Why Doctors Think Gay Men on Creatine and PrEP Have Kidney Issues
Introduction
Many gay men begin working on their bodies and have heard of all the seemingly miraculous benefits of the supplement creatine, so they begin taking it. A few weeks later when they go to the doctor they are in shock when they get the alarming news: "Your kidneys look like they are failing".
The truth is in many situations, their kidneys are fine. This confusion often happens because creatine supplementation, PrEP use, and creatinine blood tests overlap in ways that make it look like your kidneys are failing when they’re actually healthy. Before we dive into the details, I have to remind you, I’m not a doctor. I’m sharing this so you can avoid a scary situation I experienced that caused me to stop taking PrEP, doxycycline, protein powder and any other powder you can think of. This post is for education only. Always check with a healthcare provider before making changes to your routine.
Does Creatine Damage Your Kidneys?
No, research has shown that creatine, one of the most studied studied supplements in the sports space, is completely safe. When used in the recommended dose of 5 grams per day, it does not cause kidney failure.
The confusion usually is because when taking creatine, your body’s creatinine levels will read elevated. Creatinine is a breakdown product of muscle metabolism. This is especially true if you are on PrEP. Serum creatinine is the measurement of creatinine in the blood. Doctors often use serum creatinine as a quick marker for kidney health. Elevated serum creatinine, however, does not always equal kidney damage.
Though I know this to be true now, it certainly didn't seem that way when I had a doctor tell me my kidneys were failing when I initially added creatine to the supplements I was taking. I had been on PrEP for a while and returned for my quarterly checkup when I initially got the news. I went to a second doctor and they gave me the same dark news. As a knee-jerk reaction I stopped taking everything since I had seen people on dialysis and wanted to avoid this at all costs.
Later, I realized it was going to be difficult for me to remain safe sexually or build the muscle I wanted without supplements and the medication, so I began educating myself. The information below is what I found.
Creatine & Creatinine : Why the Numbers Look Scary
Especially if you are on PrEP, if you are taking creatine, your blood tests may show elevated serum creatinine levels. Doctors often interpret this as a sign of kidney failure, but that's not always the case. Here's why:
Creatine is a supplement that makes your muscles perform better and has other cognitive benefits.
Creatinine is a byproduct that shows up in blood tests when muscles break down.
Serum Creatinine is the measurement of creatinine in the blood.
Remember, doctor's check serum-creatinine as a quick measurement to see how your kidneys are performing. If it is high, they could assume your kidneys are failing. Here is a list of things that could cause your creatinine levels to increase, also raising your serum creatinine levels:
Taking Creatine - Just taking the creatine causes your levels to raise. Creatine is mostly stored in your muscles. Every day of it naturally breaks down into creatinine. Test do not know the difference between elevated creatinine from normal metabolism of creatine and from poor kidney function.
Just knowing this would have helped me remain a bit calmer the first time I was told the shocking news and ask more questions.
Training Hard - When you train hard, more muscle is broken down. This means more creatinine will be produced. All the test shows is that levels of serum creatinine are elevated. Some doctors don't think to ask about exercise routine.
When I was tested I had been training 6 days a week since starting the supplement which likely was also being factored into the results.
Being a Black Male - Being a black male is also something that is likely to cause you to have elevated creatinine levels. Black males usually have higher muscle mass.
I came out late. This is important because I was a 206 pound black male with a 5% body fat when I got into males and started taking PrEP. I also had built that physique without creatine and just came around to wanting to try it. Me already being a pretty muscular person combined with the fact that black men have a higher muscle mass may also have skewed my results.
How PrEP Plays Into Kidney Health
The type of PrEP medication you take also matters:
Truvada is a TDF-based PrEP. This means it works by creating higher levels of tenofovir in the blood, which is what makes it great for anal or vaginal sex. The trade-off is that these higher blood levels can put more strain on the kidneys and bones over time. This is why if your doctor sees your serum creatinine is elevated, they may recommend that you switch from Truvada to Descovy, which is gentler on the kidneys.
Descovy is a TAF-based PrEP. This means it delivers tenofovir more directly into the cells where it’s needed. This keeps blood levels lower. The benefit is that it’s gentler on the kidneys than Truvada. The downside is that Descovy hasn’t been approved for people at risk through vaginal sex, since there’s not enough data yet. This is why most doctors recommend Descovy mainly for transwomen, gay men, and bisexual men, while Truvada remains the option for everyone else.
What Gay Men Should Do?
Here are 4 things I would recommend doing before you assume your kidneys are going to shut down:
Stay hydrated - Dehydration alone can cause your kidneys stress. Try to drink a gallon a day. If you would like a number more specific to you: take your body weight, divide by 2 and drink that number in ounces a day.
Be Up Front About Supplements, Medications, & Drugs - Tell your doctors about the supplements, medication, or any drugs you are taking. Also communicate about your training routine and nutrition plan if you feel it may be a factor.
Consider Switching PrEP Options - If you are concerned, ask your doctor if you should switch to another PrEP option.
Ask for a Full Kidney Panel - Don't rely on one marker to determine your fate before changing supplementation. There are alternative kidney markers, like the cystatin-C, that can be looked into to give the doctor a more accurate view of your kidney health.
Want to Learn More?
If you would like to learn more about this for free I made the Gay Guy's Guide to Supplements and a free training video to assist you: https://b.link/gggsfreetraining1
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