phrased

6 items
Oh my god, it's great.
Unfiltered enthusiastic expert verdict on creatine, immediately establishing credibility and countering any hesitation.
It's an illusion that people should only take creatine on days that they're working out.
Directly challenges the common gym-rat belief, opening the door for daily health-oriented use.
Women have about 70 to 80% of the stores that men do by the nature of having less muscle mass. And unfortunately, women don't eat enough to really supply what they need.
Quantitative anchor for the biological sex difference that explains why women particularly need creatine supplementation.
There is no evidence to show that it promotes hair loss. … We see that women who start taking it midlife are complaining about it, but it's actually a progesterone driven thing.
Definitive myth-busting on the most feared side effect, shifting blame to perimenopausal hormones.
The dose or the poisons in the dose.
Succinct principle framing creatine’s effects entirely around dosage, not the compound itself.
I didn't want to go on a serotonin reuptake inhibitor because I was doing my PhD and I didn't know how it was going to affect me. So I started looking at creatine and because your brain is a is a very energetic organ and needs a lot of glucose and fast energetics and it was very compelling to read how creatine when it is available through all the body that all the tissues benefit.
Powerful personal story grounding the science of creatine for mental health in a relatable, high-stakes dilemma.

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Topics covered

creatinewomen's-healthperimenopausemenopausemood-disordersgut-healthbrain-healthmuscle-performancesupplement-safetyhair-loss-mythcreatine-dosagevitamin-domega-3momentouscreapure
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