Barbell Medicine Podcast

Once a month we answer Barbell Medicine Plus subscribers’ questions on the Direct Line. This is a free look at June’s episode. We start with GLP-1 drugs and muscle: why DEXA overstates the loss, what resistance training actually does, and whether creatine is worth taking. Then whether bulking and cutting does anything the scale can’t already tell you, how to get real benefit from one training hour a week, and what happens to your muscle, strength, tendons, and bone when you take time off, including why muscle memory brings it back faster than you built it.
What we cover:
•   GLP-1s and muscle: the DEXA problem, resistance training, and creatine
•   Bulking vs cutting vs just maintaining, and a health-first way to choose
•   Training on one hour a week: the least that still moves the needle
•   How fast you lose muscle when you stop, and why it comes back fast
The full two-hour episode and every back episode are on Barbell Medicine Plus, which can bundled with Premium. Resources and full references below.

Timestamps
0:00 Intro + GLP-1 and the DEXA muscle-loss myth
3:00 Do GLP-1s spare or waste muscle?
8:03 Does creatine help on a GLP-1?
10:45 Does bulking and cutting do anything?
13:18 Health first: when to lose fat before gaining
22:30 Training on one hour a week
36:22 How fast you lose muscle when you stop
43:19 Muscle memory: why it comes back
48:25 The full episode on Plus

Resources
Barbell Medicine coaching and templates: https://www.barbellmedicine.com
https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/
https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/
Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/

https://www.barbellmedicine.com/blog/glp-1-muscle-loss/
https://www.barbellmedicine.com/blog/creatine-on-ozempic-does-it-prevent-muscle-loss/
https://www.barbellmedicine.com/blog/novice-intermediate-advanced-strength-training/
Lundgren JR, et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined (S-LITE). N Engl J Med 2021;384:1719-1730. nejm.org · NEJMoa2028198
T-REX trial: tirzepatide with or without resistance training (Univ. of Western Australia). Preliminary. ANZCTR ACTRN12623001236684
Creatine + GLP-1 pilot (Univ. of Saskatchewan). Ongoing, results expected 2027. ClinicalTrials.gov NCT07625202
Momma H, et al. Muscle-strengthening activities and lower risk/mortality in major non-communicable diseases. Br J Sports Med 2022. PubMed 35228201
Wall BT, et al. 2014. Immobilization and disuse muscle atrophy (quadriceps −3.5% at 5 days, −8% at 14 days). PubMed 24168489
Gaffney CJ, et al. 2021. Grip strength loss with short-term arm immobilization. PMC8107283
Farthing JP, et al. 2009. Cross-education and preservation of the immobilized limb. PubMed 19150859
Marusic U, et al. 2021. Bed rest: strength loss outpaces size loss. PMC8325614
Yoshihara, et al. 2023. Sepsis-associated muscle wasting (−26% in a week). PMC10003568
Warren GL, et al. 2017. Strength loss and recovery after muscle injury (meta-analysis). PMC5214801
Hortobágyi T, et al. 1993. Short-term detraining in strength athletes. PubMed 8371654
Gavanda S, et al. 2020. Training cessation in previously untrained adolescents. PMC7241623
Lovell DI, et al. 2010. Detraining strength loss in older adults. PubMed 20140683
Mujika I, Padilla S. 2001. Physiology of detraining (review). PubMed 11474330
Smith K, et al. 2003. Two years of training, then detraining, in older adults. PubMed 12955872
Staron RS, et al. 1991. Detraining and muscle cross-sectional area in women. PubMed 1827108
Ivey FM, et al. 2000. Detraining across age and sex. PubMed 10795719
Taaffe DR, et al. 2009. Training and detraining in older adults. PMC2756799
Grgic J, et al. 2022. Muscle size loss with detraining (meta-analysis). PubMed 36360927
Bosquet L, et al. 2013. Detraining effects on strength and power. PubMed 23347054
Bruusgaard JC, et al. 2010. Myonuclei acquired by overload persist after detraining (muscle memory). PMC2930527
Weakley J, et al. 2017. Day-to-day variation in strength performance. PubMed 28277425
McGuigan MR, et al. 2004. Strength performance variability. PubMed 15320651
Andreoli A, et al. 2009. DEXA precision and assumptions. PMC9263164

