Creatine is a widely used sports supplement known for enhancing muscle performance and energy metabolism, but questions have emerged about its potential role in erectile dysfunction. Erectile dysfunction (ED) affects a substantial proportion of UK men, with prevalence increasing with age, and has multiple physical and psychological causes. Whilst creatine supplementation has been extensively researched for athletic performance, there is currently no robust scientific evidence supporting its use for treating or managing erectile dysfunction. This article examines the relationship between creatine and erectile function, explores what the current evidence shows, and outlines the evidence-based treatments available through the NHS for men experiencing erectile difficulties.

What Is Creatine and How Does It Work in the Body?

Creatine is a naturally occurring compound synthesised primarily in the liver, kidneys, and pancreas from the amino acids glycine, arginine, and methionine. It is also obtained through dietary sources, particularly red meat and fish. Approximately 95% of the body's creatine is stored in skeletal muscle tissue, where it plays a crucial role in energy metabolism.

The primary function of creatine is to facilitate the rapid regeneration of adenosine triphosphate (ATP), the body's main energy currency. During high-intensity, short-duration activities, creatine phosphate donates a phosphate group to adenosine diphosphate (ADP), quickly converting it back to ATP. This mechanism is particularly important during the first few seconds of intense muscular effort, such as weightlifting or sprinting.

Creatine monohydrate is the most extensively researched form of creatine supplementation and is widely used by athletes and fitness enthusiasts to enhance exercise performance, increase muscle mass, and improve recovery. While some people follow a loading protocol of 20 grams daily (divided into four doses) for 5–7 days followed by a maintenance dose, a simpler approach of 3–5 grams daily will achieve similar intramuscular saturation over 3–4 weeks. Research has demonstrated that creatine supplementation can increase intramuscular creatine stores by approximately 10–40%, depending on baseline levels.

It's important to note that creatine is regulated as a food supplement in the UK, not as a licensed medicine, and product quality may vary. People with kidney disease should consult their doctor before taking creatine, and all users should maintain adequate hydration. Creatine may cause a benign rise in serum creatinine without indicating true kidney injury.

Beyond its role in muscle metabolism, some research has explored creatine's potential effects on other physiological systems, though evidence remains preliminary. However, it is important to emphasise that creatine supplementation is not recognised or approved for the treatment of erectile dysfunction by regulatory bodies such as the Medicines and Healthcare products Regulatory Agency (MHRA) or the National Institute for Health and Care Excellence (NICE).

Understanding Erectile Dysfunction: Causes and Risk Factors

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is a common condition affecting men of all ages, though prevalence increases significantly with age. In the UK, erectile dysfunction affects a substantial proportion of men, with prevalence increasing from around 30% in men aged 40 to approximately 60% in those aged 70 and above.

The pathophysiology of erectile dysfunction is multifactorial and can be broadly categorised into organic (physical), psychological, and mixed causes. Organic causes include:

• Vascular disease: Atherosclerosis, hypertension, and other conditions that impair blood flow to the penis are the most common physical causes of ED

• Endocrine disorders: Diabetes mellitus, hypogonadism (low testosterone), thyroid dysfunction, and hyperprolactinaemia

• Neurological conditions: Multiple sclerosis, Parkinson's disease, spinal cord injury, and pelvic surgery complications

• Medications: Antihypertensives (particularly beta-blockers and thiazide diuretics), antidepressants (especially SSRIs and SNRIs), antipsychotics, 5-alpha-reductase inhibitors (finasteride, dutasteride), and opioids can contribute to erectile difficulties

Psychological factors play a significant role in many cases and include performance anxiety, depression, relationship difficulties, and stress. It is important to recognise that psychological and organic causes often coexist, with physical limitations leading to anxiety that further exacerbates the problem.

Modifiable risk factors for erectile dysfunction include smoking, excessive alcohol consumption, obesity, physical inactivity, and poor cardiovascular health. Erectile dysfunction can serve as an early warning sign of cardiovascular disease, as the penile arteries are smaller than coronary arteries and may show signs of atherosclerotic disease earlier. Consequently, men presenting with ED should undergo cardiovascular risk assessment (such as QRISK3) and diabetes screening as part of their initial evaluation.

The Relationship Between Creatine and Erectile Function: What Does the Evidence Show?

There is currently no robust scientific evidence to support the use of creatine supplementation for the treatment or management of erectile dysfunction. No randomised controlled trials have demonstrated that creatine improves erectile function. While creatine has been extensively studied for its effects on muscle performance and energy metabolism, research specifically examining its impact on erectile function is extremely limited and inconclusive.

Some proponents have theorised that creatine might indirectly benefit erectile function through several proposed mechanisms. These include improved vascular function through enhanced nitric oxide production, increased testosterone levels, or improved overall physical fitness and body composition. However, these theories remain largely speculative and are not supported by clinical trial evidence.

Regarding testosterone, the evidence is mixed and controversial. A small number of studies have suggested that creatine supplementation combined with resistance training might influence androgen levels, but the findings are inconsistent and of questionable clinical significance. Importantly, even if creatine were to have a modest effect on testosterone levels, this would not necessarily translate to improvements in erectile function, as the relationship between testosterone and erectile dysfunction is complex and testosterone deficiency accounts for only a small proportion of ED cases.

