Journal of Strength and Conditioning Research, 1997, 11(3), 182-187 (© 1997 National Strength & Conditioning Association Response of Testosterone and Cortisol Concentrations to High-Intensity Resistance Exercise Following Creatine Supplementation JeffS. Volek, Mark Boetes, Jill A. Bush, Margot Putukian, Wayne J. Sebastianelli, and William J. Kraemer Center for Sports Medicine, Dept. of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania 16802. Reference Data Volek, J.S., M. Boetes, J.A. Bush, M. Putukian, W). Sebastianelli, and W.J. Kraemer. Response of testoster- one and cortisol concentrations to high-intensity resis tance exercise following creatine supplementation. j. Strength and Cond, Res. 11(3):182-187. 1997. ABSTRACT ‘This study investigated the influence of oral creatine monohy- drate supplementation on hormone responses to high-intensity resistance exercise in 13 healthy, normally active men. Subjects ‘were randomly assigned in double-blind fashion to either acre- atine or placebo group. Both groups performed bench pressand jump squat exercise protocols before (T,) and after (T,) ingest- ing either 25 g creatine monohydrate or placebo per day for 7 days. Blood samples were oblained pre-and 5 min postexercise to determine serum lactate, testosterone, and cortisol concen- trations. Creatine ingestion resulted in a significant (p < 0.05) increase in body mass but no changes in skinfold thickness. Serum lactate concentrations were significantly higher atS min postexercise in both groups compared to resting values. From "T,toT, there were no significant differences in postexercise lac- tate concentration during both exercise protocolsin the placebo ‘group, but the creatine group had significantly higher lactate concentrations after the bench press and a trend toward lower concentrations during the jump squat atT,. There were signifi cant increases in testosterone concentration postexercise after the jump squat, but not the bench press, for both groups; 5-min, postexercise cortisol concentrations did not differ significantly from preexercise values forboth groups for either protocol. Cre atine supplementation may increase body mass; however test- osterone and cortisol may not mediate this initial effect. Key Words: ergogenic aid, anabolic, catabolic, body ‘composition Introduction Creatine is a nitrogenous substance synthesized in the human body ata rate of ~1 g -day" from the precursor amino acids glycine, methionine, and arginine. Itis also consumed in the diet primarily through meat products. Supplementation with much larger quantities (e.g., 20 to 25 g creatine monohydrate -day" for 5 to 6 days) has been shown to result in increases in total creatine con- 182 tent of muscle (8, 11), exercise performance (1, 3, 6, 9, 24, 29), and body mass (1, 2, 5, 6, 24, 28, 29). Creatine increases intermittent high-intensity exercise perfor- mance mostly through an increased availability of cre- atine and phosphocreatine prior to exertise (i) and a higher rate of phosphocreatine resynthesis during re- covery (8). Although this energy based mechanism can, explain the improvement in exercise performance fol- lowing creatine supplementation, itdoes not adequately explain the creatine-induced increases in body mass. Few studies have examined body composition fol- lowing creatine supplementation. An increase in fat-free ‘mass (6) and total body water (1) have been proposed. After 4 weeks of resistance training, Earnest et al. (6) reported that creatine supplementation enhanced the accumulation of fat-free mass compared to a control group who received a placebo. Also after 4 weeks of, resistance training, Staron et al. (25) reported that rest- ing testosterone concentrations were increased, but af- ter 6 weeks the resting cortisol concentrations were de- creased in previously untrained men. Based on these two findings, we speculated that creatine may act in a synergistic fashion with either tes- tosterone or cortisol by augmenting the typical increase in resting testosterone or the typical decrease in resting, cortisol concentrations normally observed with resis- tance training in men. Furthermore, since the increases in creatine and phosphocreatine in muscle tissue, exer- cise performance, and body mass all occur after 5 or 6 days, we reasoned that any potential interaction be- tween creatine and testosterone or cortisol metabolism would be discernible at this time (i, after 1 wk). There- fore, the primary purpose of this investigation was to examine the effects of 1 week of creatine monohydrate supplementation on resting and postexercise testoster- one and cortisol concentrations. Methods ‘Thirteen healthy resistance-trained men volunteered for this study. None had any orthopedic or medical prob- lems that would affect their participation, and none were smokers or users of anabolic drugs. Descriptive data for the 13 subjects are presented in Table 1. All subjects,‘Table ‘Characteristics of Creatine and Placebo Groups Variable Age (yts) Resistance maining (ys) «S88 5.734 Height (cm) 136 66 «172188 Weight (kg) 718 6 76378 ESkinfolds® (mm) 36 412961190 TERM squat (kg) 1441262 143.7 480 TO-RM bench press (ke) 87.6134 TBS ITS "Sum of triceps, subscapula abdomen, gnd thigh skinfolds. rmidaxillary, chest, supailia, were informed as to the possible risks of the investiga- tion prior to giving their written informed consent in accordance with the university's institutional review board policy for the use of human subjects. Experimental Design Prior to the investigation, the subjects were matched and randomly