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Is there really a “menopause-specific” way to train, eat, and supplement — or is most of it marketing? In the finale of our 4-part menopause series, Drs. Jordan Feigenbaum and Austin Baraki go straight to the evidence on building muscle and bone before, during, and after the transition.
We cover whether menopause blunts your response to lifting (the Isenmann 2023 head-to-head trial and the 2026 meta-analysis of ~4,000 women say it doesn’t), the one-index-card prescription that actually works. Then we work through the loudest claims in the space — cortisol “wrecking” your fat loss, anabolic resistance, the protein and creatine hype, hormone therapy as a cure-all, and “you need a different paradigm” — steelmanning each before we push back. We close with the strongest case in the whole space: heavy lifting for bone density (the LIFTMOR trial), the pelvic-floor evidence, your three biggest fears answered, and how to tell a good coach or clinician from a bad one.
Claims discussed are associated with Stacey Sims, Mary Claire Haver, Mindy Pelz, and the broader functional-medicine space. We push back on the claims, not the people.

Timestamps:
0:00 The 90-year-olds who tripled their strength
 1:10 Why this matters: heart disease and falls, not vanity
 2:28 Can women still build muscle after menopause? (Isenmann 2023)
 7:31 Does menopause blunt your gains? The 2026 meta-analysis
 8:49 Is it menopause, or just individual variation?
 14:42 The estrogen "shield" and the mechanical override
 18:31 Does hormone therapy replace training? (the 2021 estradiol trial)
 22:44 What actually works: the whole prescription
 24:18 Program details: frequency, volume & insulin sensitivity
 30:22 Nutrition: protein and the 2026 review
 35:06 Creatine, vitamin D & calcium
 43:29 Anabolic resistance: mostly overstated
 47:22 Clinical case: the supplement-stack patient
 52:23 A short history of wrong advice for women
 53:38 Claim 1: "Lift heavy or lose your bones" (Stacey Sims)
 1:01:09 Claim 2: the cortisol myth
 1:15:18 Clinical case: the cortisol-anxious patient
 1:18:20 Claim 3: "It's all hormonal, HRT fixes it" (Mary Claire Haver)
 1:20:45 Testosterone in women: what it does and doesn't do
 1:21:51 Claim 4: "Menopause needs its own paradigm" & the SWAN data
 1:24:48 Bone density done right: the LIFTMORE trial
 1:33:07 Does heavy lifting wreck your pelvic floor?
 1:38:59 Your three biggest fears, answered
 1:40:44 Green flags & red flags 
Resources:
Menopause Series Part 1 : https://www.youtube.com/watch?v=yzk0IkTy0WM
Menopause Series Part 2 — https://www.youtube.com/watch?v=YKAlamIOiwU
 Menopause Series Part 3 — https://www.youtube.com/watch?v=jzoNMQaBAcI 
Hypercortisolism episode - https://open.spotify.com/episode/7tDdUi8dDFWjMYx0fRJdOz 
Barbell Medicine coaching and templates: https://www.barbellmedicine.com

Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/

Isenmann (2023) https://doi.org/10.1186/s12905-023-02671-y
Isenmann (2026) https://doi.org/10.1016/j.jsams.2026.01.004
Fiatarone (1990) https://doi.org/10.1001/jama.1990.03440220053029
Fiatarone (1994) https://doi.org/10.1056/NEJM199406233302501
Dam (2021) https://doi.org/10.3389/fphys.2020.596130
Markofski (2015) https://doi.org/10.1016/j.exger.2015.02.015
Orsatti (2022) https://doi.org/10.1016/j.exger.2022.111904
Walter (2026) https://doi.org/10.1186/s40798-025-00954-2
dos Santos (2021) https://doi.org/10.3390/nu13113757
Myung (2021) https://doi.org/10.3390/nu13020368
Dote-Montero (2021) https://doi.org/10.1111/sms.13999
Ravussin (2015) https://doi.org/10.1093/gerona/glv057
Cadegiani (2016) https://doi.org/10.1186/s12902-016-0128-4
Greising (2009) https://doi.org/10.1093/gerona/glp082
Islam (2019) https://doi.org/10.1016/S2213-8587(19)30189-5
Testosterone in women review (2026) https://doi.org/10.1080/09513590.2025.2592402
NAMS nonhormone position statement (2023) https://doi.org/10.1097/GME.0000000000002200
Vasomotor exercise meta-analysis (2022) https://doi.org/10.1080/13697137.2022.2097865
Greendale (2019) https://doi.org/10.1172/jci.insight.124865
Watson, LIFTMOR (2018) https://doi.org/10.1002/jbmr.3284
Skaug (2024) https://doi.org/10.1249/MSS.0000000000003278
Skaug (2021) https://doi.org/10.1007/s00192-021-04739-5
Dumoulin (2018) https://doi.org/10.1002/14651858.CD005654.pub4

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Most women in 2026 are told menopause affects everything, the weight, the belly fat, the bones, the heart, the brain, and that the fix is hormones, supplements, and a proprietary protocol. The data tell a different story. Menopause does some of it, but not all of it.

In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki, with OB-GYN Dr. Loraine Baraki at the clinical handoffs, put real numbers on what menopause actually changes, e.g. body composition, the cardiometabolic shift around the final menstrual period, bone, cognition and sleep — and on the single biggest modifiable lever against what actually kills postmenopausal women.

This is Episode 3 of Barbell Medicine's four-part menopause series.

Timestamps:
01:23 Intro 
02:45 Body composition & the SWAN study 
04:16 How much weight gain is really menopause?
 06:55 The answer: about 1.5 kg 08:14 Subcutaneous vs visceral fat
 11:08 Why waist beats weight (and body-fat %) 
17:21 Does menopause crash your metabolism? 19:02 Clinic: MHT for body composition 
23:51 Dr. Loraine Baraki — MHT, weight & testosterone 
27:29 The cardiometabolic shift: cholesterol at the FMP 
30:18 Insulin resistance & metabolic syndrome 
33:12 Blood pressure & 10-year heart risk 
34:54 Clinic: the "estrogen crisis" lipid panic 
39:13 Bone: the advice vs the data 40:34 Why DXA misses most fractures 
41:24 LIFTMOR: lifting heavy with low bone density 
44:47 The LIFTMOR results 
46:53 Lifting vs Pilates, and falls 
52:17 Clinic: "Should I be deadlifting?" 
56:14 Cognition & brain fog 
57:50 Why brain fog is mostly a sleep problem 
59:17 Clinic: brain fog, night sweats, broken sleep 
1:03:06 Depression & dementia in midlife 
1:05:43 Does hormone therapy protect the brain? 
1:08:53 Clinic: "Am I getting early dementia?" 
1:13:19 Dr. Loraine Baraki — the timing hypothesis & the brain
1:16:15 What actually kills postmenopausal women 
1:17:31 Fitness: the biggest mortality lever 
1:20:21 Strength, power & grip 
1:25:15 Clinic: where to start when you're overwhelmed 
1:30:41 The detraining problem 
1:32:38 Trained vs untrained: what's recoverable 
1:34:53 The actual plan 
1:39:48 Takeaways

Resources:

Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/

Barbell Medicine coaching and templates: https://www.barbellmedicine.com/

Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/

Body composition & metabolism

 Greendale et al., SWAN body composition, JCI Insight 2019: https://doi.org/10.1172/jci.insight.124865

 Lovejoy et al., visceral fat across the transition, Int J Obes 2008: https://doi.org/10.1038/ijo.2008.25

 Pontzer et al., daily energy expenditure across life, Science 2021: https://doi.org/10.1126/science.abe5017

