Creatine
Creatine is a widely used supplement best known for improving short-burst strength, power output, and muscle performance. Outside of athletics, it is sometimes promoted for cognitive energy, fatigue reduction, and even mood support. Because of this reputation, people with post-finasteride syndrome (PFS) or post-SSRI sexual dysfunction (PSSD) may encounter recommendations to try creatine as a “safe” or “natural” way to boost brain or physical energy. However, anecdotal reports within these communities show highly inconsistent outcomes, with some individuals experiencing no benefit and others reporting clear and sometimes severe worsening of symptoms after use.
From a mechanistic standpoint, creatine is not biologically inert in these conditions. Creatine supplementation can increase intramuscular and neural phosphocreatine, alter cellular energy signaling, and influence androgen-related pathways by increasing dihydrotestosterone (DHT) in some individuals, as shown in human studies. In the context of PFS and related syndromes—where androgen receptor signaling, neurosteroids (such as allopregnanolone), and GABA-A modulation are already dysregulated—this shift in androgen or energy signaling may destabilize an already fragile system. Multiple patient reports describe “crashes” following creatine use, including worsened anhedonia, anxiety, cognitive dysfunction, and sexual symptoms. Given the modest and non-essential benefits of creatine for daily functioning, these risks are not justified for individuals with PFS/PSSD, and avoidance is generally advised.
Anecdotes:
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/
My Personal Risk Ranking:
Moderate Risk of Permanent Worsening (for PFS/PSSD/PAS):
If you currently have PFS/PSSD/PAS, creatine is generally considered a moderate risk substance for worsening symptoms—potentially in a lasting way—because it is not biologically inert in this context. While often marketed as a “safe” performance supplement, creatine can meaningfully shift cellular energy signaling (phosphocreatine/ATP buffering) and may influence androgen-related pathways; notably, some human data suggests it can raise DHT in certain individuals. In a system already prone to instability (androgen receptor signaling, neurosteroids like allopregnanolone, and GABA-A modulation), that kind of push can be enough to trigger destabilization rather than improvement.
There are community reports of flares/crashes after creatine—ranging from worsened anhedonia, anxiety, brain fog, fatigue, and sexual symptoms—and the upside is usually modest (mainly short-burst strength/power and minor cognitive-energy effects). For most people with these conditions, the benefit simply isn’t worth the risk, especially during stabilization or recovery attempts. If encountered, avoid “loading phases,” high doses, or stacked pre-workout blends, and discontinue immediately if you notice a clear, consistent worsening.