divided in double-blind fashion into 2 groups, creatine (1 = 6) and placebo (n = 7), based on individual body mass and power production during a jump squat. A crossover design was not used because the washout period for creatine is longer than I month, which would make testing reliability problematic (7). All subjects completed a 2-day experimental protocol on 2 occasions (I, and T,) separated by 6 days. Day 1 consisted of a bench press session and Day 2 a jump squat session Creatine Administration Immediately following T, the creatine group began in- gesting capsules amounting to 25 g creatine monohy- drate “day”! divided into 5 equal doses consumed every 2-3hrs with food) (Twin Laboratories, Inc, Ronkonkoma, NY)until T,, During the same time, the placebo group ingested an identical looking and equivalent amount of placebo (powdered cellulose capsules). Although cre- atine was not directly measured in this investigation, this same pattern of supplementation has been shown, to increase muscle creatine, on average, more than 20% in men similar in physical characteristics to the men in, this study (8, 11). Exercise Sessions All subjects reported to the laboratory for initial exer cise tests, the 1-RM squat and 10-RM bench press as pre- viously described (18, 19). All exercise testing was per- formed on a plyometric power system (PPS) (Lismore, NSW, Australia) interfaced with a computer data ac- quisition system as described by Wilson et al. (30). Thi machine is illustrated in Figure 1 Each testing session was conducted at the same time of day for each subject so.as to reduce diurnal varia- Response to Creatine Supplementation 183 Power System. A bench also unfolds to accommodate a bench press exercise, The machine is interfaced to a com- puter and on-line data aquisition system (not shown), Photograph courtesy of the laboratory at Penn State's Center for Sports Medicine. tions in circulating hormone concentrations (27). Each subject refrained from alcohol and any strenuous weight training or other activity for 48 hrs prior to any testing, Subjects reported being well rested the day prior to each exercise session. Each test was preceded by a standard warm-up of 5 min of low-intensity cycling on a station- ary ergometer, static stretching, and 1 to 2 sets of move- ment-specific exercises with light resistance for a local warm-up. The bench press protocol consisted of 5 sets using a resistance equal to each subject's pretest 10-RM bench press. The jump squat protocol involved 5 sets of 10 con- tinuous repetitions with a resistance equal to 30% of the subject's 1-RM squat. The 30% 1-RM was chosen as the resistance because mechanical power is maximized near this value (30). Starting in an upright position, subjects ‘were instructed to jump repeatedly as high as possible without pausing between repetitions withina set. There was exactly a 2-min rest period between all sets, Anthropometric Measurements Prior to exercise, body mass was weighed on a Toledo electronic scale (Reliance Electronic Co., Worthington, OH) to the nearest 100 g. Two skinfold measurements on the right side were obtained from 7 sites (triceps, subscapular, midaxillary, chest, suprailiac, abdomen, and thigh) in serial fashion by the same investigator with a Lange caliper using standard methods (22). Skinfold thickness was determined using the average of the two trials (which varied by <1.0 mm).184 Volek, Boetes, Bush, Putukian, and Kraemer Blood Analyses Approximately 5 ml of blood was drawn from a fore- arm vein using a 20-gauge needle and vacutainer setup. The blood was allowed to clot at room temperature for approximately 12 to 15 min and was then centrifuged at 1500 x g for 15 min at 4°C. The resultant serum was separated and stored at -88 °C. The samples were thawed within 1 month of storage and analyzed in du- plicate for lactate, testosterone, and cortisol concentra- tions. Lactate concentrations were determined via a YSI ‘Model 1500 sport lactate analyzer (Yellow Springs In- strument Co,, Yellow Springs, OH), Serum testosterone and cortisol were measured using radioimmunoassay procedures, Immunoreactivity values were determined with the use of a gamma counter (1272 Clinigamma, Pharmacia Wallac, Wallac Oy, Finland) and Silent 700 data terminal (Texas Instruments, Temple, TX). All samples were analyzed in the same assay in duplicate for total testosterone and total cortisol using a single antibody I solid phase radioimmunoassay (Diagnostic Products Corp., Los Angeles). Intra-assay variances for testosterone and cortisol were <5%, and sensitivity of the assays was 0.14 and 5.5 nmol “L*, re- spectively. Statistical Analyses Corresponding pre- and postsupplementation values for all measured variables were compared via repeated- measures ANOVA. When a significant F value was achieved, Fisher’s PSLD test was used to locate the dif- ference between paired means across treatments. The level of significance was p< 0.05. All values presented herein represent means + 1 SD. Results Details of the resistance exercise results are to be pre- sented elsewhere (29). Briefly, significant increases in muscular power and endurance were observed after creatine ingestion but not after placebo ingestion. Body mass and skinfold thickness were not significantly dif- ferent for the placebo group (-0.4 kg and +1.4 mm, re- spectively). In the creatine group, body mass was sig- nificantly increased at T, (+1.3 kg) but skinfold thick- ness was not statistically different (+4.3 mm). Pre- and postexercise lactate concentrations are listed in Table 2. Serum