 Karppinen et al., metabolism in midlife women, Eur J Prev Cardiol 2023: https://doi.org/10.1093/eurjpc/zwad177

Cardiometabolic

Matthews et al., lipid changes & the menopause transition, JACC 2009: https://doi.org/10.1016/j.jacc.2009.10.009

Janssen et al., menopause & metabolic syndrome (SWAN), Arch Intern Med 2008: https://doi.org/10.1001/archinte.168.14.1568

 El Khoudary et al., AHA Scientific Statement on midlife women, Circulation 2020: https://doi.org/10.1161/CIR.0000000000000912

Bone

Greendale et al., SWAN bone loss across the FMP, JBMR 2012: https://doi.org/10.1002/jbmr.534

 Siris et al., undiagnosed low BMD & fractures (NORA), JAMA 2001: https://doi.org/10.1001/jama.286.22.2815

 Watson et al., LIFTMOR, JBMR 2018: https://doi.org/10.1002/jbmr.3284

Kemmler et al., EFOPS 16-year, Menopause 2017: https://doi.org/10.1097/GME.0000000000000720

Kistler-Fischbacher et al., MEDEX-OP, JBMR 2021: https://doi.org/10.1002/jbmr.4334

 Sherrington et al., exercise for preventing falls, Cochrane 2019: https://doi.org/10.1002/14651858.CD012424.pub2

ACSM Position Stand: Osteoporosis and Exercise, Med Sci Sports Exerc 1995;27(4):i–vii (no DOI)

Cognition & mood

Greendale et al., SWAN cognition, Neurology 2009: https://doi.org/10.1212/WNL.0b013e3181a71193

Kravitz et al., sleep in midlife women, Obstet Gynecol Clin North Am 2018: https://doi.org/10.1016/j.ogc.2018.07.008

Cohen et al., Harvard Study of Moods and Cycles, Arch Gen Psychiatry 2006: https://doi.org/10.1001/archpsyc.63.4.385

Bromberger & Kravitz, mood and menopause (SWAN), Obstet Gynecol Clin North Am 2011: https://doi.org/10.1016/j.ogc.2011.05.011

Livingston et al., Lancet Commission on dementia 2024: https://doi.org/10.1016/S0140-6736(24)01296-0

Shumaker et al., WHIMS (estrogen+progestin & dementia), JAMA 2003: https://doi.org/10.1001/jama.289.20.2651

 Espeland et al., WHIMS (estrogen-alone & cognition), JAMA 2004: https://doi.org/10.1001/jama.291.24.2959

Gleason et al., KEEPS-Cog, PLoS Med 2015: https://doi.org/10.1371/journal.pmed.1001833

 Henderson et al., ELITE (timing hypothesis & cognition), Neurology 2016: https://doi.org/10.1212/WNL.0000000000002980

USPSTF, hormone therapy for primary prevention, JAMA 2022: https://doi.org/10.1001/jama.2022.18625

Fitness & mortality

 Mandsager et al., cardiorespiratory fitness & mortality, JAMA Netw Open 2018: https://doi.org/10.1001/jamanetworkopen.2018.3605

Kodama et al., fitness & mortality meta-analysis, JAMA 2009: https://doi.org/10.1001/jama.2009.681

Sui et al., fitness & adiposity in older adults, JAMA 2007: https://doi.org/10.1001/jama.298.21.2507

Momma et al., muscle-strengthening activity & mortality, Br J Sports Med 2022: https://doi.org/10.1136/bjsports-2021-105061

Araújo et al., muscle power vs strength & mortality (CLINIMEX), Mayo Clin Proc 2025: https://doi.org/10.1016/j.mayocp.2025.02.015

Leong et al., grip strength & mortality (PURE), Lancet 2015: https://doi.org/10.1016/S0140-6736(14)62000-6

Detraining & trained-vs-untrained

Troiano et al., accelerometer-measured activity, Med Sci Sports Exerc 2008: https://doi.org/10.1249/mss.0b013e31815a51b3

