The coral structural framework is crucial for maintaining reef ecosystem function and services. Rising seawater temperatures impair the calcification capacity of reef-building organisms on a global scale, but in the Red Sea total alkalinity is naturally high and beneficial to reef growth. It is currently unknown how beneficial and detrimental factors affect the balance between calcification and erosion, and thereby overall reef growth, in the Red Sea. To provide estimates of present-day carbonate budgets and reef growth dynamics in the central Red Sea, we measured in situ net-accretion and net-erosion rates (Gnet) by deployment of limestone blocks to estimate census-based carbonate budgets (Gbudget) in four reef sites along a cross-shelf gradient (25 km). In addition, we assessed abiotic (i.e., temperature, inorganic nutrients, and carbonate system variables) and biotic (i.e., calcifier and bioeroder abundances) variables. Our data show that aragonite saturation states (Ω = 3.65–4.20) were in the upper range compared to the chemistry of other tropical reef sites. Further, Gnet and Gbudget encompassed positive (offshore) and negative (midshore-lagoon and exposed nearshore site) carbonate budgets. Notably, Gbudget maxima were lower compared to reef growth from undisturbed Indian Ocean reefs, but erosive forces for Red Sea reefs were not as strong as observed elsewhere. In line with this, a comparison with recent historical data from the northern Red Sea suggests that overall reef growth in the Red Sea has remained similar since 1995. When assessing reef sites across the shelf gradient, AT correlated well and positive with reef growth (ρ = 0.9), while temperature (ρ = −0.7), pH variation (ρ = −0.8), and pCO2 (ρ = −0.8) were weaker negative correlates. Noteworthy for this oligotrophic sea was the positive effect of PO43− (ρ = 0.7) on reef growth. In the best-fitting distance-based linear model, AT explained about 64 % of Gbudget. Interestingly, parrotfish abundances added up to 78 % of the explained variation, further corroborating recent studies that highlight the importance of parrotfish to reef ecosystem functioning. Our study provides a baseline for reef growth in the central Red Sea that will be particularly useful in assessing future trajectories of reef growth capacities under current and future ocean warming and acidification scenarios.