lactate concentrations were sig- nificantly higher at 5 min postexercise in both groups compared to resting values. From T, to T, the placebo group had no significant differences in 5-min post- exercise lactate concentrations during the bench press or jump squat protocols. However, the creatine group had significantly higher lactate concentrations after the bench press protocol, and a trend (p = 0.08) toward lower concentrations during the jump squat at T,, Figures 2 and 3 present testosterone and cortisol concentrations for each group at each exercise session. Both groups had significant increases in testosterone postexercise following the jump squat at T, and T,, Table 2 S-min Postexercise Serum Lactate Concentration (mmol - L*) During the 4 Protocols Placebo Creatine Protocol M 48D Mo 48D TT, Bench press Preexercise a1 16 24 12 Postexercise 98 20 03 20 "T, Bench press Preexercise 28 0 1d 24 10 Postexercise na 1s" 6 29 ‘T, Jump squat Preexercise 29 16 19 05 Postexercise us ln 143. 39 ‘T, Jump squat Preexercise 21 06 2108 Postexercise oo 25 W434 *P 5005 from corresponding value at T, Serum Testosterone (moll) > i i i i ; ° Pre-Ex — PostEx Preex — Postex a a Figure 2. Serum testosterone concentration (nmol the creatine group (top) and placebo group (bottom) during, the bench press and jump squat. T; = Test 1; Ts = Test 2. *p S 0.05 from corresponding preexercise value. Postexercise testosterone concentrations were not sig- nificantly higher than preexercise values for the bench press, except at T, for the placebo group. Postexercise cortisol concentrations did not differ significantly from preexercise values for either group; however, the pl cebo group had significantly lower pre- and postexercis cortisol concentrations at T, than atT,.Serum Corto! (amet) oF stump squat creatine group (top) and placebo group (bottom) during the bench press and jump squat. T; = Test 1; Ts = Test 2. *p $0.05 from corresponding T; value. Discussion The present investigation was the first to demonstrate that following creatine supplementation, total repeti- tions performed during 5 sets of bench press as well as peak power output during 5 sets of jump squat were enhanced. These specific performance results are pre- sented elsewhere (29). The 1.3-kg increase in body mass in the creatine group is similar to that reported in stud- ies involving creatine supplementation (1, 2,5,6,24, 28, 29), Earnest et al. (6) reported an increase in fat-free mass of 1.6 kg in weight-trained men after 28 days of creatine supplementation, indicating that at least part of this increase in body mass may be due to an increase in fat- free mass. To date, no studies have examined the pos- sible role of anabolic or catabolic hormones in mediat- ing the exercise performance and body mass increases, associated with creatine supplementation. The significant increase in testosterone following the jump squat exercise protocol, but not the bench press protocol, was most likely due to the greater muscle mass, used in the jump squat (16, 20). The lack of a significant, increase in testosterone concentration following the bench press is in agreement with Guzennec et al. (10), who showed a nonsignificant testosterone response to a similar bench press protocol. ‘The lack of a significant cortisol response to the re- sistance exercise protocols may have been due to the time of blood sampling (i. cortisol concentrations may have still been on the rise) or the amount of rest periods Response to Creatine Supplementation 185 between sets (ie,,2vs. 1 min) (17). The significantly lower pre-and postexercise cortisol concentrations in the pla- cebo group during the T, bench press protocol compared to the corresponding cortisol concentrations during all other testing sessions is difficult to explain, but it may bbe due to the normal diurnal variation in this hormone (27) or to decreased preexercise anxiety levels, Our findings that pre- and postexercise testoster- one and cortisol concentrations did not differ signifi- cantly between groups indicates that the increases in exercise performance and body mass associated with 1 ‘week of creatine supplementation are not due to any measurable alteration in circulating concentrations of these steroid hormones. Rather, improvement in exer- cise performance after 1 week is most likely related to an increase in energy substrate availability and resyn- thesis. A significant increase in resting testosterone con- centrations after 4 weeks and a decrease after 6 weeks has been found in previously untrained men undergo- ing heavy-resistance training (25). Therefore, our fail- ure to detect an interaction between creatine and test osterone or cortisol may have been due to training sta- tus. Inother words, the subjects in this study may have already made adjustments in the homeostatic mecha- nisms that control circulating testosterone and cortisol, therefore making it difficult for creatine supplementa- tion to provide additional stimulus toalter the hormonal cascade of events responsible for resting steroid con- centrations. Hence our data suggest that the enhance- ment of fat-free mass after 4 weeks of resistance train- ing in creatine-supplemented subjects (6) is not medi- ated by alterations in resting testosterone or cortisol concentrations. The lack of change in skinfold thickness following creatine supplementation indicates that the increase in. body mass is due to an increase in fat-free mass and/or an increase in total body water. Analysis of skinfold thickness does not allow us to determine which of these components