It is crucial to emphasise that creatine is not licensed or recommended for erectile dysfunction by UK regulatory authorities or clinical guidelines. Men experiencing erectile difficulties should not rely on creatine supplementation as a treatment strategy. Instead, they should seek proper medical evaluation to identify underlying causes and receive evidence-based treatment.

While creatine supplementation is generally considered safe when used appropriately for its intended purposes (sports performance enhancement), it is not without potential adverse effects. Common side effects include gastrointestinal discomfort, muscle cramping, and weight gain due to water retention. People with pre-existing kidney disease should avoid creatine or consult their doctor before use, and all users should maintain adequate hydration. As a food supplement rather than a licensed medicine, creatine products may vary in quality, so purchasing from reputable suppliers is advisable.

Evidence-Based Treatments for Erectile Dysfunction in the UK

The management of erectile dysfunction in the UK follows NICE guidelines (Clinical Knowledge Summary on Erectile Dysfunction) and typically involves a stepwise approach beginning with lifestyle modification and progressing to pharmacological and, if necessary, specialist interventions.

First-line lifestyle interventions are recommended for all men with ED and include:

• Smoking cessation: Smoking significantly impairs vascular function and is strongly associated with ED

• Weight reduction: Obesity is an independent risk factor for erectile dysfunction

• Increased physical activity: Regular aerobic exercise improves cardiovascular health and erectile function

• Alcohol moderation: Excessive alcohol consumption can impair sexual function

• Optimisation of cardiovascular risk factors: Management of hypertension, diabetes, and hyperlipidaemia

Phosphodiesterase type 5 (PDE5) inhibitors are the first-line pharmacological treatment for erectile dysfunction. These medications work by enhancing the effects of nitric oxide, promoting smooth muscle relaxation in the corpus cavernosum and increasing blood flow to the penis. All require sexual stimulation to be effective. Available PDE5 inhibitors in the UK include:

• Sildenafil (Viagra): Typically taken 30–60 minutes before sexual activity (absorption delayed by fatty meals), effective for 4–6 hours

• Tadalafil (Cialis): Can be taken as needed (effective for up to 36 hours) or as a daily low-dose option

• Vardenafil (Levitra): Similar onset and duration to sildenafil, also affected by food

• Avanafil (Spedra): Faster onset of action (15–30 minutes)

These medications are generally well-tolerated, with common side effects including headache, facial flushing, nasal congestion, and dyspepsia. Contraindications include concurrent use of nitrate medications or guanylate cyclase stimulators (riociguat) due to risk of severe hypotension. Use is not recommended in patients where sexual activity is inadvisable due to cardiovascular status, and caution is needed when used with alpha-blockers. An adequate trial (6-8 attempts at the optimal dose) is recommended before considering treatment failure.

For men who do not respond to or cannot tolerate PDE5 inhibitors, second-line treatments include:

• Intracavernosal injections: Alprostadil (prostaglandin E1) injected directly into the penis

• Intraurethral therapy: Alprostadil pellets inserted into the urethra

• Vacuum erection devices: Mechanical devices that draw blood into the penis

Testosterone replacement therapy may be considered when hypogonadism is confirmed and symptomatic.

Specialist interventions, such as penile prosthesis surgery, may be considered for men with refractory ED. Psychological therapy or psychosexual counselling should be offered when psychological factors are identified as contributing to the condition. Low-intensity shockwave therapy is not routinely recommended outside research settings.

When to Speak to Your GP About Erectile Dysfunction

Men experiencing persistent or recurrent erectile difficulties should not hesitate to consult their GP. Erectile dysfunction is a common medical condition, and healthcare professionals are well-equipped to provide confidential, non-judgmental assessment and management. Early consultation is important for several reasons.

You should arrange to see your GP if:

• You have persistent difficulty achieving or maintaining erections sufficient for sexual activity

• Erectile problems are causing distress, anxiety, or affecting your relationship

• You experience sudden onset of erectile dysfunction

• You have cardiovascular risk factors (hypertension, diabetes, high cholesterol, smoking) as ED may indicate underlying vascular disease

• You are taking medications that might be contributing to erectile difficulties

• You have symptoms of low testosterone such as reduced libido, fatigue, loss of muscle mass, or mood changes

Seek urgent medical attention if:

• You experience chest pain or severe breathlessness (call 999)

• You have a prolonged erection lasting more than 4 hours (priapism) – this requires immediate attendance at A&E

• You have penile deformity or pain

• You have unexplained or persistent blood in urine or semen that requires investigation

During your consultation, your GP will take a comprehensive medical and sexual history, review current medications, and assess cardiovascular risk factors. Physical examination may include blood pressure measurement, examination of secondary sexual characteristics, and genital examination if appropriate. Initial investigations typically include:

• Blood glucose and HbA1c (to screen for diabetes)

• Lipid profile (non-fasting is acceptable for initial assessment)

• Morning testosterone level (ideally between 9-11am, repeated if low) with LH, FSH and prolactin if testosterone is low

• Thyroid function tests if clinically indicated

Your GP can initiate first-line treatments and provide lifestyle advice. If initial management is unsuccessful or if there are complex underlying issues, referral to specialist services (urology, endocrinology, or psychosexual medicine) may be arranged. Remember that effective, evidence-based treatments are available, and seeking help is an important step towards addressing this common condition.

If you experience any suspected side effects from medications or supplements, report them through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions