More than two-thirds of surveyed sales attendants at health food and vitamin supplement stores endorsed creatine and testosterone boosters for teenage customers, despite explicit recommendations against pediatric use by both the AAP and American College of Sports Medicine.

Categorized as dietary supplements, popular sports performance supplements such as creatine and testosterone boosters do not adhere to FDA drug requirements regarding safety and efficacy outcomes. Since many teenagers do not receive information about supplement use from physicians or dietitians, there is growing concern over possible misinformation disseminated by retailers.

“Teens commonly get information about muscle supplements from health food stores and are most likely to purchase these supplements from these types of stores,” Ruth Milanaik, DO, from the division of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children’s Medical Center of New York, North Shore – Long Island Jewish Health System, and colleagues wrote. “Because many health food stores present their employees as ‘expert(s) in health and wellness products’ (GNC) or ‘knowledgeable, courteous and extensively trained Health Enthusiasts ready to help with all your health and wellness needs’ (Vitamin Shoppe), teenagers may be led to believe that they are receiving the best possible advice.”

In the first investigation to determine the extent to which health food stores would recommend or sell creatine or testosterone boosters to young teens, the researchers identified 244 health food stores in the U.S. and inquired via telephone which supplements sales attendants would recommend to build muscle strength.

Identifying himself as a 15-year-old male high school football player interested in strength training, the principal researcher, Maguire Herriman, inquired about what supplements the sales attendant would recommend. If the sales attendant did not initially recommend creatine or testosterone booster supplements, Herriman would specifically ask whether they would recommend these supplements, and if they could be purchased without an adult.

Of sales attendants contacted, 164 (67%) recommended creatine for a 15-year-old boy to increase muscle strength, and 24 (9.8%) recommended a testosterone booster. Ninety-four (38.5%) recommended creatine without prompting, but only 2 attendants recommended a testosterone booster without prompting.

However, following prompting, 70 (28.7%) of sales attendants recommended creatine and 22 (9%) recommended a testosterone booster.

Further, 181 (74%) sales attendants said a 15-year-old person could purchase creatine on his or her own, and 101 (41%) stated the same for a testosterone booster.

“Supplements, such as creatine and testosterone boosters, can pose significant health risks if used by young adolescents,” Milanaik and colleagues wrote. “Until additional safeguards are introduced by retailers, states, or the FDA, pediatricians should counsel all adolescents, not just teen athletes, about the risks associated with supplement use.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.