contributed to the increase in body mass. However, given the short time period of creatine supple- mentation, we speculate that the weight gain is mainly due to an increase in total body water. Creatine is an osmotically active substance, thus an increase in intracellular creatine concentration may likely induce the influx of water into the cell. Since cre- atine is predominantly located intramuscularly, part of the increase in total body water may be intracellular due to the direct influx of water into the cell; however, there are no available data to support this hypothesis. Never- theless, an increase in cell water may be seen as.an ana- bolic proliferative signal (12, 13) while a decrease may be seen as a protein-catabolic signal (21), The exact nature of this signal linking cellular hy- aration with proteolytic activity has not been identified, but an alteration in intracellular pH may play an im- portant role. More specifically, the fact that cell swell-186 Volek, Boetes, Bush, Putukian, and Kraemer ing induces an alkalinization of lysosomes and prelyso- somal endocytotic compartments, and that autophagic proteolysisis dependent on an acidic intralysosomal pH, has been postulated as a way to explain the correlation between cell volume and proteolytic activity (14). Hence, if creatine increases cellular hydration, this may be speculated to increase protein synthesis, decrease pro- tein degradation, and thus increase fat-free mass. In support of this hypothesis, Ingwall (15) demon- strated that creatine isa key chemical signal that couples increased muscular activity to increased contractile pro- tein synthesis in the hypertrophy of muscle. Further- more, direct evidence of an increase in the diameter of type I muscle fiber with creatine supplementation has been found in gyrate-atrophy patients supplemented with low doses (2 g per day) of creatine for 1 year (23). ‘Thus it may be hypothesized that creatine supplemen- tation initially causes an increase in cellular hydration which may augment the signals that increase protein synthesis under conditions of muscular overload. An increase in total body water induced by creat- ine supplementation may be postulated to occur via sev- eral mechanisms. We speculated that regulation of body water may be indirectly mediated through testosterone. ‘There is evidence that regulation of body fluids may be controlled via steroid-sensitive and osmosensitive neu- rons located in the preoptic area (4). Increases in both testosterone and osmotic pressure increase the firing rate of neurons that function in the regulation of body wa- ter. Since creatine has been hypothesized to increase total body water, this may be partially mediated via an in- crease in testosterone. Serum lactate concentrations were significantly el- evated 5 min postexercise for the bench press and jump. squat, indicating that both exercise protocols stressed the glycolytic energy system. There were no significant differences in postexercise lactate concentration be- tween creatine and placebo conditions during the jump squat, yet more work had been performed after creat- ine supplementation. In contrast, lactate concentrations were significantly higher after creatine supplementa~ tion for the bench press. ‘We had hypothesized that lactate production would be lower due to a reduced reliance on anaerobic glyco- lysis for energy following creatine supplementation. The finding of no differences between creatine and placebo conditions has been observed in prior studies (3,9, 26). However, others (1, 24) have reported significantly lower postexercise lactate concentrations after creatine supplementation. The most likely explanation for our results in the bench press was that more total repeti- tions were performed (~8 more reps) after creatine supplementation, therefore resulting in higher lactate concentrations despite a possibly more efficient utiliza- tion of the phosphagen pool. In summary, our data demonstrate that 7 days of supplementation with creatine monohydrate signifi- cantly increases muscular performance and body mass with no measurable changes in skinfold thickness. Fur- thermore, the increases in exercise performance and body mass are not related to changes in the circulating concentrations of either testosterone or cortisol. Practical Application ‘Our data suggest that 1 week of creatine supplementa- tion increases body mass with no measurable change in skinfold thickness. This process occurs independent of a change in resting testosterone and cortisol concen- trations. Furthermore, creatine supplementation ap- pears to have no effect on the resistance-exercise-in- duced concentrations of these hormones, as measured by 5-min postexercise blood samples. Thus the mecha- nisms involved with the increase in body mass associ- ated with creatine supplementation are most likely not steroid-hormone-driven, at least not during just 1 week of creatine ingestion, ‘The underlying mechanisms by which creatine supplementation enhances exercise performance are beginning to be fully elucidated, yet the processes that mediate the changes in body mass are not clear. It is still possible that there is a creatine-endocrine interac- tion; however, testosterone and cortisol are probably not key factors in the initial adaptations that occur with creatine supplementation Future studies should focus on the mechanisms by Which creatine increases body mass. The time-course and body composition changes need to be examined over a longer period of time. 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