Fleg et al., aerobic-capacity decline (BLSA), Circulation 2005: https://doi.org/10.1161/CIRCULATIONAHA.105.545459

Ratley et al. aerobic-capacity changes during menopause, 2025
https://pmc.ncbi.nlm.nih.gov/articles/PMC12358808/

Janssen et al., skeletal muscle mass across adulthood, J Appl Physiol 2000: https://doi.org/10.1152/jappl.2000.89.1.81

 Pollock et al., master athletes & aerobic capacity, J Appl Physiol 1987: https://doi.org/10.1152/jappl.1987.62.2.725

Latella et al., strength across ages in powerlifters, Sports Med 2024: https://doi.org/10.1007/s40279-023-01962-6

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The story goes that hard exercise is risky for women, and that the idea is ancient. Both halves fall apart on contact. In this solo episode, Dr. Jordan Feigenbaum follows the claim that physical effort harms the female body across twenty centuries, and shows that almost every version of it arrived as a verdict first, with the science bolted on afterward.
It runs from antiquity to the present: what Galen actually wrote, why Sparta trained its women on purpose, the Victorian “vital force” panic and Edward Clarke’s claim that studying would sterilize girls, the doctor who prescribed bed rest to women and the wilderness to men, and the 1928 Olympic 800m that was erased for 32 years over a collapse that never happened. Then the correction: the research that finally tested heavy training in older women and women with low bone mass, and what it found. The episode closes on 2026, where the guidelines say lift and the menopause market often says don’t.
What we cover
•    Why the “ancient Greeks” origin story for the no-hard-exercise rule doesn’t hold up.
•    How a Victorian energy-budget idea became a medical case against women lifting and studying.
•    The real story of the 1928 Olympic women’s 800m and the 32-year ban.
•    The strong women who were relabeled as freaks or exceptions instead of counted.
•    What Fiatarone’s nonagenarians and LIFTMOR actually showed about lifting heavy later in life.
•    The cortisol panic, the fasting scare, and cycle syncing, examined against the data.
•    Why the cautious messaging now comes from the market, not the medical guidelines.

Timestamps
00:00 The 1928 Olympic “massacre” that never happened
03:37 Antiquity: what the Greeks actually said
06:50 The Victorians and “vital force”
10:02 Mary Putnam Jacobi tests the claim, and is ignored
11:53 1928 in full: who killed the women’s 800m
13:53 The double standard, and Alice Milliat
15:39 The strong women history relabeled
20:26 The correction: what the evidence shows
22:27 LIFTMOR: lifting heavy with low bone mass
24:35 2026: guidelines, the market, and cortisol
28:34 Cycle syncing, and naming the pattern
30:40 What to take away

Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/

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References
Cahn S. Coming on Strong: Gender and Sexuality in Twentieth-Century Women's Sport. Harvard University Press; 1994.
Clarke EH. Sex in Education; or, A Fair Chance for the Girls. Boston: James R. Osgood and Company; 1873.
Colenso-Semple LM, McKendry J, Lim C, et al. Menstrual cycle phase does not influence muscle protein synthesis or whole-body myofibrillar proteolysis in response to resistance exercise. J Physiol. 2025. PMID: 39630025.
Daly W, Hackney AC. Is exercise cortisol response of endurance athletes similar to levels of Cushing's syndrome? J Sports Med Phys Fitness. 2019. PMID: 31371847.
Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. PMID: 30907953.
Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990;263(22):3029-3034. PMID: 2342214.
Fiatarone MA, O'Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330(25):1769-1775.
Galen. On the Preservation of Health (De Sanitate Tuenda). 2nd century CE. Various translations.
Jacobi MP. The Question of Rest for Women During Menstruation. New York: G.P. Putnam's Sons; 1877. (Awarded the Harvard Boylston Prize.)
Latella C, Teo WP, Spathis J, et al. Using powerlifting athletes to determine strength adaptations across ages in males and females: a longitudinal growth modelling approach. Sports Med. 2024;54(3):753-774.
Maudsley H. Sex in mind and in education. Fortnightly Review. 1874;15:466-483.
Plutarch. Life of Lycurgus. Approx. 75 CE. Various translations.
Schultz J. Qualifying Times: Points of Change in U.S. Women's Sport. Urbana: University of Illinois Press; 2014.
Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-596. PMID: 6487063.
Soranus of Ephesus. Gynecology. Approx. 2nd century CE. Translated by Temkin O. Baltimore: Johns Hopkins University Press; 1991.
Switzer K. Marathon Woman: Running the Race to Revolutionize Women's Sports. Cambridge, MA: Da Capo Press; 2007.
Todd J. Various publications. Iron Game History. Stark Center for Physical Culture and Sports, University of Texas at Austin.
Tunis JR. Women and the Olympic Games. Harper's Magazine. July 1929. (And contemporaneous press coverage.)
Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211-220. PMID: 30861219.
Xenophon. Constitution of the Lacedaemonians. Approx. 4th century BCE. Various translations.

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In 1889 a French physiologist injected himself with guinea pig and dog testicle extract and published a claim of self-rejuvenation in The Lancet. That announcement kicked off a 200-year medicalization of menopause that ran through leeches and bromides, Premarin, the 2002 Women's Health Initiative, and the contemporary menopause-content space. 
In Episode 1 of our three-part menopause series, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through what menopause actually is at the hormonal level, which midlife symptoms are menopause-driven and which are not, the KNDy neuron mechanism behind hot flashes (and the new medication that blocks it), and the 24-year follow-up on the WHI that substantially revised the original conclusions. OB-GYN Dr. Loraine Baraki walks the clinical workup, the lab panel she actually orders, and how she handles patients arriving with DUTCH panels and compounded hormone protocols.
If you have heard contradictory things about menopause hormone therapy from your primary care, your menopause coach, and your sister, that is not your fault. The evidence base has been revised in significant ways since the 2002 publication, and most patient-facing summaries are out of date.
Timestamps
00:00 Cold open: 200 years of menopause medicine
03:23 Welcome and roadmap
04:20 The HPG axis, follicles, and the FSH lag
09:11 STRAW+10 staging and the timing of perimenopause
13:47 Austin: the 49-year-old with a hormone panel
20:00 Loraine: the OB-GYN workup
28:00 Symptom attribution: what menopause actually causes
33:46 Austin: the all-estrogen patient
37:58 VMS duration and the KNDy mechanism (Avis, SKYLIGHT)
43:53 Austin: who actually gets fezolinetant
47:22 The WHI 24-year correction (Manson, Chlebowski, Boardman)
01:00:15 Modern prescribing today
01:06:52 Where the menopause-content space gets it right and wrong
01:11:50 Testosterone, compounded bioidenticals, and DUTCH panels
01:24:13 Takeaways
What we cover

The HPG axis and the estrogen shield: what is happening across the 35-year reproductive era and what changes at perimenopause.
STRAW+10 staging: how long perimenopause actually lasts and where most women fall in the timeline.
 Symptom attribution: hot flashes and genitourinary syndrome are menopause. Weight gain, sleep, and joint pain are mostly other things.
The KNDy neuron mechanism behind hot flashes and the new pharmacology that blocks it (fezolinetant, elinzanetant).
The Women's Health Initiative: what the trial actually tested, what the 2002 result said, and what 24 years of follow-up have shown since then. The estrogen-alone arm reduced breast cancer incidence by 22% and mortality by 40% over 20 years.
The timing hypothesis: hormone therapy started within 10 years of the final menstrual period vs more than 10 years out.
Modern prescribing today: transdermal estradiol plus micronized progesterone, and why the formulations matter.
Where the contemporary menopause-content space gets it right and wrong: the undertreatment problem, the zone-of-chaos framing, and the testosterone-for-everything marketing.
Testosterone in women: one guideline-supported indication.
Compounded bioidenticals and DUTCH panels.

Resources
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